Effect of Mobilization with Movement on gait and function in athletes with chronic ankle instability- A Randomized Controlled Trial

Ankle sprain is the most common sport-related injury (Fong et al., 2007). The International Ankle Consortium defines the pathology of residual symptoms after a significant ankle sprain as chronic ankle instability (CAI). The International Ankle Consortium characterized CAI as a condition in which an individual has a significant ankle sprain and/or experienced recurrent ankle sprain on the sprained ankle, and/or feels ankle instability, and/or experienced giving way at least twice in the past 6 months (Gribble et al., 2014).

Ankle sprains account for about 16-40% of sports related injuries (Jungmann et al., 2023). The prevalence of CAI among athletes is 23.4% (Tanen et al., 2014). According to Roos et al. (2017), noncontact, player contact, or surface touch may be the most frequent mechanism of injury resulting in inversion ankle sprain. This could result in internal rotation, ankle plantar flexion, and subtalar inversion, all of which would put undue strain on the lateral ankle ligament complex. Ankle sprain discomfort and incapacity may be caused by fibula malpositioning, which has been observed in injured ankles (Fukuhara et al., 2012; Hubbard & Hertel, 2008), rather than injury to the anterior talofibular ligament itself (Mulligan, 2010). The CAI group exhibited dorsiflexion deficits (Inje et al., 2022). A reduction in posterior glide of the talus in the ankle mortise in subjects was observed 6 months following ankle sprain (Denegar et al., 2002). Athletes with unilateral CAI reported significantly lower ankle function in the Foot and Ankle Ability Measure (FAAM), when compared with controls (Donovan et al., 2020).

Symptoms of CAI are not limited to pain, swelling, the feeling of giving way, and limited range of motion (ROM) (Kosik et al., 2019). Gait alterations have been documented in CAI, and most of the studied parameters were spatiotemporal ones. Step length, cadence, walking speed, and single limb duration were reduced in those with CAI, while their base of support was larger. Patients with CAI were found to walk with approximately 16% slower walking velocity, 9% lower cadence, and approximately 7% lower step length. Furthermore, the base of support during walking in the CAI group was approximately 43% wider, and the single limb support phase was 3.5% shorter compared to the control group (Gigi et al., 2015). In order to decrease discomfort and improve joint range of motion (ROM), management includes exercise therapy that emphasizes neuromuscular and proprioceptive training in addition to joint mobilization (Doherty et al., 2014).

One of the most recent ideas in active joint mobilization is mobilization with movement (MWM). The patient actively moves in the direction of pain and movement limitation while the therapist provides a prolonged, pain-free mobilization force at the afflicted joint. The goal is to make the patient’s painfully limited movement pain free so they can participate in a gradual recovery to their regular functional activity (Hing Wayne et al., 2019).

For chronic recurring ankle sprains, Weerasekara et al. (2020) found moderate quality evidence supporting MWM in their recent systematic review. The most often studied MWM technique in the review was a posterior talar glide MWM (Weerasekara et al., 2020). Mulligan’s mobilization with movement improves dorsiflexion range of motion (DFROM) in individuals with CAI (Vallandingham et al., 2019).

Previous studies have assessed reduced function and alterations in gait parameters in subjects affected with chronic ankle instability. To the best of my knowledge, no previous study has examined gait parameter changes after giving mobilization with movement. Therefore, this study aims to bridge this gap by assessing the effect of MWM on gait and function in university athletes with chronic ankle instability.