Tag Archives: treatment

Prevent Dysfunctional Movement by Improving Ankle Mobility – A Research Review of Manual Therapy Techniques

Topic Overview:

A single joint with altered arthrokinematics can precipitate a kinetic chain domino effect that will wreck havoc on functional human movement.  One such joint is the ankle, where altered arthrokinematics has been linked to several forms of human movement dysfunction and subsequent musculoskeletal injury. Specifically, limited ankle dorsiflexion, has been associated with patellar tendionopathy, ipsilateral gluteus medius weakness, plantar fasciitis, medial tibial stress syndrome, contralateral shoulder pathologies, sacroiliac joint dysfunction, recurrent ankle sprains, chondromalacia, ACL tears, Iliotibial band syndrome, increasing frontal plane motion of the knee, external snapping hip syndrome and osteitis pubis (just to name a few).  In addition to the aforementioned injuries athletes ware at risk of significant performance declines in overall power, agility, and speed.  I am not saying that these are all caused from limited ankle dorsiflexion, but I am saying that limited ankle dorsiflexion can cause these issues.

These issues can create a huge headache for the athlete, health care practitioner, personal trainer or performance coach. So, the question is what can we do that to prevent or treat these dysfunctional patterns or injuries? Simple, increase ankle dorsiflexion. But how? There are several treatment methods so I began thinking what is the single best way to improve ankle dorsiflexion; static stretching, manual therapy, soft tissue release, dynamic flexibility? I could come up with only one solid, and universal one stop treatment option – manual therapy, specifically Movement with Mobilization (MWM). So I found a good research article to review that talks about MWM and the effect it has on ankle dorsiflexion.

Complete Reference: Vicenzino B, Branjerdporn M, Teys P, Jordan K. Initial Changes in Posterior Talar Glide and Dorsiflexion of the Ankle After Mobilization With Movement in Individuals With Recurrent Ankle Sprain. J Ortho Sports Phys Ther Jul 2006;36(7):464-71.

Introduction to the Study:

Mobilization with Movement  (MWM) techniques are commonly utilized to improve joint range of motion and reduce pain. Recent evidence indicates posterior glide of the talus and ankle dorsiflexion is deficient in patients suffering from recurrent ankle sprains. Clinicians have used MWM techniques as an effective tool to increase posterior talar glide and increase talocrural dorsiflexion. The purpose of this study is to evaluate effectiveness of two MWM techniques (weight-bearing and non-weight bearing) for treatment of recurrent ankle inversion ankle sprains.

Study Limitations:

  • Imaging studies have not been done to validate assessment of posterior talar glide.
  • Age range was limited to University’s student population age range of 18-27.
  • Time from injury only  9.4 months (mean) since most recent injury

Methods:

Subjects:

  • 16 subjects (8 male, 8 female) age 18-27 from University of Queensland student population. Subjects must have history of recurrent unilateral ankle sprains, must not have had injury on contralateral side and must not have had injury within the past 6 months.

Dependent Variables:

  • Posterior Talar Glide – Posterior glide was applied while passively dorsiflexing at the ankle and flexing the knee.  Posterior talar glide measured with use of tibial inclinometer.
  • Weight-Bearing Ankle Dorsiflexion – Standing lunge until anterior knee touches wall. Measurement taken via tape measurement of toe to wall distance was taken.

Independent Variables:

  • Weight Bearing  Mobilization with Movement (MWM-WB)
  • Non-Weight Bearing Mobilization With Movement (MWM-NWB)
  • Control Group               

Procedures:

  • Randomized, double-blind, repeated-measures, cross over control design.

Statistical Analysis:

  • Three repeated trials of posterior talar glide and dorsiflexion taken pre and post treatment.
  • Omnibus 3×2 repeated-measures ANOVA
  • Paired t tests to determine pretreatment differences of affected and unaffected limbs for intrastudy use.

Results:

  • Pretreatment:
    • Posterior Talar Glide – 2.4° for the affected side and 6.3° for unaffected side.
    • Dorsiflexion – 4.2° affected side and 6.4° unaffected side.
  • Post treatment :
    • Posterior talar glide increased to 4.0° or 55% following MWM-WB.
    • Posterior talar glide increased to 4.1° or 50% following MWM-NWB.
    • Dorsiflexion increased to 4.8° or 26% following MWM-WB.
    • Dorsiflexion increased to 4.8° or 26% following MWM-NWB.
    • Control group increased to 3.3° or 17% following MWM-WB
    • Control group increased to 4.4° or 9% following MWM-NWB

Conclusion:

Overall, both weight-bearing and non-weight-bearing MWM demonstrated significant positive effectiveness for improving posterior talar glide and ankle dorsiflexion. Maximum possible effect (MPE) for posterior talar glide utilizing Weight bearing MWM and non weight-bearing MWM was 55% and 50% respectively. MPE for ankle dorsiflexion was 26% for both weight-bearing and non-weight bearing MWM.  There was not a significant difference when comparing weight bearing and non-weight bearing MWM.

If you are an athlete, health care practitioner, personal trainer or performance coach and think that your issue might be associated with limited ankle mobility seek out a qualified practitioner. They will be able to identify if dorsiflexion limitations exist and will be able to treat that limitation properly and restore proper function.

Research Review: Muscle Energy Technique on Non-Specific Lumbopelvic Pain

Complete Reference: Selkow NM, Grindstaff TL, Cross KM, Pugh K, Hertel J, Saliba S. Short-Term Effect of Muscle Energy Technique on Pain in Individuals with Non-Specific Lumbopelvic Pain: A Pilot Study. J Manual and Manip. Ther 2009; 17(1): E14–E18.

Clinical Relevance:

Low back pain effects nearly 80% of the adult population. It is the most costly injury in terms of workers’ compensation costs and indemnity. Oftentimes clinicians treat non-specific low back pain with unfocused rehabilitation, medications, or biophysical modalities. Hypertonicity of neuromyofascial tissue can be the primary cause of low back pain. This can be quickly and effectively addressed with manual therapy techniques.

Introduction:

Muscle Energy Techniques (MET) is a form of manipulative therapy that has been used to treat muscle imbalance and pain disorders. Clinicians have frequently utilized MET as a tool to treat lumbopelvic pain (LPP). Lumbopelvic pain is often associated with muscular imbalance which can cause unilateral anterior innominate rotation of the pelvis. The purpose of this study is to examine the effectiveness of a single MET treatment for immediate lumbopelvic pain reduction and pain reduction 24 hours following treatment.

Study Limitations:

  • Control group had a higher visual analog scale (VAS) for current pain than worst pain.
  • Only 1 MET treatment intervention was used
  • Subjects were selected from general population, not from health care settings.
  • No measures taken to confirm if the pain was secondary to lumbopelvic disorder.
  • Post-study measure pain but did not measure correction of anterior innominate rotation.

Methods:

Subjects:

  • 20 subjects taken from general population; 10 control and 10 treatment
  • 16 male; 4 female
  • Average age; control group = 29.7 years, treatment group = 24.1 years
  • Subjects must have acute episode of LPP and demonstrated anterior innominate rotation of at least 2°.
  • Subjects exclusions: LBP for > 6 weeks, radicular pain below the knee, history of back surgery, or have been diagnosed by a physician.

Dependent Variables:

  • Current pain
  • Worst pain over 24 hours
  • Pain provocation test yielded greatest pain
  • Pain intensity produced by the provocation test

Independent Variables:

  • Treatment Condition
    • MET treatment
    • Control
  •  Time
    • Pretest
    • Post treatment
    • 24 hours post treatment            

Procedures:

  • Double blind, randomized, controlled trial
  •  Examiner #1 – performed 5 sacro-illiac pain provocative exams then notified in writing of physical exam findings to ensure treatment was performed on proper side for treatment group
  • Examiner #2 – Performed MET or control treatment

Instrumentation:

  • Visual Analog Scale (VAS) – used to measure subjective pain rating
  • PALM – Palpation meter to measure relative anterior innominate rotation

Statistical Analysis:

  • Baseline VAS current and worst pain measured by t-tests.
  • 2X3 repeated ANOVA to analyze treatment and control groups for current VAS, worst over 24 hour VAS, and worst pain provocation VAS
  • Mann-Whitney U test analyzed difference in the number of pain provocative tests pre and post treatment.

Results:

  • VAS worst pain; significant difference with MET treatment group for worst pain over 24 hours (F=5.36, P= .03)
  • No significant difference for VAS of current pain (F=3.93, P=.06
  • No significant difference for VAS pain provocation (F=0.81, P=.46)
  • Significant pain reduction for both groups (P=.04) between days

Conclusion:

Overall, worst pain over 24 hours was significantly reduced following MET treatment when compared to the control. As a clinician working with clients and non-specific low back look for muscle imbalances that can be corrected with manual therapy techniques such as muscle energy, which inhibits overactive tissue then allows for elongation.