The effectiveness of combined manipulation and rehabilitation versus rehabilitation only, in the management of chronic ankle instability

Abstract

Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation