The Effect of Manual Therapy on Postural Control in Individuals with Chronic Ankle Instability

Open Access
Author:
Crespo, Jennifer Alexandria
Area of Honors:
Kinesiology
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
  • Dr Nicole M Mc Brier, Thesis Supervisor
  • Nicole M Mc Brier, Thesis Supervisor
  • Sayers John Miller Iii, Thesis Supervisor
  • Stephen Jacob Piazza, Honors Advisor
  • Giampietro Luciano Vairo, Faculty Reader
Keywords:
  • manual therapy
  • chronic ankle instability
  • postural control
Abstract:
The Effect of Manual Therapy on Postural Control in Individuals with Chronic Ankle Instability Crespo JA, Miller SJ, Vairo GL, Shields CA, McBrier NM: Athletic Training Research Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA Context: Evidence has suggested that manual therapy, consisting of ankle joint mobilization, improves postural control in an elderly population. Investigators have hypothesized that improvement in ankle joint range of motion plays a role in these outcomes. However, the exact mechanisms explaining this phenomenon are unknown. Objective: To profile ankle joint range of motion and functional postural control following a therapeutic manual therapy intervention in chronic ankle instability (CAI) patients. It was hypothesized that manual therapy treatment would increase ankle joint dorsiflexion range of motion (straight knee, bent knee) and reach distances on the Star Excursion Balance Test (SEBT). Design: Pretest-posttest control group true experimental design. Setting: Controlled laboratory environment. Participants: 16 (nine women, seven men) subjects with CAI (age = 22.3 ± 4.7 years, height = 171.9 ± 7.6 cm, mass = 70.3 ± 11.6 kg, BMI = 23.54 ± 3.02) and 16 (nine women, seven men) healthy matched controls (age = 21.2 ± 1.6 years, height = 172.1 ± 8 cm, mass = 67.8 ± 10.6 kg, BMI = 22.84 ± 2.91) volunteered for this research study. No participants to either group presented with a history of previous lower extremity injury. Interventions: The independent variable was the treatment condition (manual therapy or sham treatment) for CAI and control groups. The manual therapy treatment consisted of five different joint mobilization and manipulation techniques that were applied to the joints of the lower leg involved in dorsiflexion. Main Outcome Measures: The dependent variables were ankle joint dorsiflexion range of motion (straight knee, bent knee), and reach distances during the SEBT. Pre- and post-treatment measures were recorded for patients. First post-treatment measures were recorded immediately following the first treatment session and the second post-treatment measures were taken 2 weeks later. The involved and uninvolved ankles of patients were randomized to control for an order effect. Healthy control participants performed the same testing sessions as the chronic ankle instability participants. Averaged maximum reach distances for the single-leg anterior, posterolateral, and posteromedial reach directions of the balance task were normalized to the non-stance leg-length (%MAXD). A repeated measures analysis of variance (ANOVA) was conducted to assess differences among group, treatment and time factors as well as interaction effects. Separate repeated measures ANOVA were calculated to assess within group differences for ankle (treated/untreated) and time as well as the interaction effect. Results: There were no statistically significant differences in factors and interaction effects between groups for ankle joint dorsiflexion range of motion and reach distances during the SEBT. Within group analyses suggested an overall significant difference between straight knee ankle joint dorsiflexion range of motion for the involved versus uninvolved ankle (P=0.029) and between the second and third follow-up time periods (P=0.050) in CAI patients receiving a true treatment. No other statistically significant differences existed within groups. Conclusion: Our findings suggest a manual therapy technique is no more effective than a sham treatment for improving ankle joint dorsiflexion range of motion and functional postural control in CAI patients or when compared to healthy matched controls. Word Count: 514