Efficacy of fibular mobilisation with movement and tape for the treatment of ankle inversion sprains: A randomised clinical trial

Group 1. Distal fibular mobilisation with movement - This treatment technique involves the application of a posterior-lateral and superior glide over the distal end of the fibula that is then maintained while the subject actively inverts the ankle to the end of pain-free range. If full pain-free range is achieved, overpressure is applied by the therapist (Vicenzino et al., 2011). 3 sets of 10 repetitions have been found to provide an immediate improvement in ROM and function (Merlin, McEwan, & Thom, 2005). In addition to this treatment, a posterior gliding fibular tape will be used. This will be in the form of two diagonal strips of non-stretch tape at the level of the tibiofibular joint applying a posterior-superior glide to the fibula. This has been advocated for the prevention and treatment of lateral ankle sprains (Hopper et al., 2009). Moiler, Hall and Robinson (2006) found the posterior gliding fibular tape to reduce the incidence of ankle sprains in basketball players when compared to other forms of prophylactic methods including traditional ankle taping and ankle bracing. Group 2. This group will only have the distal fibular mobilisation with movement and not the posterior gliding fibular tape that is being used in Group 1. The mobilisations and the posterior gliding tape will be applied for a maximum of 3 times per week for 2 weeks. The mobilisations and the posterior gliding tape will be discontinued before the end of week 2 if full pain-free range of movement has been restored. Discontinuation of mobilisations and posterior gliding tape will be decided by the investigator measuring the outcome measures, who will be blind to the treatment allocation of the subject. The discontinuation of mobilisations and tape will be recorded, and used itself as a measure of the effectiveness of each intervention. Proprioceptive exercises will start in week 3 at the latest. When mobilisations and the posterior gliding tape are discontinued prior to the end of week 2, proprioceptive exercises will start as soon as treatment with mobilisations and tape is discontinued. These exercises involve standing on uneven surfaces while being challenged with environmental and external stimuli/perturbations, starting with less difficult challenges and progressing as balancing ability improves. This is a standard physiotherapy treatment following ankle sprains and is usually done daily and at training sessions as a warm up when returning to sport. The exercises should take about 15-20 minutes each session. All subjects (in all three intervention groups) will receive 20 minutes of TENS (50-100Hz, pulse width 150microseconds) and 5 minutes of oedema draining massage. This will be administered after the distal fibular mobilisation with movement treatment and before the application of tape in Group 1. All groups will also receive general advice on self management of their ankle injury (i.e., ice, elevation). Proprioception exercises, which have been found to significantly reduce injury recurrence (Hupperets, Verhagen, & van Mechelen, 2009), will also be included in all groups. Adherence will be monitored through regular physiotherapy visits and interviews in the first 5 weeks (weekly visits in weeks 3, 4, 5) and then by email or phone communication.