Author Names
Weerasekara,I., Deam,H., Bamborough, N., Brown,S., Donnelly, J., Thorp, N., Rivett, D.
Reviewer Name
Alexander Caspary-Isar, SPT
Reviewer Affiliation(s)
Duke University Doctor of Physical Therapy Division
Paper Abstract
Purpose: To investigate the evidence for the effectiveness of MWM’s in isolation for ankle sprains.
Materials and methods: Medline, Embase, CINHAL and SPORTDiscuss were searched. Any RCT or cross-over trial assessing adolescents to adults with grade I/II lateral ankle sprains, and treated with any MWM technique was included. Any conservative intervention was chosen as the comparator, and any clinical outcome was eligible as the outcome. Methodological quality was determined using the Cochrane Handbook risk of bias assessment tool.
Results: Eighty-two full-texts were included after screening 1707 of title and abstracts. Six full-texts were included and data were extracted based on the outcomes of range of movement, balance or pain from patients with sub-acute to chronic sprains. Pooled data from four studies with 201 participants with chronic recurrent sprains were grouped for analysis of the effects of weight-bearing MWM on dorsiflexion range and has shown significant immediate improvements after treatment (MD = 0.91, CI = 0.06-1.76, p = 0.04). There was insufficient data to permit analysis for evaluation of immediate or short-term benefits of MWM on other assessed outcomes.
Conclusion: Weight-bearing MWM appears to be beneficial for improving weight-bearing dorsiflexion immediately after application for chronic recurrent ankle sprains compared to no treatment or sham. Long-term benefits have not been adequately investigated.
Keywords: Ankle sprains; Mulligan taping; Mulligan’s mobilisation with movement; Systematic review.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Cannot Determine, Not Reported, Not Applicable
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Yes
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Yes
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Yes
Key Finding #1
Mobilizations with movement known as Mulligan’s technique do not have any clinical benefits on acute ankle sprains, due to the pain the patient is experiencing. This technique should be explored only with chronic lateral ankle sprain patients.
Key Finding #2
There was an immediate positive effect of utilizing weight bearing mobilizations with movement for improving dorsiflexion range of motion for patients presenting with chronic ankle sprains.
Key Finding #3
There was an improvement in dynamic balance over time, due to mulligan’s technique being performed at the talocrural joint. A combination of patient confidence and perceived stability contributed to the improvements exhibited by the patients.
Key Finding #4
Talar stiffness has shown to improve over time when mobilizations with movement are performed at the subtalar and talocrural joint. They especially helped grade I and II lateral ankle sprains.
Please provide your summary of the paper
This systematic review and meta analysis study sought out to evaluate the effectiveness of Mulligan’s mobilization with movement (MWM) technique in isolation from the other techniques on patients presenting with lateral ankle sprains focusing on balance, talar stiffness and dorsiflexion range of motion. The data were analyzed utilizing the validated measures emphasized in the methods section. They found that this technique in isolation was effective in improving various outcomes in patients presenting with chronic lateral ankle sprains. They found that the technique was effective in immediate benefits for the patient such as an improvement in dorsiflexion range of motion assessed by having the patient perform a weight bearing lunge test. The study also found acute benefits with dynamic balance when applying mulligan’s technique to the talocrural joint, however, no improvements were shown with static balance.This supports that mulligans technique performed at the talocrural joint have an immediate impact on ankle dorsiflexion ROM that can help with patients demonstrating chronic lateral ankle sprains.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The results of this systematic review support the benefit of manual therapy in improving impairments in the body structure and function such as limitations in ankle dorsiflexion after developing a chronic lateral ankle sprain. It also shows the benefits it has on function such as helping with any reduced dorsiflexion ROM required in gait and improving dynamic balance over time. This study may impact clinical practice by implementing this technique at the talocrural and subtalar joints for patients presenting with the decreased range of motion as well as being applicable to patients that have had lateral ankle sprain for more than six months. It helps provide the patient with an objective measure of their progress by being able to notice acute improvements that will help with their confidence and trust in physical therapy. Further research should be done to assess the long term effects of mobilizations with movement beyond the time span they used of three days to three months being defined as acute.
