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Cameron J. Powden, Kathleen K. Hogan, Erik A. Wikstrom and Matthew C. Hoch


Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI).


Examine the immediate effects of talocrural joint traction in those with CAI.


Blinded, crossover.




Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering “yes” to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool.


Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected.

Main Outcome Measures:

The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05.


No significant treatment effects were identified for any variables.


A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

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Kathleen K. Hogan, William O. Perkins, Cameron J. Powden, and Matthew C. Hoch

Clinical Scenario:

Chronic low back pain is one of the most common causes of pain and disability. Currently, there is a need for more effective interventions to treat low back pain.

Clinical Question:

Does the use of custom foot orthotics improve self-reported measures of pain and function in adults with chronic low back pain?

Summary of Key Findings:

A comprehensive and systematic search was conducted for studies of level 2 evidence or higher that pertained to the clinical question. The search yielded 11 studies, of which one randomized control trial and two prospective cohorts fit the inclusion and exclusion criteria. The articles examined the effectiveness of custom foot orthotics in isolation compared with no treatment as well as custom foot orthotics in combination with usual care compared with usual care alone. The included studies all demonstrated that the use of custom foot orthotics reduce chronic low back pain after seven weeks of use. One included study was considered high-quality evidence while two were deemed low-quality evidence using the PEDro.

Clinical Bottom Line:

There is moderate evidence to support the use of custom foot orthotics to improve self-reported measures in adults with chronic low back pain after seven weeks of use.

Strength of Recommendation:

The Strength of Recommendation Taxonomy recommends a grade of B for consistent limited-quality patient-oriented evidence.