Effects of Talocrural Joint Mobilizations in the Treatment of Subacute Lateral Ankle Sprains

• Change in self-reported function [ Time Frame: Baseline and four weeks ] [ Designated as safety issue: No ]
  We hypothesize that the group that receives joint mobilization in addition to standard therapy will show greater improvements in Functional Ankle and Ability Measure (FAAM) and FAAM-Sport (FAAM-S) scores than those who receive standard therapy alone.
• Change in self-reported pain [ Time Frame: Baseline and 4 weeks ] [ Designated as safety issue: No ]
  We hypothesize visual analog scale (VAS) scores for pain will have a greater improvement in those who received joint mobilization in addition to standard therapy when compared to standard therapy alone.

• Change in ankle dorsiflexion range of motion [ Time Frame: Baseline and 4 weeks ] [ Designated as safety issue: No ]
  We hypothesize that mobilization when applied to the talocrural joint in addition to standard therapy will result in a greater increase of ankle dorsiflexion ROM than just standard therapy alone.
• Change in ligamentous laxity [ Time Frame: Baseline and 4 weeks ] [ Designated as safety issue: No ]
  We hypothesize that ligamentous laxity in both groups will be reduced.

The goal is to determine if standard therapy including joint mobilizations of the ankle performed 3 times per week for 2 weeks will increase self-reported function and decrease pain in patients with mild lateral ankle sprains.

The purpose of this protocol is to assess the effects of grade IV anterior to posterior joint mobilization on self-reported function, dorsiflexion range of motion and talar glide on subjects suffering from lateral ankle sprain in the past 2-10 days and exhibit 5 degree dorsiflexion deficit in range of motion or a restriction in posterior glide of the talus.

• Other: Mobilization therapy in addition to standard therapy
  Subject will receive three 60-second bouts of posterior joint mobilizations applied to the ankle joint during each treatment session. Standard therapy will consist of ankle strengthening exercises with elastic bands, balance, active ROM, and 20 minutes of ice bag application, elevation and compression.
• Other: Sham intervention
  Physical therapist will lay hands as if to perform the joint mobilization but no movement will occur.

• Sham Comparator: "Laying of hands" plus standard therapy
  Subjects will lie on their back as if they were receiving the joint mobilization treatment and the therapist will place their hands in a position as if to perform the mobilization but no movement will occur. Standard therapy will consist of ankle strengthening exercises with elastic bands, balance, active ROM, and 20 minutes of ice bag application, elevation and compression
  Intervention: Other: Sham intervention
• Experimental: Standard therapy with joint mobilization
  This group will receive three 60-second bouts of posterior joint mobilizations applied to the ankle joint during each treatment session, in addition to standard therapy. Standard therapy will consist of ankle strengthening exercises with elastic bands, balance, active ROM, and 20 minutes of ice bag application, elevation and compression
  Intervention: Other: Mobilization therapy in addition to standard therapy

Inclusion Criteria:

• Incomplete tear of lateral ligaments with mild laxity as measured by anterior drawer test and talar tilt
• Slight reduction in function
• Anterolateral ankle tenderness
• Dorsiflexion ROM asymmetry greater than 5° compared to uninvolved limb
• Posterior talar glide restriction greater than 5° compared to uninvolved limb; or
• Posterior talar glide less than 19°, which is one standard deviation (7°) from our previously established normative values (26°)9, 10
• Suffered from grade 1 or 2 lateral ankle sprain within the last 48hr - 8 days

Exclusion Criteria:

• A history of ankle surgery that involves intra-articular fixation,
• Syndesmotic ankle sprain (to be ruled out based on clinical examination),
• History or signs of reflex sympathetic dystrophy,
• Have received manual therapy for the ankle sprain prior to enrollment
• Grade III ankle sprain.