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Introduction
Lateral ankle sprains are common in active people and the ankle is one of the most commonly injured joints in sports. 1 2 A recent systematic review demonstrated that the ankle was the most common site of injury in 24 of 70 sports examined, accounting for 10-30% of all sport injuries. 2 In addition, 19% of sports injuries presenting to emergency rooms were ankle injuries. 3 Ankle sprains result in a substantial number of missed work days 4 and participation in sports activity. 5
The majority of these sprains are a result of forced ankle inversion and plantarflexion. Lateral ankle sprains are also referred to as inversion ankle sprains or occasionally as supination ankle sprains. The severity of ankle sprains can vary widely. Ankle injuries are common with athletic activities that require jumping, running and/or explosive lateral cutting. 2 6
An acute ankle sprain results in injury to the lateral ligaments, 7 pain, swelling and limitation of movement. 7 Subsequent short-term and long-term losses of joint range of motion (ROM), specifically dorsiflexion, and muscle strength lead to functional and sport-specific limitations. A concern for healthcare providers is the potential progression of acute ankle sprains to chronic problems, including arthritic changes in the talocrural joint. 8 Symptoms have been shown to persist for 6 weeks to 18 months after a lateral ankle sprain in 55-72% of patients. 9-11
Dorsiflexion limitations exist in the acute and subacute stages. 12 Denegar et al 13 found restricted posterior talar glide in athletes 12 weeks after acute ankle sprain. This loss of mobility of the talus can lead to inadequate ROM resulting in altered biomechanics and dysfunction during gait. 14 Biomechanically limited ankle dorsiflexion places the talus in a more anterior position during weight-bearing, increasing the load on the anterior talofibular ligament, leaving the patient susceptible to repetitive ankle sprains. 15 Chronic ankle instability may be caused by mechanical instability, functional instability or a combination of both. 16
Previous studies have demonstrated that manual therapy techniques are beneficial in restoring or improving dorsiflexion, 9 13 17 posterior talar glide, 13 17 stride speed and step length 9 and force distribution of the foot. 18 Whitman et al 19 documented favourable clinical outcomes in approximately 75% of patients postacute...