Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain

Clinicians apply therapeutic interventions including stretching, manual therapy, electrotherapy, ultrasound, and exercises, to improve ankle dorsiflexion. However, authors of past studies haven’t determined which intervention or combination of interventions is most effective. With this in mind the authors conducted this review in order to determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. They performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental relaxation interventions. They extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. Data Synthesis :  In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39).

The review found that static-stretching intervention when added to standardized care yielded the strongest effects on dorsiflexion following acute ankle sprains. The authors noted that existing evidence indicates that clinicians should consider what may be the limiting factor of ankle dorsiflexion to choose the most appropriate treatments and interventions. They added in closing that investigators need to explore the relationship between improvements in dorsiflexion and patient progress using measures of patient self-reported functional outcome after therapeutic interventions to determine the most appropriate forms of therapeutic interventions to address ankle-dorsiflexion limitation.