Short-Term Effect of Manual Therapy & Taping on Subacute Ankle Sprains with Potential Syndesmotic Sprain: A Case Series

ABSTRACT

Study Design

Case Series

Background

Syndesmotic ankle sprains can occur in up to 17% of ankle trauma and can lead to long-term disability. This study describes the management of seven patients with subacute, high-grade ankle sprains with concerns of concurrent syndesmotic strain utilizing manual therapy and rigid sports taping.

Methods

Seven active duty military members with clinically diagnosed, high-grade ankle sprains and concern for syndesmotic sprain participated in this case series. All patients received multi-modal treatment consisting of manual therapy, rigid sports taping, progressive exercises, and proprioceptive training. Decrease in Numeric Pain Rating Scale (NPRS) following manual therapy and taping treatment, number of sessions before discharge, and the Global Rating of Change (GROC) at discharge were retrospectively reviewed.

Results

All patients demonstrated an immediate decrease in NPRS following treatment on average of 5 points (range, 3–8 points) with a functional asterisk sign. The improvement in pain and function was maintained until the next treatment session with a mean GROC score of +3. The mean time until recovery was 5.4 weeks (range, 1–8 weeks).

Discussion

A multimodal approach for patients diagnosed clinically with high-grade ankle sprains and concern for syndesmotic sprain was useful to immediately reduce pain and improve function, and improvements were maintained throughout the duration of care. This study is the first to assess a combination of manual therapy and rigid sports taping for the treatment of suspected syndesmotic ankle sprains, and more stringent research is needed to validate the findings.

Level of Evidence

Therapy, 4

KEYWORDS:

• Mobilization with movement
• rigid sport taping
• high ankle sprain

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Notes on contributors

Joshua D Shumway

Major Shumway currently serves as the Flight Commander for Physical Therapy and Chiropractic Clinics at Langley Air Force Base, VA. After graduating University of Wyoming’s ROTC program in 2009, he attended the Army Baylor DPT Program and has served in the Air Force for 12 years. In 2015, Josh deployed to Al Dhafra Air Base, UAE where he served as Officer in Charge of Physical Therapy. The next year, he was one of the first to attend the new Tactical Sports and Orthopedic Manual Physical Therapy Fellowship. He is dual board certified in Orthopedic and Sports Physical Therapy, is an item writer for the Orthopedic Board exam, and is currently completing his Doctor of Science studies through Bellin College. His lanes of research include outcome measure correlation & predictability, manual therapy, syndesmotic ankle sprains, rhabdomyolysis, bone stress injuries, and injury prevention – the last of which he has presented on twice at the national level. Prior to his time at Langley AFB, Major Shumway was the Chief of Human Performance for the Special Warfare Training Wing.

Derek Vraa

Dr. Vraa is a co-founder of the USAF Tactical Sports and Orthopaedic Manual Physical Therapy Fellowship Program where he serves as Senior Faculty, mentoring fellows and teaching didactic coursework. Prior to moving to Colorado, he spent over a decade treating complex pain patients in private practice. He has lectured and taught at a number of physical therapy schools in the upper Midwest including creating the orthopedic content for a candidacy DPT program. Derek is a board certified orthopedic clinical specialist, a certified strength and conditioning specialist, certified in dry-needling and completed his Fellowship training in Orthopaedic Manual Physical Therapy through Regis University in Denver, CO. He has spoken at CSM, AAOMT, the United States Air Force Advanced Training Course, the United States Air Force’s Embedded PT Symposium, has 6 published abstracts, and authored a chapter in the Travell, Simons & Simons Myofascial Pain and Dysfunction 3rd edition textbook. Additionally, Derek serves as the AAOMPT Academic and Clinical Faculty Special Interest Group Vice-President and as an IFOMPT External Auditor for AAOMPT/ACOMPTE.