Lateral ankle sprains have been found to be associated with altered arthrokinematics and restrictions in the talocrural and distal tibiofibular joints. Individuals with a history of ankle sprain have also demonstrated decreased muscle activity, altered latency of the ankle, knee, and hip musculature during functional tasks and altered proximal function during balance tasks.
Arthrogenic muscle inhibition (AMI) is defined as ongoing reflex inhibition of musculature around a joint after distension or damage to the structure of that joint, leading to altered afferent signals and decreased motoneuron pool excitability. Delayed firing and decreased firing ratios in ankle musculature after lateral ankle sprain are suggestive of AMI. Further, diminished firing of the hip extensors and ipsilateral weakness of the hip abductors has been found after ankle sprains. Overall, this suggests that damage to the lateral ankle ligaments causes neuromuscular alterations that are not limited to the ankle joint, often affecting proximal structures.
Most studies published to date have employed proximal manipulation to affect distal function (ex. pelvic SMT for quadriceps activation). This study took an opposite approach, looking at the effect of distal (ankle) HVLA manipulations on proximal (hip) function. To do this, they recruited patients with a history of ankle sprain and demonstrable hip muscle weakness on the affected side. They then applied a combination of HVLA manipulations of the talocrural, subtalar, proximal tibiofibular, and distal tibiofibular joints, testing hip muscle function before, immediately after and two days later - a cool study with interesting results!
THIS WEEK'S RESEARCH REVIEW: “Effects of Tibiofibular & Ankle Manipulation on Hip Strength & Muscle Activation after Ankle Sprain”
This paper was published in JMPT (2020) and this Review is posted in Recent Reviews, Ankle - Foot, Hip and the 2021 Archive.
Ankle manipulation