Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial.
BACKGROUND
Recurrent ankle sprains often involve residual symptoms for which subjects often perform proprioceptive or/and strengthening exercises. However, the effectiveness of mobilization to influence important nerve structures due to its anatomical distribution like tibial and peroneal nerves is unclear.


OBJECTIVE
To analyze the effects of proprioceptive/strengthening exercises versus the same exercises and manual therapy including mobilizations to influence joint and nerve structures in the management of recurrent ankle sprains.


METHODS
A randomized single-blind controlled clinical trial.


METHODS
Fifty-six patients with recurrent ankle sprains and regular sports practice were randomly assigned to experimental or control group. The control group performed 4 weeks of proprioceptive/strengthening exercises; the experimental group performed 4 weeks of the same exercises combined with manual therapy (mobilizations to influence joint and nerve structures). Pain, self-reported functional ankle instability, pressure pain threshold (PPT), ankle muscle strength, and active range of motion (ROM) were evaluated in the ankle joint before, just after and one month after the interventions.


RESULTS
The within-group differences revealed improvements in all of the variables in both groups throughout the time. Between-group differences revealed that the experimental group exhibited lower pain levels and self-reported functional ankle instability and higher PPT, ankle muscle strength and ROM values compared to the control group immediately after the interventions and one month later.


CONCLUSIONS
A protocol involving proprioceptive and strengthening exercises and manual therapy (mobilizations to influence joint and nerve structures) resulted in greater improvements in pain, self-reported functional joint stability, strength and ROM compared to exercises alone.
Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain. Electronic address: gustavo@fisioterapiamanual.es.
Gustavo
G
Plaza-Manzano
Community Health Centre Maria Wolff, Madrid, Spain; Physiotherapy Department, University of Alcalá, E-28871, Madrid, Spain. Electronic address: ver.vergara90@gmail.com.
Marta
M
Vergara-Vila
Physiotherapy Department, University of Alcalá, E-28871, Madrid, Spain. Electronic address: Val.sandra@hotmail.com.
Sandra
S
Val-Otero
Physiotherapy Department, University of Alcalá, E-28871, Madrid, Spain. Electronic address: cris309cr@gmail.com.
Cristina
C
Rivera-Prieto
Physiotherapy Department, University of Alcalá, E-28871, Madrid, Spain. Electronic address: daniel.pecos@uah.es.
Daniel
D
Pecos-Martin
Physiotherapy Department, University of Alcalá, E-28871, Madrid, Spain. Electronic address: tomas.gallego@uah.es.
Tomás
T
Gallego-Izquierdo
Physiotherapy and Nursery Department, University of the Balearic Islands, E-07122, Mallorca, Spain. Electronic address: alejandro_sft@yahoo.es.
Alejandro
A
Ferragut-Garcías
Physiotherapy and Nursery Department, University of the Balearic Islands, E-07122, Mallorca, Spain. Electronic address: narf52@gmail.com.
Natalia
N
Romero-Franco
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000503:physiopathology* / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011434:Proprioception / Q000502:physiology*; D016037:Single-Blind Method; D013180:Sprains and Strains / Q000503:physiopathology* / Q000628:therapy*
Ankle sprain; Exercises; Manual therapy; Proprioception