Immediate Effects of Anterior-to-Posterior Talocrural Joint Mobilization after Prolonged Ankle Immobilization: A Preliminary Study

Abstract

Ankle dorsiflexion range of motion (ROM) typically decreases after prolonged immobilization. Anterior-to-posterior talocrural joint mobilizations are purported to increase dorsiflexion ROM and decrease joint stiffness after immobilization. The purpose of this study was to determine if a single bout of Grade III anterior-to-posterior talocrural joint mobilizations immediately affected measures of dorsiflexion ROM, posterior ankle joint stiffness, and posterior talar translation in ankles of patients who had been immobilized at least 14 days. Ten physically active patients (5 males, 5 females; age=21.4+/-3.3 years) participated. Each had the ankle immobilized following a lower extremity injury for at least 14 days and presented with at least a 5 degrees dorsiflexion ROM deficit compared to the contralateral ankle. A crossover design was employed so that half of the subjects received joint mobilizations first and half of the subjects received the control intervention (no treatment) first. All subjects ultimately received both treatments. Active dorsiflexion ROM was assessed with a bubble inclinometer, and posterior ankle stiffness and talar translation were assessed with an instrumented ankle arthrometer. After a single application of grade III anterior-to-posterior talocrural joint mobilization, dorsiflexion ROM and posterior ankle joint stiffness were significantly increased. There was also a trend toward less posterior talar translation immediately after mobilization. The trend toward decreased posterior talar translation and increased posterior ankle joint stiffness supports the positional fault theory. Correction of an anterior talar positional fault offers a possible explanation for these results.

Keywords: Dorsiflexion; Grade III Mobilization; Positional Fault; Tibiotalar Joint.

Figures

Figure 1A

(top) Positioning of subject's limb for arthrometer testing.

Figure 1B

(bottom) Examiner positioning for arthrometer testing. The arrow represents the posteriorly directed force applied through the arthrometer.

Figure 2

Dorsiflexion range of motion (ROM) means (± SE) for both groups at each testing interval. There was not a significant time by group interaction (p=.49), but there was a significant time main effect (p=.03) indicating that regardless of group membership, there was improved ROM at each testing interval.

Figure 3

Estimates of posterior talocrural joint stiffness means (± SE) for both groups at each testing interval. Stiffness was estimated as the slope of the force-displacement curve from the arthrometer testing. There was not a significant time by group interaction (p=.19), but there was a significant time main effect (p=.04). Regardless of group membership, there was increased stiffness at the last testing interval compared to baseline.

Figure 4

Posterior talar translation means (± SE) for both groups at each testing interval. There was not a significant time by group interaction (p=.25) or time main effect (p=.08).