40, 41 We also calculated 95% confidence intervals (CIs) around the effect size. The strength of an effect size was interpreted as weak (Cohen d ≤ 0.4), moderate (Cohen d range = >0.40–≤ 0.8), or strong (Cohen d > 0.8). 40, 41 If effect sizes were provided in the original publication, we recalculated the effect size for consistency in comparison across all the studies included in this review. To assess the magnitude of treatment effects, we calculated Cohen d effect sizes using means and standard deviations of pretreatment and posttreatment data or baseline and follow-up data for each study. Only 2 articles included participants with recurrent ankle sprain, so this group was not subdivided. We further subdivided the acute/subacute ankle sprain group into 4 subcategories of interventions: (1.1) manual therapy, (1.2) therapeutic modalities, (1.3) therapeutic exercises, and (1.4) psychological intervention. The 2 groups were termed as (1) acute/subacute ankle sprain and (2) recurrent ankle sprain. To be combined for data analysis, we categorized the included studies into 2 primary groupings of evidence based on onset of injury. By providing a quantitative estimate of the magnitude of the effect of therapeutic interventions, our review provides a new perspective on the evidence of interventions to restore ankle dorsiflexion in various stages of ankle-sprain conditions. In contrast to previous reviews, 24 – 26 we comprehensively searched the existing literature to determine the effectiveness of various therapeutic intervention techniques in restoring ankle dorsiflexion in patients with acute, subacute, or recurrent ankle sprains. Therefore, the purpose of this systematic review was to determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. In addition, Bleakley et al 27 conducted a systematic review with a comprehensive search of various therapeutic interventions to provide evidence for the management of ankle sprains and the prevention of long-term complications however, the authors focused only on patients with an acute ankle sprain. In previous systematic reviews, 24 – 26 researchers have examined the effects of specific intervention techniques of manipulative therapy on various outcome variables. However, the intervention or combination of interventions that most effectively improves ankle dorsiflexion has not been established. Therefore, ensuring appropriate restoration of ankle dorsiflexion after ankle sprain has important clinical implications for restoring full functional abilities, ultimately leading to reduced risk of recurrent ankle sprain.Ĭlinicians perform several therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. 23 Limited ankle-dorsiflexion range of motion (ROM) after lateral ankle sprain has been considered a predisposing factor for recurrent ankle sprain because diminished dorsiflexion prevents the ankle from reaching its closed-pack position by holding the ankle in a hypersupinated position. Inadequate restoration of ankle dorsiflexion may increase the risk of developing recurrent ankle sprain 11, 16 and limit functional activities, such as walking, with long-term pain and disability. The importance of restoring ankle dorsiflexion after an acute ankle sprain often is emphasized in rehabilitation guidelines, 9 and proper recovery of ankle dorsiflexion is a vital component of ankle rehabilitation. 7, 13 – 22 Limitation of dorsiflexion may be a predisposition to reinjury of the ankle 11, 16 and several future lower limb injuries, including plantar fasciopathy, 13, 20, 21 lateral ankle sprains, 13, 15, 17, 19 iliotibial band syndrome, 14 patellofemoral pain syndrome, 18 patellar tendinopathy, 22 and medial tibial stress syndrome. The amount of available ankle dorsiflexion plays a key role in the cause of lower extremity injuries. 6 A loss of normal ankle dorsiflexion usually is observed at the talocrural joint after lateral ankle sprain. 5 Injury to the lateral ligamentous complex at the ankle joint results in pain, swelling, and limited osteokinematics. 1 – 4 Approximately 85% of all ankle sprains result from an inversion mechanism and damage to the lateral ligamentous complex of the ankle. Lateral ankle sprain has been documented to be the most common lower extremity injury sustained during sport participation.
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