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A Randomized Controlled Trial of a Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains

T Green, GradDipPhty, GradDipManipTher, MAppSc, is Senior Research Physiotherapist, Physiotherapy Department, Calvary Hospital, PO Box 254, Jamison, Australian Capital Territory 2614 Australia.
K Refshauge, GradDipPhty, GradDipManipTher, PhD, is Senior Lecturer, School of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia
J Crosbie, GradDipPhys, PhD, is Associate Professor, School of Physiotherapy, University of Sydney
R Adams, PhD, is Senior Lecturer, School of Physiotherapy, University of Sydney

Address all correspondence to Ms Green

Background and Purpose. Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time. Subjects. Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial. Methods. Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment. Results. The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. Discussion and Conclusion. Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.

Key Words: Ankle sprain • Gait • Passive mobilization • Physical therapy

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