- Title
- Characteristics of chronic ankle instability and the role of joint mobilisation
- Creator
- Rajapaksha Mudiyanselage Weerasekara, Ishanka Madhurangani
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Chronic ankle instability (CAI) is the occurrence of giving way and/or recurrent sprain and/or feelings of instability of a previously injured ankle. Compared to a simple ankle sprain, the additional morbidity and additional costs incurred due to diagnostic imaging related to CAI create significant economic and other societal consequences. Direct costs can include consultations with physicians, physiotherapists and other health professionals, diagnostic imaging and various hospital expenses, while indirect costs may arise from productivity losses, absenteeism (from school, work and sports) and diminished levels of physical activity resulting in economic burden on the healthcare system and for the individual patient. Rehabilitation of CAI commonly involves manual therapy procedures applied to joints in the ankle region, such as non-thrust passive joint mobilisation, high-velocity thrust manipulation and mobilisation with movement (MWM) as described by Brian Mulligan. These techniques largely involve a continuum of skilled passive movements of joints that are applied at different speeds and amplitudes. The overall aims of this thesis were to explore the clinical characteristics of CAI and to determine the effects of joint mobilisation in CAI. This thesis comprises four studies designed to meet these aims, presented as five manuscripts which have either been published in peer-reviewed journals or are in the process of review or submission. Study 1 is a systematic review and meta-analysis undertaken to evaluate the current evidence for joint mobilisation in the clinical rehabilitation of ankle sprains, using the previously published body of literature. Based upon this investigation, joint mobilisation appears to be beneficial for improving dynamic balance immediately after application and dorsiflexion range of movement in the short-term in chronic ankle sprains. The results of this study also suggested that the combination of MWM and associated fibular repositioning taping is more likely to exhibit a clinical benefit than other assessed mobilisation techniques, and potentially supporting the hypothesis of Brian Mulligan that the distal fibula is displaced anteriorly in CAI. Study 2 explored the position of the distal fibula in relation to the position of the distal tibia in CAI using weight-bearing radiographs. The findings of this study indicated that there is a more anteriorly positioned fibula in individuals with CAI compared to individuals with healthy ankles when assessed in a weight-bearing position, consistent with Mulligan’s hypothesis. Notably, this study was the first to use weight-bearing radiographs to measure the fibula position in CAI. Study 3 investigated other clinical characteristics of CAI including ankle dorsiflexion range of motion, balance, self-reported function, pain and pressure pain threshold which have not been consistently reported, or for which little research has been published in the previous literature. It was found that individuals with CAI exhibit a multi-factorial presentation including impaired ankle dorsiflexion range, reduced static and dynamic balance, lower self-reported function and greater pain intensity, compared to individuals with healthy ankles. Despite the persistence of pain often reported in CAI, no evidence was found to suggest maladaptive central nervous system sensitisation (nociplastic pain). Study 4 involved a randomised controlled trial (RCT) to investigate the effects of MWM of the distal tibio-fibular joint with fibular repositioning taping on fibular position and other clinical characteristics of CAI. The protocol for this study was published, and in contrast to almost all previously published studies of this manual therapy technique, highlighted the long-term nature of the trial with a one year follow-up. The immediate and short-term findings revealed no significant differences in any of the outcomes measured except for improvements in two self-reported function subscales (pain and sports on the foot and ankle outcome score (FAOS) questionnaire) in the placebo (detuned laser) intervention group. The long-term results were still being collected at the time of the submission of this thesis so are not reported or considered in the discussion. The body of work contained in this thesis extends our current understanding of CAI and its clinical management. The results have implications for the identification of the features of CAI and for improving its treatment using joint mobilisation. Reproduction of the contained research using more homogeneous samples of CAI may permit a greater understanding of this persistent condition and how it responds to manual therapy. In addition, the use of weight-bearing radiographs in future studies to assess fibula position may be a more functional method. Other future directions for research and implications for clinical practice are discussed in detail in relation to the results of each of the studies in this thesis.
- Subject
- recurrent sprain; chronic ankle instability; ankle injuries; ankle; manual therapy; joint mobilisation; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1411275
- Identifier
- uon:36321
- Rights
- Copyright 2020 Ishanka Madhurangani Rajapaksha Mudiyanselage Weerasekara
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 15 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 370 KB | Adobe Acrobat PDF | View Details Download |