Effect Of Joint Mobilization Combined With Routine Exercise Therapy On Chronic Ankle Instability In Young People

Research background and purpose:Chronic ankle instability,CAI)is one of the most common musculoskeletal injuries in sports,which is characterized by peripheral ligament damage,decreased ankle dorsiflexion,abnormal proprioception and decreased nerve excitability,and it is also an important public health problem among sports people.As a new rehabilitation therapy,joint loosening has been widely concerned.Within the range of joint movement,therapists and apprentices can loosen joints by hand or with the help of loosening bands,adjust the position of internal joints,loosen soft tissues around joints,improve joint mobility,relieve pain,adjust motion control and improve the function of daily life.However,in the treatment of CAI patients,is it more effective to increase joint mobilization treatment than simple routine rehabilitation training? There is widespread controversy.Based on this,this study intends to explore the influence of joint looseness on CAI patients by using meta-analysis,and compare the differences of balance stability and ankle biomechanics between CAI patients and healthy people by using techniques such as muscle strength test,joint mobility test,balance stability test and exercise biomechanics test.To observe the effects of joint mobilization therapy+routine rehabilitation training,sham manipulation intervention+routine rehabilitation training and+routine rehabilitation training intervention on the improvement of muscle strength,joint mobility,balance stability and biomechanical function of foot and ankle in CAI patients,and to reveal the curative effect of joint mobilization therapy on CAI patients.This study will reveal the effect of joint mobilization therapy on CAI patients and its related mechanism,and provide new ideas and new technical platforms for developing effective CAI treatment methods.This research is divided into three parts:Part I: Effect of Joint mobilization treatment for chronic ankle instability function recovery:A meta-analysisMETHODS: Search electronic databases such as CNKI,Pub Med,EBSCO,Web of Science,and Cochrane Library,Collect randomized and controlled trials on joint mobilization intervention for chronic ankle instability(CAI).The keywords were“mobilization with movement,Joint Mobilization,Maitland,Mulligan’s,chronic ankle instability,CAI,ankle instability” in Chinese and English.The search time is from the establishment of the database to June 2021.According to the "Bias Risk Assessment" tool in the "Cochrane Intervention System Evaluation Manual",the risk assessment of the selected literature was carried out,and the Rev Man5.3 software was used for meta-analysis.RESULTS: Nine randomized controlled trials involving 336 subjects were finally included.Joint mobilization can effectively improve the CAIT score of CAI patients(MD=5.79,95%CI(4.95,6.62),P<0.00001).After a single joint mobilization intervention,there was no significant improvement in the ankle DFROM measured in WBLT(MD=0.93,95%CI(-0.53,2.38),P=0.21)or NWBI(MD=1.53,95%CI(-1.69,4.76),P=0.35),after 6 joint mobilization interventions,the ankle DFROM measured by WBLT has been significantly improved(MD=4.45,95%CI(0.41,8.49),P=0.03).Joint mobilization surgery has a better improvement in balance(SEBT test)intervention(MD=6.17,95%CI(3.12,9.23),P<0.00001),especially for the forward and backward inward improvement is the most obvious(P<0.05).But joint mobilization surgery failed to effectively improve the pain of CAI(MD=-0.74,95%CI(-2.01,0.53),P=0.25).A subgroup analysis based on different intervention methods found that dynamic joint mobilization(MWM)is better than joint mobilization(JM)in improving ankle dorsiflexion range of motion(WBLT).CONCLUSION: Joint mobilization can effectively improve the range of motion and balance of the ankle joint,but the effect of improving pain is not obvious,and further research should be done.Mobilization with movement(MWM)improves ankle dorsiflexion range of motion(WBLT test)better than joint mobilization(JM).Part II: Biomechanical characteristics of chronic ankle instability and quantitative analysis of its balanceMethods: A total of 48 CAI subjects and 30 healthy subjects were enrolled in the experiment.The healthy subjects tested their feet with the right foot,and finally 30 CAI subjects with unstable right ankle were included for comparison.The simple star excess balance test(SEBT),the 8-lens three-dimensional dynamic capture system infrared point high-speed motion capture test system(Qualisys)and Kistler three-dimensional force platform were used in the two groups to test the balance stability and the spatiotemporal parameters of gait as well as the kinematics and dynamics indexes.Time standardization of kinematics and dynamics data was carried out using Matlab.software.Statistical software SPSS was used for processing.The data were expressed as "mean standard deviation"((3? ± SD).Independent sample t test was used for statistical analysis.P< 0.05 indicated that the difference was significant.Results There were significant differences in the overall score of SEBT and the balance stability in three directions(SEBTA,SEBTPL and SEBTPM)between the two groups(P < 0.05).There were significant differences in pace,step size and stride length between the two groups(P < 0.05).There were significant differences in the angle at the time of sagittal plane touchdown,the angle at the time of touchdown from the ground,the angle at the time of frontal plane touchdown,and the maximum varus angle between the two groups(P < 0.05).The first peak,the second peak,and the trough of the vertical ground reaction force between the two groups had significant differences(P < 0.05).Conclusion: 1)The balance stability of patients with 1)CAI is significantly worse than that of healthy subjects,especially in the direction of SEBTA.2)Seen from the spatio-temporal parameters of gait,the pace,step size and stride length of patients with CAI were lower than those of healthy subjects.3)Comparison of the kinematic parameter characteristics of the ankle joint reveals that the angles at the time of sagittal contact with the ground,the maximum dorsiflexion angle,the angle at the time of lifting off the ground,the angle at the time of frontal contact with the ground,and the maximum varus angle of the patients with CAI are different from those in the healthy subjects.4)There is no significant difference in peak moment of ankle between 4)CAI patients and healthy subjects,but there is a significant difference in vertical reaction force,which may be an important factor leading to the secondary injury.Part Ⅲ:Intervention effect of joint mobilization combined with routine exercise therapy on functional and biomechanical characteristics of CAI subjectsMethods: A total of 48 CAI subjects were recruited and randomly divided into three groups: EG(joint mobilization+routine exercise therapy);CG(routine exercise therapy);SG(pseudarthrosis+routine exercise therapy),3 times a week for 4 weeks,a total of 12 interventions.Participants completed the Star Shift Balance Test(SEBT),ankle dorsiflexion range of motion(WB-DFROM),painless active ankle range of motion,muscle strength,Cumberland Ankle Instability Scale(CAIT),self-conscious comfort(SCS-VAS),self-conscious stability(SISS-VAS)test,walking time and space parameters(pace,stride width,stride length,gait duration,gait duration,gait duration,gait duration,gait duration,gait duration,gait duration,gait duration,gait duration,All experimental data were collected and counted by Excel 2019.Kinematics and dynamics data were time standardized by Matlab.Software,and processed by SPSS.ShapiroWilk test was used to evaluate the normality of data and chi-square test of classified variables.The data were expressed as "mean standard deviation"(X ?±SD).Paired sample T test was used in the statistical method group,and One-way analysis of variance(ANOVA)was used after intervention to evaluate whether the ankle joint muscle strength,joint range of motion,lower limb balance ability and ankle biomechanics were statistically significant.When Bonferroni was used for back testing,it was significant,with a confidence interval of < 0.05.Results: A total of 45 subjects(36 subjects with 12 subjects in each group)completed the study finally.There were 16 subjects in the experimental group,15 subjects in the control group and 14 subjects in the sham stimulation group.WBDFROM(P=0.005,F=6.158),SEBT-A(P<0.001,F=18.831),SEBTPM(P=0.001,F=8.071),SEBT-PL(P=0.003,F=6.868),SEBT-C(P=0.001,F=8.377),dorsiflexion range of motion(P=0.011,F=5.069),plantar flexion range of motion(P=0.047,F=3.323),varus range of motion(P=0.028,F=3.964),valgus range of motion(P=0.015,F=4.736),varus muscle strength(P=0.002,F=7.496),and the differences were statistically significant among the three groups.Ankle biomechanical test: There were significant differences among three groups of EG,CG and SG in pace(P=0.039,F=3.585),maximum dorsiflexion angle(P =0.011,F=5.151),peak varus moment(P=0.041,F=3.719),peak valgus moment(P =0.006,F=6.544),and trough value of vertical ground reaction force(P=0.040,F= 3.567).After four weeks of intervention,the improvement of EG was significantly better than that of the other two groups.Conclusion: The purpose of this study is to explore whether joint loosening has a positive effect on improving the balance ability,ankle range of motion,muscle strength,walking time-space parameters,ankle kinematics and dynamics of patients with CAI.It has been found that after three different interventions,each index was improved.However,after the joint loosening was added to the routine rehabilitation training,it positively promoted the balance ability and ankle range of motion of patients with chronic ankle instability,but did not significantly improve muscle strength.After joint loosening,compared with the other two groups,gait cycle,kinematics and dynamics were improved and enhanced,especially in the maximum toe flexion angle,the maximum dorsiflexion angle,the peak varus moment and the peak valgus moment.However,due to the small sample size,there were no significant differences between the other indicators.Joint loosening means that the position of the internodes of Neiguan can be adjusted,the soft tissues around the joint can be released,and the mechanical receptors around the joint can be stimulated to improve the joint range of motion,relieve pain and enhance proprioception.Future experimental design needs to include mid-term and long-term follow-up investigations for evaluation,and the number of subjects should be increased to conduct more effective tests to clarify the role of manual therapy in CAI.