The immediate effect of manipulation in chronic ankle instability syndrome in terms of objective clinical findings

Abstract

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)