Ankle Manual Therapy for Ankle Sprains

Ankle sprains can cause ankle joint stiffness. Ankle joint stiffness may be a cause of pain,
disability, and repeated sprains. Physical therapists use many ways to treat ankle joints
that do not move well. One way takes 1-2 seconds. Another way may take up to 1 minute. Both
kinds of stretches seem to improve ankle flexibility. However, we do not know how well they
work to improve pain and disability in individuals following ankle sprains. The purpose of
this research is to find out which physical therapy treatments work best for people with
ankle sprains. To start the study, subjects will be asked to fill out some forms that ask
about their ankle problem. Subjects will receive an examination by a physical therapist that
includes gentle movements of the feet and legs to test their flexibility, strength, and
balance. Subjects will then be assigned to 1 of 3 treatments to be provided by a separate
physical therapist. They will not get to choose their group. All 3 groups will receive ankle
stretching by the physical therapist. The groups will differ in how much and how fast the
stretch will be. The first group will have an ankle stretch that lasts 1-2 seconds. The
second group will have a stretch that lasts 1 minute. The third group will have their foot
held without any stretching. After stretching, all subjects will receive the same kind of
exercise program. Study-related treatment will last 5 sessions over 4 weeks, with 2 sessions
for stretching within the 1st week and 1 session per week for the 3 following weeks for the
exercise program. After 1 week and 4 weeks, subjects will fill out the same forms as at the
initial examination. The treatment part of the study will then be finished. After 6 months,
1 year, and 2 years from enrollment in the study, subjects be asked to fill out many of the
same forms that ask about their ankle problem. We think subjects that get a stretch will
have a better outcome than subjects that get ankle holding. To test our idea, we will
compare how subjects in each group tell us they are doing with their ankle problem on the
Foot and Ankle Ability Measure at 1 week, 4 weeks, 6 months, 1 year, and 2 years following
entry into the study. Since the way a person thinks and feels about their injury may have
something to do with how much they improve during physical therapy, we will also measure
these factors to find out if they affect the results of this study.

Inclusion Criteria:

- Age 16-60 years

- Onset of ankle sprain at least 2 weeks prior to enrollment

- Foot and Ankle Ability Measure Activity of Daily Living subscale score less than or
equal to 80%

Exclusion Criteria:

- Current status of assisted ambulation (eg, use of cane or crutches)

- Inability to bear weight through the affected extremity immediately after injury
combined with tenderness to palpation of the medial and lateral malleolar zones,
styloid process of the 5th metatarsal, and navicular

- Positive anterior drawer or talar tilt dimple test

- Volume of the affected limb greater than 10% of the unaffected limb

- Previous history of ligament or bony reconstructive surgery to the ankle and foot

- Concomitant injury to other lower extremity joints