None listed
Conditions
Brief summary
Objective: Study 1: To determine if differences in cortico-spinal excitability were present between subjects with FAI. Study 2: To examine the immediate and short-term effect of joint mobilization on cortico-spinal excitability in subjects with FAI. Methods: Study 1 is a observational study. We recruited 11 healthy subjects and 11 FAI, then compared the difference in all out come measurements. Study 2 is a single blind, randomized controlled trial. We recruited 45 FAI participants with self-reported ankle instability , randomly assigned to control group, training group and mobilization with training group. Mean EMG data from the fibularis longus (FL) , tibialis anterior (TA) , and soleus (SOL) were measured during the eccentric phase of the Y balance test. Single pulse transcranial magnetic stimulation (TMS) was performed, and the active motor threshold (AMT) , motor evoked potential (MEP) and the cortical silent period were recorded. To examine the immediate effect, one session of ankle joint mobilization was performed for the FAI group. Participants in both the TG and MTG were trained by a physical therapist twice weekly for 4 weeks, and participants in the MTG received additional joint mobilization in every treatment (Maitland grade II and III anterior to posterior joint mobilization to talocural joint and distal tibiofibular joint) . Results: Study 1: The FAI group demonstrated a significantly decreased active and passive dorsi-flexion ROM than healthy subjects. In Y balance three direction reach, the FAI group demonstrated a significantly lower FL muscle activity than the control group. The FAI group also demonstrated a significantly lower FL and SOL MEP than the control group. Study 2 (Immediate effect): Active dorsi-flexion ROM were significantly increased after a single session of joint mobilization. There was also a significantly higher cortico-spinal excitability compared to the CG. Study 2 (Short term effect): MANOVA indicated significant group by time interactions on self-report function, ankle girth, FL activity and SOL MEP after 4 weeks (p<0.05). The post hoc tests showed significantly decreased ankle girth in MTG compared to TG and CG,decreased FL muscle activity in MTG compared to TG and CG, increased SOL MEP with respect to TG and CG. Conclusion: Individuals with FAI had a poorer ROM and FL muscle performance during the balance task. The cortical-spinal excitability of the FL and SOL was impaired in those with FAI. This may indicate a potential link between joint instability, muscle control during tasks and the central nervous system. Joint mobilization can restore range of motion and increase neuroplasticity after joint mobilization.
Interventions
For the joint mobilization with training group, a licensed physiotherapist provided the ankle joint distraction, talocrural joint posterior glide, distal tibiofibular joint posterior glide, ankle stabilization exercise training (e.g.one-leg standing exercise, one-leg squat) and calf muscle self-stretching exercise. The whole intervention was administrated by an experienced physical therapist, and no strategy was used to monitor the adherence to the intervention. The total duration for manual the
For the joint mobilization with training group, a licensed physiotherapist provided the ankle joint distraction, talocrural joint posterior glide, distal tibiofibular joint posterior glide, ankle stabilization exercise training (e.g.one-leg standing exercise, one-leg squat) and calf muscle self-stretching exercise. The whole intervention was administrated by an experienced physical therapist, and no strategy was used to monitor the adherence to the intervention. The total duration for manual therapy took about 15 minutes, and the duration for exercise training took about 15 to 30 minutes, twice a week, last for four weeks.Participants do not need to undertake the training exercise in their own time. All the intervention was administered on an individual.
Sponsors
Yi-fen Shih
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
20 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
Patients with functional ankle instability with age between 20 and 50 years old; score of Cumberland Ankle Instability Tool (CAIT) lower than 27; one or more positive signs in the following criteria: (1) Had a serious inversion ankle sprain following with swelling, pain and functional impairment within a year; (2) recurrence of ankle sprain on the affected foot or any symptom of weakness and giving way. For healthy subjects, the inclusion criteria included age between 20 and 50 years old, no past history of lower extremity surgery, and no past history of lower extremity injury within six week. Score of Cumberland Ankle Instability Tool (CAIT) greater than 28.
Exclusion criteria
(1) ankle sprain within 6 weeks; (2) a history of lower extremity fracture or surgery; (3) seizure; (4) any mental implantation; (5) positive sign in anterior drawer test or talar tilt test; (6) neurological disease, pregnant, or serious systemic disease which might effect subjects' balance control
Outcome results
None listed