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On Dorsiflexion at the Talocrural Joint in Patients with a History of Ankle Injury

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On Dorsiflexion at the Talocrural Joint in Patients with a History of Ankle Injury Efficacy of the ‘Still technique’ on dorsiflexion at the talocrural joint in patients with a history of ankle injury Nicholas Taylor A research project submitted in partial fulfilment of the requirements for the degree of Masters of Osteopathy at Unitec New Zealand 2008 Declaration Name of candidate: Nicholas Taylor This Thesis/Dissertation/Research Project entitled: Efficacy of the ‘Still technique’ on dorsiflexion at the talocrural joint in patients with a history of ankle injury Is submitted in partial fulfilment for the requirements for the Unitec degree of Masters of Osteopathy. Candidate’s declaration I confirm that: • This Thesis/Dissertation/Research Project represents my own work; • The contribution of supervisors and others to this work was consistent with the Unitec Regulations and Policies. • Research for this work has been conducted in accordance with the Unitec Research Ethics Committee Policy and Procedures, and has fulfilled any requirements set for this project by the Unitec Research Ethics Committee. Research Ethics Committee Approval Number: 2007.706 Candidate Signature: ……………………………………………. Date: (Nicholas Taylor) Student number: 1082974 2 ABSTRACT Background and Objectives: To determine the efficacy of an osteopathic technique (‘Still Technique’) on range of motion at the talocrural joint in individuals with a history of ankle injury. This dissertation has two sections. Section I contains a review the literature regarding investigation on range of motion at the talocrural joint. Section II consists of a manuscript of a study investigating the ‘Still Technique’ on talocrural joint range of motion. Design: A randomised, controlled, blinded, experimental study. Subjects: Thirty-two volunteers (19 males, 13 females; mean age=28.3 SD= 8.4) with a history of ankle injury from a university population, aged between 18 and 47 years. Methods: Subjects with a history of ankle injury were randomly allocated to control and experimental groups. Subjects in the experimental group received three consecutive applications of ‘the Still Technique’ at the talocrural joint within a single session. Those in the control group received a sham intervention designed to mimic the ‘Still Technique’. Pre-test and post-test measures of passive dorsiflexion ROM were collected using a magnetometer. Results: A comparison of the pre and post intervention control group (n=16) means revealed a mean change of 1.5º (p= 0.163; d= 0.10) (95% CI= -0.6 to 3.6º). A comparison of the pre and post intervention experimental group (n=16) means revealed a mean change of 3.8º (p= 0.18; d=0.34) (95% CI= 0.75 to 6.8º). The observed changes in ROM for both the experimental and control groups did not exceed the smallest detectable difference (SDD=5.9°). Conclusion: The application of the Still technique did not substantially alter ROM at the talocrural joint in all subjects. Rather there was a range of responses, some subjects did respond to the single treatment and further investigation into the characteristics of these responsive patients could be warranted. Keywords: Ankle joint, Still Technique, dorsiflexion, range of motion, osteopathy 3 Table of Contents Declaration............................................................................................................ 2 ABSTRACT.......................................................................................................... 3 List of Tables......................................................................................................... 5 List of Figures ....................................................................................................... 5 Acknowledgements ............................................................................................... 6 Abbreviations ........................................................................................................ 7 SECTION I - LITERATURE REVIEW.................................................................... 8 Introduction............................................................................................................... 9 Literature Selection............................................................................................ 9 Still Technique Model ......................................................................................10 Historical Background..............................................................................................10 Classification of osteopathic technique .............................................................13 Somatic Dysfunction ........................................................................................14 Efficacy versus effectiveness ............................................................................15 Efficacy of peripheral joint manual therapy techniques.....................................16 Ankle anatomy .................................................................................................17 Measurement of ankle joint ROM.....................................................................17 Studies reporting effects of ankle joint interventions in asymptomatic subjects .21 Studies reporting effects of ankle joint interventions in symptomatic subjects...24 Conclusion ...............................................................................................................27 References................................................................................................................29 Appendix – Literature Review Table ...................................................................31 SECTION II –MANUSCRIPT .................................................................................35 ABSTRACT.............................................................................................................38 INTRODUCTION....................................................................................................39 METHODS ..............................................................................................................43 Participants...........................................................................................................43 Study Design........................................................................................................43 DATA COLLECTION.............................................................................................44 Measurement........................................................................................................44 Technique.............................................................................................................44 Sham Technique...................................................................................................45 Testing Procedure.................................................................................................45 Analysis ...............................................................................................................47 RESULTS ................................................................................................................48 DISCUSSION ..........................................................................................................50 Literature..............................................................................................................50 Internal validity: strengths/limitations/weaknesses................................................52 External validity ...................................................................................................53 Further work.........................................................................................................54 CONCLUSION........................................................................................................55 REFERENCES.........................................................................................................57 SECTION III – APPENDICES.................................................................................59 Appendix A - Figures and Tables .........................................................................60 Appendix B – Reliability Study ............................................................................72 Appendix C –Ethics Resources.............................................................................81 Appendix D – Instruction for authors for manuscript submission..........................85 4 List of Tables Table 1. Subject Characteristics……………………………………………………67 Table 2. Dorsiflexion measurements from the Control Group…………………….68 Table 3. Dorsiflexion measurements from the Experimental Group…………….…69 Table 4. Pre Intervention initial category comparison for participant’s dorsiflexion ROM………………………………………………………………………………..70 Table 5. Final dorsiflexion ROM category comparison for participants…………...71 Table 6. Dorsiflexion ROM percentage increase of participants…………………..72 List of Figures Figure 1. CONSORT Study Flowchart………………………………………………62 Figure 2. Knee to the wall dorsiflexion measure…………………………………….63 Figure 3. Experimental Setup………………………………………………………..64 Figure 4. Control Group Results…………………………………………………….65 Figure 5. Dorsiflexion Measurements for Experimental Group…………………….66 5 Acknowledgements I wish to thank the following people for their support throughout the process of completing this research project: To all the participants who generously gave up their time to be part of my research. To my supervisors: Rob Moran, for his time, feedback and support, and Andy
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