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    The effectiveness of manipulation combined with static stretching of the gastrocnemius-soleus complex compared to manipulation alone in the treatment of subacute and chronic grades I and II ankle inversion sprains
    (2001) Needham, Kim Jane; White, Horace Lindsay
    The purpose of this study was to evaluate the relative effectiveness of chiropractic manipulation alone compared to chiropractic manipulation in conjunction with gastrocnemius and soleus stretching in the treatment of subacute and chronic grade I and II ankle inversion sprains
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    The immediate effect of manipulation in chronic ankle instability syndrome in terms of objective clinical findings
    (2005) Lindsey-Renton, Catriona; Dip, Jones; Korporaal, Charmaine Maria
    Damage to the proprioceptive organs, as well as lack of proprioceptive retraining, after an inversion ankle sprain, has been shown to contribute to the problem of recurring ankle joint injuries, which has the highest incidence of sports related injuries. The proprioceptive organs are important as afferent pathways in reflexes and for the adjustment of posture and muscle tone (Miller and Narson, 1995 and Jerosch and Bischof, 1996). Manipulation is thought to cause a change in the afferent pathways of the manipulated joints and it is proposed that this change may restore normal proprioceptive input, in a previously injured joint (Wyke, 1981 and Slosberg 1988). This however is unproven as indicated in a study by Lephart and Fu, (1995), where techniques to improve proprioception remain untested and according to Brynin and Farrar (1995), screening for proprioceptive and neuromuscular co-ordination should be carried out as part of a chiropractor's physical examination and injury evaluation. This was a qualitative pre-post clinical study. Forty (40) subjects between the ages of 25 and 45, who had been diagnosed with chronic ankle instability syndrome, were recruited. The only treatment they received was a single mortise separation adjustment and all participants received the same treatment. Clinical outcomes were measured before and after the adjustment on both ankles using a Dualer Electronic Inclinometer and algometer. Only the affected ankle received an adjustment, but both ankles were measured. The participants were evaluated by the examiner at an initial consultation during which diagnosis of chronic ankle instability syndrome was made based on case history, physical examination and foot and ankle regional examination. Participants presented with at least four of the following (Kessler and Hertling 1983)
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    The relative effectiveness of Piroxicam versus Protease administration in the treatment of acute grade 1 and 2 ankle inversion sprains
    (2001) Bellingham, Simon; White, Horace Lindsay
    The purpose of this study was to evaluate Piroxicam versus Protease administration, in terms of subjective and objective clinical findings, in order to determine the effectiveness of each approach in the treatment of grade 1 and 2 acute ankle inversion sprains. The study was a prospective, randomized, double blinded, controlled study. The study involved 30 subjects, 15 in each group which were selected from the general population. One group received Protease and strapping while the other group two received Piroxicam and strapping. Patients received 3 treatments over a period of one week. Patients in the Protease group received 1200mg (3 x 400mg) of Protease daily before meals for seven days. Patients in the Piroxicam group received 40mg (2 x 20mg) of Piroxicam for the first two days, and then 20mg (1 x 20mg) for the following five days, administered with meals. All patients were taught how to apply an elastic crepe bandage to the ankle, which was to be used at all times, except during bathing for the duration of the study
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    The relative effectiveness and correct sequencing of proprioceptive neuromuscular facilitation techniques (PNFT) and active rocker-board exercises in the rehabilitation of chronic ankle sprains
    (2005) Gaines, Dominique
    Previously the focus has been on the improvement of strength prior to proprioception (Calliet, 1997; Flemister et al. 1998 and Buhler et al. 2002). However according to Oloff (1994); Vegso (1995); Calliet (1997); Kawaguchi (1999); Buhler et al. (2002) and McGrew et al. (2003), focus should lie in obtaining a functional range of motion (increased flexibility) and proprioceptive ability and strength will follow with normalization of the relationship of the anatomical structures. All research in this regard has never assessed the assumption that the strength of the relevant musculature would return (Blokker et al.1992 and Klaue et al.1998). The objectives of this study were: to determine the relative effectiveness of Proprioceptive Neuromuscular Facilitation as compared to the Active Rocker-Board Exercises in the rehabilitation of chronic ankle sprains; as well as to determine the best sequence of applying these techniques to chronic ankle sprains in terms of objective clinical findings.
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    The immediate effect of manipulation in chronic ankle instability syndrome in terms of objective clinical findings
    (2005) Lindsey-Renton, Catriona
    Damage to the proprioceptive organs, as well as lack of proprioceptive retraining, after an inversion ankle sprain, has been shown to contribute to the problem of recurring ankle joint injuries, which has the highest incidence of sports related injuries. The proprioceptive organs are important as afferent pathways in reflexes and for the adjustment of posture and muscle tone (Miller and Narson, 1995 and Jerosch and Bischof, 1996). Manipulation is thought to cause a change in the afferent pathways of the manipulated joints and it is proposed that this change may restore normal proprioceptive input, in a previously injured joint (Wyke, 1981 and Slosberg 1988). This however is unproven as indicated in a study by Lephart and Fu, (1995), where techniques to improve proprioception remain untested and according to Brynin and Farrar (1995), screening for proprioceptive and neuromuscular co-ordination should be carried out as part of a chiropractor’s physical examination and injury evaluation. This was a qualitative pre-post clinical study. Forty (40) subjects between the ages of 25 and 45, who had been diagnosed with chronic ankle instability syndrome, were recruited.
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    The short and intermediate effect of manipulation on chronic ankle instability syndrome
    (2005) Kohne, Eckard Peter; Jones, Andrew D.; Korporaal, Charmaine Maria
    Following an inversion ankle joint sprain, damage to the proprioceptive organs can occur, which is made worse by lack of proprioceptive retraining and will increase the chances of re-injury (Hoffman and Payne 1995:144 and Anderson, 2002). Pellow and Brantingham (2001) indicated that patients who received multiple manipulations improved more rapidly than patients in the placebo group. Therefore it is proposed that manipulation provokes changes in afferent input that may restore normal proprioceptive input (Slosberg, 1988). However, Pellow and Brantingham (2001) were not able to establish what effect multiple manipulations had, as opposed to a single manipulation, on the proprioception on the foot and ankle complex and how this may influence the clinical outcome of the patient’s treatment. Therefore, it was hypothesized that multiple manipulations of the foot and ankle complex would have a greater effect on chronic ankle instability syndrome than a single treatment in terms of overall improvement subjectively and objectively. In addition to this the following was also hypothesized: • That multiple manipulations of the foot and ankle complex would increase the ROM to a greater extent than single manipulations. • That multiple manipulations would decrease point tenderness more effectively than a single manipulation.
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    The prevalence and clinical presentation of fibularis myofascial trigger points in the assessment and treatment of inversion ankle sprains
    (2007) Van der Toorn, Ingrid; White, Rowan
    Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points.