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Journal of Chiropractic Medicine logoLink to Journal of Chiropractic Medicine
. 2004;3(4):153–159. doi: 10.1016/S0899-3467(07)60103-7

The Impact of Chiropractic Manipulative Therapy on Chronic Recurrent Lateral Ankle Sprain Syndrome in Two Young Athletes

Scott F Gillman a,*
PMCID: PMC2647025  PMID: 19674638

Abstract

Objective

To describe two cases of abrupt resolution of chronic, recurrent, inversion sprain to ankles in young recreational athletes.

Clinical Features

A 13-year-old, female, avid recreational soccer player with ankles that would spontaneously invert during various inconsistent points in the weight bearing gait cycle, sometimes with acute pain or sprain to the ankle. No intervention was attempted prior to her entry to the chiropractic office. A 17-year-old male avid skate- boarder and snowboarder whose left ankle routinely “gave out” into inversion upon mundane weight bearing activity, usually with pain and with dependence on wearing an ankle support when skateboarding to lessen ankle pain. The patient had used an ankle support prior to seeking chiropractic care.

Intervention and Outcome

High velocity, low amplitude chiropractic manipulative therapy applied to the spine, pelvis and extremity joints was the primary intervention in both cases, with particular focus on the ankle. Other procedures used included taping and orthotics, but not before the manipulation effect was noted.

Conclusion

High velocity, low amplitude chiropractic manipulative therapy to the spine, pelvis, and extremities, particularly at the ankle, should be considered when managing young recreational athletes with functional chronic, recurrent, ankle inversion sprains.

Key Indexing Terms: Ankle Injuries, Sprains and Strains, Joint Instability, Chiropractic Manipulation, Lower Extremity

References

  • 1.Hayes DW, Mandracchia VJ, Webb GE. Nerve injury associated with plantarflexion-inversion ankle sprains. Clin Podiatr Med Surgery. 2000;17:361–369. [PubMed] [Google Scholar]
  • 2.Ebig M, Lephart SM, Burdett RG, Miller MC, Pincivero DM. The effect of sudden inversion stress on EMG activity of the peroneal and tibialis anterior muscles in the chronically unstable ankle. J Orthop Sports PhysTher. 1997;26:73–77. doi: 10.2519/jospt.1997.26.2.73. [DOI] [PubMed] [Google Scholar]
  • 3.Leanderson J, Bergqvist M, Rolf C, Westblad P, Wigelius-Roovers S, Wredmark T. Early influence of ankle sprain on objective measures of ankle joint function. Knee Surg Sports Traumatol Arthrosc. 1999;7:51–58. doi: 10.1007/s001670050120. [DOI] [PubMed] [Google Scholar]
  • 4.Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg. 1998;37:280–285. doi: 10.1016/s1067-2516(98)80063-x. [DOI] [PubMed] [Google Scholar]
  • 5.Thacker SB, Stroup DF, Branche CM, Gilchrist J, Goodman RA, Weitman EA. The prevention of ankle sprains in sports: a systematic review of the literature. Am J Sports Med. 1999;27:753–760. doi: 10.1177/03635465990270061201. [DOI] [PubMed] [Google Scholar]
  • 6.Tochigi Y, Yoshinaga K, Wada Y, Moriya H. Acute inversion injury of the ankle: magnetic resonance imaging and clinical outcomes. Foot Ankle Int. 1998;19:730–734. doi: 10.1177/107110079801901103. [DOI] [PubMed] [Google Scholar]
  • 7.Demeritt KM, Shultz SJ, Docherty CL, Gansneder BM, Perrin DH. Chronic ankle instability does not affect lower extremity functional performance. J Athl Train. 2002;37:507–511. [PMC free article] [PubMed] [Google Scholar]
  • 8.Zimmer TJ. Chronic and recurrent ankle sprains. Clin Sports Med. 1991;10:653–659. [PubMed] [Google Scholar]
  • 9.Renstrom PA. Persistently painful sprained ankle. J Am Acad Orthop Surg. 1994;2:270–280. [PubMed] [Google Scholar]
  • 10.Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19:653–660. doi: 10.1177/107110079801901002. [DOI] [PubMed] [Google Scholar]
  • 11.Konradson L, Bech L, Ehrenbjerg M, Nickelsen T. Seven years followup after ankle inversion trauma. Scand J Med Sci Sports. 2002;12:129–135. doi: 10.1034/j.1600-0838.2002.02104.x. [DOI] [PubMed] [Google Scholar]
  • 12.Busconi B, Pappas A. Chronic, painful ankle instability in skeletally immature athletes. Ununited osteochondral fractures of the distal fibula. Am J Sports Med. 1996;24:647–651. doi: 10.1177/036354659602400514. [DOI] [PubMed] [Google Scholar]
  • 13.Osborne MD, Rizzo TD. Prevention and treatment of ankle sprains in athletes. Sports Med. 2003;33:1145–1150. doi: 10.2165/00007256-200333150-00005. [DOI] [PubMed] [Google Scholar]
  • 14.Cohen RS, Balcom TA. Current treatment options for ankle injuries: lateral ankle sprain, Achilles tendonitis, and Achilles rupture. Curr Sports Med Rep. 2003;2:251–254. doi: 10.1249/00149619-200310000-00004. [DOI] [PubMed] [Google Scholar]
  • 15.Lynch SA. Renstrom. Treatment of acute lateral ankle ligament rupture in the athlete; conservative verses surgical treatment. Sports Med. 1999;27:61–71. doi: 10.2165/00007256-199927010-00005. [DOI] [PubMed] [Google Scholar]
  • 16.Hertel J, Denegar CR, Monroe NM, Stokes WL. Talocrural and subtalar joint instability after lateral ankle sprain. Med Sci Sports Exerc. 1999;31:1501–1508. doi: 10.1097/00005768-199911000-00002. [DOI] [PubMed] [Google Scholar]
  • 17.Holmer P, Sondergaard L, Konradsen L, Nielsen PT, Jorgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;5:72–74. doi: 10.1177/107110079401500204. [DOI] [PubMed] [Google Scholar]
  • 18.Bown KW, Morrison WB, Schweitzer ME, Parellada JA, Nothnagel H. MRI findings associated with distal tibiofibular syndesmosis injury. Am J Roentgenol. 2004;182:131–136. doi: 10.2214/ajr.182.1.1820131. [DOI] [PubMed] [Google Scholar]
  • 19.Safran MR, Benedetti RS, Bartolozzi AR, Mandelbaum BR. Lateral ankle sprains: a comprehensive review: part 1: etilogy, pathoanatomy, histopathogenesis, and diagnosis. Med Sci Sports Exerc. 1999;31:S429–S437. doi: 10.1097/00005768-199907001-00004. [DOI] [PubMed] [Google Scholar]
  • 20.Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000;29:361–371. doi: 10.2165/00007256-200029050-00005. [DOI] [PubMed] [Google Scholar]
  • 21.Denegar CN, Miller SJ. Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. J Athl Train. 2002;37:430–435. [PMC free article] [PubMed] [Google Scholar]
  • 22.Pellow JE, Brantingham J. The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. J Manipulative Physiol Ther. 2001;24:17–24. doi: 10.1067/mmt.2001.112015. [DOI] [PubMed] [Google Scholar]
  • 23.Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32:166–173. doi: 10.2519/jospt.2002.32.4.166. [DOI] [PubMed] [Google Scholar]
  • 24.Leanderson J, Eriksson E, Nilsson C, Wykman A. Proprioception in classical ballet dancers; a prospective study of the influence of an ankle sprain on proprioception in the ankle joint. Am J Sports Med. 1996;24:370–374. doi: 10.1177/036354659602400320. [DOI] [PubMed] [Google Scholar]
  • 25.Baumhauer JF, Alosa DM, Renstrom AF, Trevino S, Beynnon B. A prospective study of ankle injury risk factors. Am J Sports Med. 1995;23:564–570. doi: 10.1177/036354659502300508. [DOI] [PubMed] [Google Scholar]
  • 26.Hearon K. What you should know about extremity adjusting. Olympic Graphic Arts, Inc.; Forks, WA: 1990. [Google Scholar]
  • 27.Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc. 2003;103:417–421. [PubMed] [Google Scholar]
  • 28.Collins N, Teys P, Vicenzino B. The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Man Ther. 2004;9:77–82. doi: 10.1016/S1356-689X(03)00101-2. [DOI] [PubMed] [Google Scholar]
  • 29.Dananberg HJ, Shearstone J, Guillano M. Manipulation method for the treatment of ankle equines. J Am Podiatr Med Assoc. 2001;91:105–106. doi: 10.7547/87507315-90-8-385. [DOI] [PubMed] [Google Scholar]
  • 30.Fryer G, Mudge J, McLaughlin P. The effects of talocrural joint manipulation on range of motion at the ankle. J Manipulative Physiol Ther. 2002;25:384–390. doi: 10.1067/mmt.2002.126129. [DOI] [PubMed] [Google Scholar]
  • 31.Nield S, Davis K, Latimer J, Maher C, Adams R. The effect of manipulation on range of movement at the ankle joint. Scand J Rehabil Med. 1993;25:161–166. [PubMed] [Google Scholar]
  • 32.Charrette, Mark M. Extremity adjusting for chiropractic stabilization and rehabilitation. Dallas: Parker College of Chiropractic.
  • 33.Michaud T. Foot orthosis and other forms of conservative foot care. Williams & Wilkins; Baltimore: 1993. p. 80. [Google Scholar]
  • 34.Viladot A, Lorenzo JC, Salazar J, Rodriguez A. The subtalar joint: embryology and morphology. Foot Ankle. 1984;5:54–66. doi: 10.1177/107110078400500203. [DOI] [PubMed] [Google Scholar]
  • 35.Palmeri RM, Ingersoll CD, Hoffman MA, Cordova ML, Porter DA, Edwards JE. Arthrogenic muscle response to a simulated ankle joint effusion. Br J Sports Med. 2004;38:26–30. doi: 10.1136/bjsm.2002.001677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Feuerback J, Grabiner MD, Koh TJ, Weiker GG. Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception. Am J Sports Med. 1994;22:223–229. doi: 10.1177/036354659402200212. [DOI] [PubMed] [Google Scholar]
  • 37.DeCarlo MS, Talbot RW. Evaluation of ankle joint proprioception following injection of the anterior talofibular ligament. J Orthop Sports Phys Ther. 1986;8:70–76. doi: 10.2519/jospt.1986.8.2.70. [DOI] [PubMed] [Google Scholar]
  • 38.Willems T, Witvrouw E, Verstuyft J, Vaie P, DeClercq D. Proprioception and muscle strength in sunects with a history of ankle sprains and chronic instability. J Athl Train. 2002;37:487–493. [PMC free article] [PubMed] [Google Scholar]
  • 39.Hiller CE, Refshauge KM, Beard DJ. Semsorimotor control is impaired in dancers with functional ankle instability. Am J Sports Med. 2004;32:216–223. doi: 10.1177/0363546503258887. [DOI] [PubMed] [Google Scholar]
  • 40.Refshauge KM, Kilbreath SL, Raymond J. The effect of recurrent ankle inversion sprain and taping on proprioception a the ankle. Med Sci Sports Exerc. 2000;32:10–15. doi: 10.1097/00005768-200001000-00003. [DOI] [PubMed] [Google Scholar]
  • 41.Surve I, Schwellnus MP, Noakes T, Lombard C. A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the sport-stirrup orthosis. Am J Sports Med. 1994;22:601–606. doi: 10.1177/036354659402200506. [DOI] [PubMed] [Google Scholar]
  • 42.Baier M, Hopf T. Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability. Arch Phys Med Rehabil. 1998;79:939–944. doi: 10.1016/s0003-9993(98)90091-0. [DOI] [PubMed] [Google Scholar]
  • 43.Richie DH. Functional instability of the ankle and the role of neuromuscular control: a comprehensive review. J Foot Ankle Surg. 2001;40:240–251. doi: 10.1016/s1067-2516(01)80025-9. [DOI] [PubMed] [Google Scholar]
  • 44.Mohr KJ, Kvitne RS, Pink MM, Fideler B, Perry J. Electromyography of the quadriceps in patellofemoral pain with patellar subluxation. Clin Orthop. Oct, 2003;(415):261–271. doi: 10.1097/01.blo.0000093918.26658.6a. [DOI] [PubMed] [Google Scholar]
  • 45.Suter E, McMorland G, Herzog W, Bray R. #Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee pain. Manipulative Physiol Ther. Mar-Apr, 1999;22(3):149–153. doi: 10.1016/S0161-4754(99)70128-4. [DOI] [PubMed] [Google Scholar]
  • 46.Herzog W, Scheele D, Conway PJ. Electromyographic responses of back and limb muscles associated with spinal manipulative therapy. Spine. 1999;24:146–153. doi: 10.1097/00007632-199901150-00012. [DOI] [PubMed] [Google Scholar]
  • 47.Hurley MV, Jones DW, Newham DJ. Atrthogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries. Clin Sci. 1994;86:xxii. doi: 10.1042/cs0860305. [DOI] [PubMed] [Google Scholar]
  • 48.Wood L, Ferrell WR, Baxendale RH. Pressures in normal and acutely distended human knee joints and effects on quadriceps maximal voluntary contractions. Q J Exp Physiol. 1988;73:305–314. doi: 10.1113/expphysiol.1988.sp003147. [DOI] [PubMed] [Google Scholar]
  • 49.Konradsen L, Olesen S, Henrik M. Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med. 1998;26:72–77. doi: 10.1177/03635465980260013001. [DOI] [PubMed] [Google Scholar]
  • 50.Lentell G, Baas B, Lopez D, McGuire L, Sarrels M, Snyder P. The contributions of proprioceptive defects, muscle function, and anatomic laxity to function instability of the ankle. J Orthop Sports Phys Ther. 1995;21:206–215. doi: 10.2519/jospt.1995.21.4.206. [DOI] [PubMed] [Google Scholar]
  • 51.Konradsen L, Ravn JB, Sorensen AI. Proprioception at the ankle: the effect of anesthetic blockade of ligament receptors. Bone Joint Surg Br. 1993;75:433–436. doi: 10.1302/0301-620X.75B3.8496215. [DOI] [PubMed] [Google Scholar]
  • 52.Beckman SM, Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil. 1995;76:1138–1143. doi: 10.1016/s0003-9993(95)80123-5. [DOI] [PubMed] [Google Scholar]
  • 53.Sjolander P, Johansson H, Djupsjobacka M. Spinal and supraspinal effects of activity in ligament afferents. J Electromyogr Kinesiol. 2002;12:167–176. doi: 10.1016/s1050-6411(02)00017-2. [DOI] [PubMed] [Google Scholar]
  • 54.Kerkhoffs GM, Struijs PA, Marti RK, Blankevoort L, Assendelft WJ, van Dijk CN. Functional treatments for acute ruptures of the lateral ankle ligament: a systematic review. Acta Orthop Scand. Feb, 2003;74(1):69–77. doi: 10.1080/00016470310013699. [DOI] [PubMed] [Google Scholar]

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