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Mobilisation with movement for ankle sprains

Ankle sprain is a very common musculoskeletal injury in both the very active and general population. There is potential for ankle sprains to develop into chronic pain due to instability, osteoarthritis, osteochondral lesions, as well as a high risk of re-injury.

The most common mechanism of ankle sprain is an inversion injury which can be caused by non-contact, player contact, or surface contact which is commonly described as rolling over your ankle. Ligaments and tendons are classically injured from this injury, but there may also be joint displacement at the tibiofibular joint. Fracture must always be ruled out.

Initial management should consist of protection with an ankle brace, rest, ice, compression and elevation. Exercise therapy is often recommended to re-educate proprioceptive and neuromuscular systems which are often affected from ankle sprain. Joint mobilisation is utilised to reduce pain and increase joint range of motion.

Mobilisation with movement is a relatively new concept of active joint mobilisation. The therapist applies a sustained pain free mobilisation force at the affected joint with a concurrent active movement performed but the patient in the direction of pain and movement deficit. The aim is to make that movement pain free and to allow the patient to be involved in progressive recovery to normal functional activity.

A clinical trial revealed that those with an acute and subacute grade I and II ankle sprain who received two weeks of mobilisation with movement targeted to the inferior tibiofibular joint experienced greater and long term improvements in ankle pain, functional dorsiflexion range of motion, disability, pressure pain threshold and balance compared to a sham intervention.

Gogate, N. et al. (2021). The effectiveness of mobilisation with movement on pain, balance and function following acute and subacute inversion ankle sprain - a randomised, placebo controlled trial. Physical Therapy in Sport. 48: 91-100.


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