Treatment For Unstable Ankles.
- Conditions
- Ankle Instability
- Registration Number
- CTRI/2022/04/041799
- Brief Summary
Anklesprain is considered as the most common injury occurring in the activepopulation.1 All patients with the history of previous ankle sprain developedsymptoms such as decreased range of motion of dorsiflexion, laxity ofligaments, loss of proprioception, pain during activity, swelling and also thefeeling of “giving way†and ankle instability.1 chronic ankleinstability is defined by Hertel et al. as “repetitive bouts of lateral ankleinstability resulting in numerous ankle sprains.â€1 Chronic ankleinstability is also considered as a complex ankle disorder that was caused bymechanical instability, functional instability, or could be the combination ofboth the conditions.1 Mechanical instability is objective andinvolves ankle joint movement beyond physiological range of motion, WhereasFunctional instability is considered as the feeling of instability which issubjective in nature and is in relation with a proprioceptive neuromusculardysfunction.1 intrinsic and extrinsic are the predisposing factorsthat could lead to chronic ankle instability.1 extrinsic factors aretype of ground surface, types of footwear, physical activity. Intrinsic factorsinclude ratio of increased ankle eversion to inversion strength, dorsiflexionto plantarflexion strength ratio, plantarflexion strength, dominance of limb,decreased ROM, postural control or lower leg alignment. Manual therapy approachtends to lengthen the joint capsule and ligaments associated with it bystretching them through accessory motion in order to restore dorsiflexion rangeof motion by increasing the extensibility of non-contractile tissues. Mobilization with movement is consideredeffective in improving function, persistent instability feeling, ankle range ofmotion of dorsiflexion, reducing swelling and pain, improving function andpostural control in patients suffered with lateral ankle sprains. Some of thesesymptoms are present together or individually in which conventional treatmenthas been inefficient. In chronicankle instability it appears that functional and mechanical impairmentsco-exist. Muscle inhibition has been identified in the fibularis longus andsoleus muscles in cases of functional instability of ankle.2 Needleet al suggested that subjective instability might be related to deficits inmuscle spindle function during mechanical loading of the ankle.2Pietrosimone et al concluded that alterations were seen in neuromuscular functionpost joint injury contributed to altered biomechanics affecting long termfunctional outcomes.2 Hence these studies are in support that there is presenceof neuromuscular dysfunction in CAI.2
Strain counterstrain is an indirect osteopathictreatment which describes the theatrical mode of neuro-muscular skeletaldysfunction where a mechanical strain injury leads to changes in muscle spindlearound the involved segment known as the proprioceptive theory. Based on thistheory, during lateral ankle sprain the affected foot turns into inversionhence the spindles of invertor muscles adapt to a newly shortened musclelength.2 The quick stretch and resulting contraction of the evertormuscles causes the invertor muscles to be quickly stretched from the adaptedshortened position, leaving the invertor muscles in a state of increased neuromuscularhyperactivity with a facilitated spindle system. According to theproprioceptive theory, this scenario leaves the ankle in a state of neuromuscular skeletal dysfunction which in future leads to chronic ankleinstability and hence repeated episodes of ankle sprains.
In strain counterstraindysfunctional muscle groups are identified through localization of significanttender points which are defined as small zones of tense, tender, and edematousmuscle and fascial tissue about 1 cm indiameter and is 4 times more tender as compared to the normal tissue.2 authors like Stillwell and melzack [48]concluded that there may not be any significant difference between SCS point and trigger point, areduction in the tenderness degree of SCS tender point is associate with a modification of bodyposition. However, till date no assessment too is available which can assessSCS tender points.
The role of soleus and gastrocnemius muscletightness has also been considered as the contributing factor for restrictionof the range of motion of dorsiflexion nevertheless following the resultsobtained by Johanson in 2008, range of motion of dorsiflexion seems to be more in relationwith subtalar joint than muscle tightness.1 there are some manual therapytechniques which are based on talocrural joint mobilization which have proventhe effectiveness of this kind of stimuli in postural control, ROM ofdorsiflexion and improvement in arthrokinematic. [2,9,20,21] during dynamicbalance tasks balance is usually altered in patients with chronic ankleinstability, this seems to be because of deficit in neuromuscular control andproprioception of the ankle joint.
**NEED FOR THE STUDY**
Conventionalphysical therapy techniques such as electrotherapy, taping, etc has been showngood results in decreasing the edema and pain which is associated with anklesprain.1 nevertheless the improvement obtained with such therapiesdoes not provide a remedy to the possible sequelae associated with sprain ofankles, such as muscle weakness, postural control deficits, nerve deficits,invertor and evertor strength deficits,sensorimotor deficits, delayed peroneal muscle reaction time ,damage toligamentous and capsular mechanoreceptors with dysfunction in theafferent–efferent mechanism, alterations in the dorsiflexion ROM of anklejoint, proprioception deficits, etc.1,2 for these reasons it isimportant to make integral approaches in the treatment of ankle sprain in orderto avoid its reoccurrence. It is estimated that about 70% re-sprain occursafter the previous episode of ankle sprain. After the onset of ankle sprainrange of motion of dorsiflexion at the ankle joint is affected, this isconsidered as a predisposing factor of re-injury. Range of motion ofDorsiflexion at the ankle joint is associated with positional alteration of thetalus in relation with the ankle mortise or an alteration in normal talararthrokinematics, being a reduced posterior talar glide.1 Another factor forrecurrent ankle sprain is the decreased balance. Mobilization of joint iseffective in reducing predisposing factors to re-injury and whose improvementis hypothesized to be derived by the posterior talar glide alteration. Literaturesuggests that the stretching of articular which is occurring due tomobilization of joints tends to increase the sensory output of mechanoreceptorsin ligaments and capsules due to the activation of gamma motor neurons bytissue traction which is related to improvement of postural control. MWMcan be used in acute and sub-acute ankle sprains in weight bearing or non-weightbearing conditions with the particularity of patient moves actively.1
Lack of required strength, functional weakness, foot laxity,neuromuscular imbalance etc. are proven intrinsic risk factors for increase inchances chronic ankle instability, hence it is imperative to study the effectsof passive MWM with strain counterstrain to achieve functional as well asmechanical stability in the ankle and thus treating the root cause of chronicankle instability.
**Research question**
Whatwill be the effect of Strain Counter Strain With Passive MWM In Patients WithChronic Ankle Instability, in terms of postural control, ankle stability anddynamic balance?
**Hypotheses**
**Null hypotheses (H0)**
Therewill be no effect in Strain Counter Strain With Passive MWM In Patients WithChronic Ankle Instability in terms of postural control and dynamic balance.
**Alternate hypotheses (H1)**
Therewill be significant effect in Strain Counter Strain With Passive MWM InPatients With Chronic Ankle Instability, in terms of postural control anddynamic balance.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- All
- Target Recruitment
- 72
- 1.History of minimum one episode of ankle sprain 3 months earlier.
- 2.Feeling of giving way in ankle.
- 3.Subjects of either gender in an age group of 18-55 years.
- 1.History of ankle fracture/surgery.
- 2.Recent soft tissue injury at ankle.
- 3.Neurologic deficit.
- 4.Pregnant woman.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Balance Master baseline, 2 weeks post treatment, 4 weeks post treatment
- Secondary Outcome Measures
Name Time Method Chronic Ankle Instability Tool baseline, post 2 weeks, post 4 weeks
Trial Locations
- Locations (1)
Dr. A.P.J. Abdul Kalam College of Physiotherapy
🇮🇳Ahmadnagar, MAHARASHTRA, India
Dr. A.P.J. Abdul Kalam College of Physiotherapy🇮🇳Ahmadnagar, MAHARASHTRA, IndiaPooja YadavPrincipal investigator8652552561dr.pooja.yadav333@gmail.com