An investigation of neurological and/or biomechanical factors underpinning the effect of a thrust manipulation on chronic ankle symptoms: an observational study

ABSTRACT

Background

Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur.

Objective

The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred.

Methods

Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle.

Results

There were no significant differences in ankle dorsiflexion (DF) (p = 0.62), plantarflexion (PF) (p = 0.23), ground reaction force (GRF), or velocity (p = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (p = 0.046). There were no significant differences in dynamic pain measurements.

Conclusions

Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms.

KEYWORDS:

• Ankle
• persistent pain
• neurophysiological mechanism

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Emily J. Slaven

Dr. Emily J. Slaven is a Professor in the Krannert School of Physical Therapy at the University of Indianapolis (UIndy). She is a board certified Orthopaedic physical therapist and is a fellow in the American Academy of Orthopaedic Manual Physical Therapists. She is an active member within the American Physical Therapy Association (APTA) APTA Indiana Chapter and the Scientific and Practice Affairs Committee of the APTA. Dr. Slaven is the Academic Residency Director for the UIndy/BodyOne Orthopaedic Clinical Residency and maintains an active clinical practice at Franciscan Health.

Nick Alarcio

Dr. Nick Alarcio graduated from the Doctor of Physical Therapy program at the University of Indianapolis in 2021. He is a member of the American Physical Therapy Association. He currently works at Gesik Physical Therapy, an outpatient orthopedic and sports physical therapy clinic based in Honolulu, HI.

Chandler Fields

Dr. Chandler Fields graduated from the Krannert School of Physical Therapy at the University of Indianapolis in 2021. He currently works for Results Physiotherapy, Raleigh, NC as a staff therapist. Dr. Fields has published in the Journal of Strength and Conditioning Research. He is currently working towards his Certified Orthopedic Manual Therapist board certification as well as becoming a Certified Strength and Conditioning Specialist. His research interests include wearable technology and blood flow restriction.

Mallory Hayes

Dr. Mallory Hayes is a graduate from the University of Indianapolis’ Doctor of Physical Therapy Program in 2021. She currently works in orthopaedics treating a variety of orthopedic injuries and conditions. She is currently working towards her dry needling certification. She has been working for Beacon Orthopaedics and Sports Medicine in Cincinnati, Ohio since graduating.

Emily Weiss

Dr. Emily Weiss graduated from the University of Indianapolis’ Doctor of Physical Therapy Program in 2021 and currently practices in the outpatient orthopedic setting in Indianapolis, Indiana. She is certified in Blood Flow Restriction Training and Office Ergonomics Evaluation, and she is in the process of becoming certified in Neurosomatic Therapy and the Schroth Method. Her research interests include spinal injury and rehabilitation, psychosomatic therapy, and pain science.

Nathanial R. Eckert

Dr. Nathanial R. Eckert is an Associate Professor and Practicum Director for the Master’s in Exercise Science Program at the University of Indianapolis within the Exercise Science department. He is an active member in both the American College of Sports Medicine national and regional chapters as well as a member of the US Association for the Study of Pain and Society for Neuroscience. His research interests include the neurological processes behind the pain experience and the influence of exercise on pain perception.