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

Context:

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

Objective:

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

Design:

Blinded, crossover.

Setting:

Laboratory.

Participants:

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.

Intervention:

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.

Results:

No significant treatment effects were identified for any variables.

Conclusion:

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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Christopher J. Burcal, Alejandra Y. Trier, and Erik A. Wikstrom

Context:

Both balance training and selected interventions meant to target sensory structures (STARS) have been shown to be effective at restoring deficits associated with chronic ankle instability (CAI). Clinicians often use multiple treatment modalities in patients with CAI. However, evidence for combined intervention effectiveness in CAI patients remains limited.

Objective:

To determine if augmenting a balance-training protocol with STARS (BTS) results in greater improvements than balance training (BT) alone in those with CAI.

Design:

Randomized-controlled trial.

Setting:

Research laboratory.

Patients:

24 CAI participants (age 21.3 ± 2.0 y; height 169.8 ± 12.9 cm; mass 72.5 ± 22.2 kg) were randomized into 2 groups: BT and BTS.

Interventions:

Participants completed a 4-week progression-based balance-training protocol consisting of 3 20-min sessions per week. The experimental group also received a 5-min set of STARS treatments consisting of calf stretching, plantar massage, ankle joint mobilizations, and ankle joint traction before each balance-training session.

Main Outcome Measures:

Outcomes included self-assessed disability, Star Excursion Balance Test reach distance, and time-to-boundary calculated from static balance trials. All outcomes were assessed before, and 24-hours and 1-week after protocol completion. Self-assessed disability was also captured 1-month after the intervention.

Results:

No significant group differences were identified (P > .10). Both groups demonstrated improvements in all outcome categories after the interventions (P < .10), many of which were retained at 1-week posttest (P < .10). Although 90% CIs include zero, effect sizes favor BTS. Similarly, only the BTS group exceeded the minimal detectable change for time-to-boundary outcomes.

Conclusions:

While statistically no more effective, exceeding minimal detectable change scores and favorable effect sizes suggest that a 4-week progressive BTS program may be more effective at improving self-assessed disability and postural control in CAI patients than balance training in isolation.

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Matthew C. Hoch, David R. Mullineaux, Richard D. Andreatta, Robert A. English, Jennifer M. Medina-McKeon, Carl G. Mattacola, and Patrick O. McKeon

Context:

A single talocrural joint-mobilization treatment has improved spatiotemporal measures of postural control but not ankle arthrokinematics in individuals with chronic ankle instability (CAI). However, the effects of multiple treatment sessions on these aspects of function have not been investigated.

Objective:

To examine the effect of a 2-wk anterior-to-posterior joint-mobilization intervention on instrumented measures of single-limb-stance static postural control and ankle arthrokinematics in adults with CAI.

Design:

Repeated measures.

Setting:

Research laboratory.

Participants:

12 individuals with CAI (6 male, 6 female; age 27.4 ± 4.3 y, height 175.4 ± 9.78 cm, mass 78.4 ± 11.0 kg).

Intervention:

Subjects received 6 treatments sessions of talocrural grade II joint traction and grade III anterior-to-posterior joint mobilization over 2 wk.

Main Outcome Measures:

Instrumented measures of single-limb-stance static postural control (eyes open and closed) and anterior and posterior talar displacement and stiffness were assessed 1 wk before the intervention (baseline), before the first treatment (preintervention), 24–48 h after the final treatment (postintervention), and 1 wk later (1-wk follow-up). Postural control was analyzed as center-of-pressure velocity, center-of-pressure range, the mean of time-to-boundary minima, and standard deviation of time-to-boundary minima in the anteroposterior and mediolateral directions for each visual condition.

Results:

No significant differences were identified in any measures of postural control (P > .08) or ankle arthrokinematics (P > .21).

Conclusions:

The 2-wk talocrural joint-mobilization intervention did not alter instrumented measures of single-limb-stance postural control or ankle arthrokinematics. Despite the absence of change in these measures, this study continues to clarify the role of talocrural joint mobilization as a rehabilitation strategy for patients with CAI.

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Bridget M. Walsh, Katherine A. Bain, Phillip A. Gribble, and Matthew C. Hoch

. Three RCTs met the inclusion criteria (Table  1 ). Characteristics of each study are shown in Table  2 . • One study 9 involved 2 groups: a balance training group and a balance training plus combination of calf-stretching, ankle joint traction, anterior/posterior ankle joint mobilizations, and plantar

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Kyle B. Kosik and Phillip A. Gribble

-bearing mobilization with movement. Participants received a total of 3 treatment sessions separated by 24 hours. Each treatment session consisted of 2 sets of 4 repetitions, separated by 1 minute of rest. The intervention consisted of a Maitland Grant III talocrurual joint traction and taclocrural joint mobilization

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Erik A. Wikstrom, Sajad Bagherian, Gary Allen, and Kyeongtak Song

Descriptions: Weight bearing mobilization with movement. Descriptions: Maitland Grade II talocrural joint traction and Grade III of talocrural joint mobilization in each session. Descriptions: Weight bearing mobilization with movement. Duration: 3 weeks Duration: 2 weeks Duration: 1 weeks Sessions per week: 2

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Adam B. Rosen, Abbis Jaffri, Andrew Mitchell, Rachel M. Koldenhoven, Cameron J. Powden, John J. Fraser, Janet E. Simon, Matthew Hoch, and Christopher J. Burcal

EA , Hoch MC . The effect of 2 forms of talocrural joint traction on dorsiflexion range of motion and postural control in those with chronic ankle instability . J Sport Rehabil . 2017 ; 26 ( 3 ): 239 – 244 . PubMed ID: 27632835 doi:10.1123/jsr.2015-0152 10.1123/jsr.2015-0152 29. Rosen A , Ko