The Effects Of Manual Therapy and Balance Training on Performance Outcomes in Individuals with Chronic Ankle Instability

Open Access
Stokes, Erin Nicole
Area of Honors:
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Sayers John Miller III, Thesis Supervisor
  • Giampietro Luciano Vairo, Thesis Supervisor
  • Jinger S. Gottschall, Honors Advisor
  • Stephen Jacob Piazza, Honors Advisor
  • Chronic Ankle Instability
  • manual therapy
  • balance training
THE EFFECTS OF MANUAL THERAPY AND BALANCE TRAINING ON PERFORMANCE OUTCOMES IN INDIVIDUALS WITH CHRONIC ANKLE INSTABILITY Stokes EN*, Vairo GL*, Miller SJ*, Sebastianelli WJ†: Athletic Training and Sports Medicine Research Laboratory, *Department of Kinesiology, The Pennsylvania State University, University Park, PA; †Penn State Hershey Orthopaedics and Sports Medicine – State College, State College, PA Objective: To determine if a combination of manual therapy and balance training improves performance outcomes in chronic ankle instability (CAI) participants when compared to respective stand-alone treatments. We hypothesized that the combination would yield greater improvements compared to stand-alone treatments. Design and Settings: A pretest-posttest experimental design conducted in a laboratory setting. The manual therapy (MT) group received Maitland’s grade III/IV ankle mobilizations and high-velocity, low-amplitude thrust manipulation treatments administered three times over one week. The balance training (BT) group performed hop-to-stabilization activities and single-leg stance exercises three times a week over four weeks. The manual therapy and balance training (MTBT) underwent multimodal interventions that paralleled parameters described for the MT and BT groups. Data was collected at baseline and four weeks following treatment. Subjects: Eighteen (10 men, 8 women) CAI participants were randomly assigned to a group: MT (23.5 ± 1.8 years, 1.8 ± 0.1 m, 71.2 ± 11.7 kg), BT (20.7 ± 1.8 years, 1.8 ± 0.1 m, 76.4 ± 10.1 kg), MTBT (20.5 ± 1.7 years, 1.7 ± 0.1 m, 72.3 ± 8.3 kg). Measurements: Passive and active dorsiflexion range of motion (ROM) using standard goniometry; center of pressure path length and average velocity during a static balance task using a force platform; modified Star Excursion Balance Test (SEBT) reach distances; and crossover hop test distances. Order of testing was randomized to prevent order effects. Results: Dorsiflexion ROM was significant at baseline {passive (°): [MT|39.0 ± 6.8, BT|39.5 ± 3.6, MTBT|49.2 ± 8.5, P = 0.000]; active (°): [MT|34.8 ± 5.7, BT|37.3 ± 3.1, MTBT|44.2 ± 8.2, P = 0.000]} and post-treatment: {passive (°): [MT|43.3 ± 5.6, BT|40.8 ± 5.7, MTBT|53.3 ±11.2, P = 0.000]; active (°): [MT|40.8 ± 5.2, BT|37.3 ± 5.4, MTBT|51.0 ± 11.9, P = 0.000]} for the involved leg. Eyes-closed static balance was significant at baseline {path length (cm): [MT|79.1 ± 14.3, BT|70.6 ± 14.5, MTBT|67.0 ± 12.2, P = 0.026]; average velocity (cm/s): [MT|7.9 ± 1.4, BT|7.1 ± 1.4, MTBT |6.7 ± 1.2, P = 0.026]} and post-treatment: {path length (cm): [MT|70.2 ± 14.3, BT|64.5 ± 11.8, MTBT|65.4 ± 17.7, P = 0.026]; average velocity (cm/s): [MT|7.0 ± 0.7, BT|6.4 ± 1.2, MTBT|6.5 ± 1.8, P = 0.026]} for the involved leg. Conclusions: Post hoc baseline measures suggest heterogeneity among groups, which may underpin the lack of statistical significance for our comparisons. However, trends were observed indicating a therapeutic effect that may suggest clinical significance. Word Count: 400.