The effectiveness of a myofascial treatment protocol combined with cryotherapy compared to cryotherapy alone in the treatment of acute and subacute ankle sprains

Abstract

Background: Ankle sprains are a frequently occurring injury sustained by sports individuals accounting for approximately 20% to 40% of all sports injuries (DiStefano et al. 2008; LeBrun and Krause, 2005). Ankle sprains are mainly caused by excessive inversion (Takao et al., 2005; Andersen et al., 2004), when the foot is twisted inwards and lands at a high velocity damaging the lateral capsule-ligamentous complex (Beynnon et al., 2005). According to Naqvi, Cunningham and Lynch (2012) untreated or inappropriately managed ankle sprains can lead to a cascade of negative alteration to both the joint structures and the individual’s lifestyle. According to Hale, Hertel and Olmsted-Kramer (2007) 30% of ankle sprains result in chronic ankle instability (CAI) and 78% of the CAI cases develop into post-traumatic ankle osteoarthritis. This poses a negative impact on an individual’s athletic performance. Ankle sprains can be managed conservatively with the utilization of the PRICE protocol during the acute stage, cross friction massage or instrument assisted soft tissue mobilization techniques (for example Graston®, FAKTR© Concept) for both acute and subacute ankle sprains (Bleakley, 2010).

Aim: The purpose of this study was to determine the effectiveness of a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy compared to cryotherapy and sham laser in the treatment of sub-acute and acute ankle inversion sprains.

Objectives: 1. To determine the effectiveness of a myofascial treatment protocol combined with cryotherapy in terms of subjective (numerical pain rating scale [NRS] and foot function index [FFI]) and objective (oedema measurements [EDM], digital inclinometer readings [DIR], algometer readings [AR] and stork balance stand test score [STR]) measurements in the treatment of acute and sub-acute ankle sprains. 2. To determine the effectiveness of sham laser combined with cryotherapy in terms of subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements in the treatment of acute and sub-acute ankle sprains.

3. To compare the relative improvement between the two groups in terms of subjective (NRS and FFI) and objective measurement (EDM, DIR, AR and STR).

Study design: This was a quantitative randomised controlled clinical trial.

Methods: Forty participants with sub-acute or acute ankle sprains of not more than three weeks were recruited into the study. All participants had a full case history, physical, and foot and ankle regional examination to assess for their eligibility for entry into the study in terms of inclusion and exclusion criteria. These participants were randomly allocated using the hat method into one of two study groups, Group A (treatment group) or Group B. Participants in Group A received a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy and Group B received cryotherapy and sham laser. These participants had four treatments in two weeks where the appropriate treatment was administered. Pre-treatment subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements were taken at each consultation. This data was analysed using SPSS software version 24.0.

Results: The General Linear Model for repeated measures was used for the intra- group and inter-group analysis of the data. Intra-group analysis of the FAKTR© treatment group showed that the group had statistically significant improvements in terms of the subjective and objective measurements of the study with the p-value < 0.05 between all treatment periods. Intra-group analysis of the control group showed no statistically significant improvements in terms of subjective and objective measurements of the study. Inter-group analysis showed no statistically significant difference in terms of the DIR and EDM. The NRS, AR, STR and FFI readings showed statistically significant differences between the two groups with a p-value of < 0.05 mainly on the last two consultations.

Conclusion: This study concluded that the myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy was more effective than cryotherapy and sham laser in the treatment of sub-acute and acute inversion ankle sprains. The FAKTR© Concept treatment group appeared to show statistically significant improvements compared to the control group.