Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain.

OBJECTIVE Distal fibula mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques. METHODS In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3 per week within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation (TENS), edema draining massage. and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure (FAAM) and Patient Global Impression of Improvement Scale (PGI-I) were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength. RESULTS Participants receiving MWM and MWMtape were equally effective and demonstrated greater function on FAAM at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for PGI-I or any of the secondary outcomes. CONCLUSION There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibula MWM is most effective to achieve activities of daily living (ADL) and sport function, when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit. IMPACT Distal fibula mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long term ADL and sport function. In the short term, antero-posterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibula mobilization with movement.