![]() ![]() Clinically, therapists will often employ a number of interventions on any single patient during a single session. Multiple applications of joint mobilizations appear to show no further benefit beyond the second application 34 although this research is sparse 35especially in professional athletes. Research in this area typically examines single interventions in a pre- post- treatment design considering only the immediate effects of intervention. ![]() Stretching interventions have shown short-term improvements in range of 2° to 5.3° 32,33 depending on the technique and duration with larger effects seen for two- to six-week home programs. 4 Manual therapy interventions (joint mobilization, mobilization with movement, and high velocity low amplitude techniques) used on patients with reduced dorsiflexion after ankle injury have shown short-term improvements of 6 to 22mm 25–30 and 3.0° to 5.5° 31 depending on the intervention and measurement method employed. Many physiotherapy interventions have been described to improve ankle dorsiflexion range of motion including electrotherapy, ice application, relaxation and imagery programs, passive mobilization, psychological interventions, stretching, and mobilization with movement techniques. 23 Previously we have documented normal dorsiflexion range of motion as approximately 35° in an athletic population 24 using this measure. Weight-bearing dorsiflexion range of motion is typically measured as a “knee to wall” distance, or as an angle of inclination of the tibia. 15–18 During rehabilitation from ankle injury, restoration of this range of motion is often identified as an important treatment goal to address impairment. Those with chronic lateral ankle instability display lower dorsiflexion range of motion during gait 13,14 as well as drop jumps, 15 and presumed compensatory movements in other parts of the kinetic chain. 10 Additionally, limited ankle dorsiflexion range of motion is associated with impaired dynamic balance 11 and increased chronicity 1 and recurrence 12 in those recovered from lateral ankle sprain. 3,4 Dorsiflexion range of motion limitation has been identified as a prospective risk factor for a number of lower-limb injuries including ankle injury, 5,6 Achilles tendinopathy, 7 patellofemoral pain, 8 plantar fasciopathy, 9 and hamstring injury. Improvements were also seen in the uninjured ankles following intervention.ĭespite recent international consortium 1 and clinical practice guideline 2 recommendations that ankle dorsiflexion range of motion be targeted during rehabilitation after ankle injury, evidence to guide the clinician regarding the effects of specific interventions remains unclear. The interventions described largely restored range of motion consistent with baseline levels of the uninjured ankles. The relatively simple clinical exercise and manipulation intervention program was associated improvement in dorsiflexion range of motion in this cohort with persisting ankle stiffness. Statistically significant (p<0.01), but clinically meaningless improvements were seen after stretching and the mobilization-with-movement intervention on the injured and uninjured legs (1.9° and 1.4° respectively) with greater improvements seen after exercise and the subsequent manipulation (6.9° and 4.7°). ResultsĮxcellent reliability was demonstrated (ICC 2,1>0.93, MDC=3.5°) for the dorsiflexion measure. Methodĭuring a single treatment session, two baseline measurements of weight-bearing dorsiflexion were taken at the start of the session to establish reliability and minimum detectable change, and then the same measures were performed after stretching and a mobilization-with-movement intervention, and again after clinical exercise and a novel manipulation which was applied on both ankles. DesignĬase series in 38 consecutive injured athletes with persisting reductions in ankle dorsiflexion range of motion (42 “stiff” ankles, 34 uninjured) in an outpatient sports physiotherapy clinic. To document the change in dorsiflexion range of motion after stretching and mobilization-with-movement and exercise and a novel manipulation intervention in a population of injured athletes. Accordingly improving identified deficits is a common goal for rehabilitation however, little data exists documenting any improvement related to interventions in these patients. Persisting reductions in ankle dorsiflexion range of motion are commonly encountered clinically and seen to be associated with adverse outcomes after ankle and other lower extremity injuries. ![]()
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