Effect of Joint Mobilization in the Treatment of Chronic Ankle Instability

Novel rehabilitation methods, that specifically target decreased muscle activation due to
joint pathology prior to strength training, have elicited greater improvements in muscle
function and self-reported disability compared to traditional therapies. Preliminary evidence
suggests ankle joint mobilization can improve contributions of spinal influences on ankle
muscle activation in individuals with ankle joint pathology, but there is a considerable gap
in understanding cortical contributions to muscle activation following joint injury. It is
unknown how joint mobilization concurrently affects cortical and spinal neural motor
pathways, as well as clinical measures of patient function. The overall aim of this grant is
to determine the immediate effects of talocrural joint mobilization on cortical and spinal
muscle activation of the fibularis longus (peroneus) and soleus muscles in individuals with
chronic ankle instability (CAI). The secondary aims of this study will examine changes in
ankle dorsiflexion range of motion (ROM) and dynamic balance. This innovate approach will
provide the necessary scientific knowledge regarding the potential mechanism and efficacy of
joint mobilization.

Inclusion Criteria:

- Age 16-45 years

- History of one or more ankle sprains

- Scoring at least an 85% on the Foot and Ankle Ability Measure (FAAM) Sport or at least
3 on the Modified Ankle Instability Instrument (AII).

- At least 5° ankle dorsiflexion asymmetry compared to the contralateral limb OR ankle
dorsiflexion ROM less than 21°

Exclusion Criteria:

- Lower extremity injury or surgery within the past 6 months (including lateral ankle
sprain)

- Diagnosed ankle osteoarthritis

- History of ankle surgery that involves intra-articular fixation

- Medical conditions which would be contraindications to mobilization/manipulation
and/or transcranial magnetic stimulation, including cardiac pacemaker, metal implants
in the head, current pregnancy, neurological disorders, recent use of stimulants or
medications known to lower seizure threshold, and personal or family history of
seizures