University of the Pacific Scholarly Commons School of Pharmacy Faculty Articles Thomas J. Long School of Pharmacy 4-1-2013 Alteration in corticospinal excitability, talocrural joint range of motion, and lower extremity function following manipulation in non-disabled individuals Todd E. Davenport University of the Pacific, [email protected] Stephen F. Reischl University of Southern California Somporn Sungkarat Chiang Mai University Jason Cozby University of Southern Claifornia Lisa Meyer University of Southern California See next page for additional authors Follow this and additional works at: https://scholarlycommons.pacific.edu/phs-facarticles Part of the Orthopedics Commons Recommended Citation Davenport TE, Reischl SF, Sungkarat S, Cozby J, Meyer L, Fisher BE. Alteration in corticospinal excitability, talocrural joint range of motion, and lower extremity function following manipulation in non-disabled individuals. Orthopaedic Physical Therapy Practice. 2013;25(2):97-102. © 2013, Orthopaedic Section, APTA, Inc. This Article is brought to you for free and open access by the Thomas J. Long School of Pharmacy at Scholarly Commons. It has been accepted for inclusion in School of Pharmacy Faculty Articles by an authorized administrator of Scholarly Commons. For more information, please contact [email protected]. Authors Todd E. Davenport, Stephen F. Reischl, Somporn Sungkarat, Jason Cozby, Lisa Meyer, and Beth E. Fisher This article is available at Scholarly Commons: https://scholarlycommons.pacific.edu/phs-facarticles/136 Alteration in Corticospinal Excitability, Todd E. Davenport, PT, DPT, OCSI Stephen E Reischl, PT, DPT, ocs2 Talocrural Joint Range of Motion, and Somporn Sungkarat, PT, PhD3 Lower Extremity Function Following Jason CozbJG PT, DPT, OCS2 Lisa Meyer, PT, OPT, OCS4 Manipulation in Non-disabled Individuals Beth E. Fisher, PT, PhD5 ....· . • .· J}/om(f! J Long . o]Ph~rmapy and Health Sciences, 2Adju:nct Associate Professor ofClinical Phyfical1herapy, Division oflJitlfei~zesi,oloJrY t.md.RhYs.#'al:YJ~tapy;(iJ(tlle.•!J[e.fr.nit_h; .•.· Dentistry, ·University ofS~uthern. California, Los Ang~les, ·Ctt. ; 9.ftrsistifnt I!rofossor qnd ,Associate Dean for. Research and lntt.r '1idlrior.ral.4f{t'tirJ.r Rwu.lty,i · Ch4i-zgA{a4: 1hfltil4nd · . ,:• · .· . · . ... ·.. fAdJu"nctftEtrtt~tor ofClinical Physj(itllfteraP}> Dit~ision · Bit,ki1.iesj,tJlo;~.·<lr7j(:t University ofS~~thern Ct¥,ifornia; Los Angeles, CA t{tSsfc#J~ Professor ofClinical Physical1herapy ~pirector of thel\.•.. re.. u:' •obirait.icitv a1'1d.l; .· Physical7J;erapy .at the Herman Ostrow School ofDentistry.. T,!niva-sity . (.d.,(ifii,rn.i;.t?, ABSTRACT to the talocrural joint in nondisabled indi­ joint mobility, which may occur as either a Background: Clinical outcomes of viduals. These results establish comparative cause or consequence ofankle sprain. Limited manual therapy procedures, including values with which to compare the cortico­ ankle dorsiflexion has been documented as a 2 27 manipulation, have been studied. However, spinal responses to manual therapy interven­ major short-term sequel to ankle sprain. 6· mechanisms underlying observed improve­ tion in individuals with pathology. In addition, several studies have identified ments remain unclear. Objective: To limited talocrural joint dorsiflexion range of determine the effect of ankle joint manipu­ Key Words: ankle, manipulation, motion (OF ROM) as an important predis­ 28 30 lation on corticospinal excitability, ankle transcranial magnetic stimulation, posing factor to ankle sprains. - Limited dorsiflexion range of motion (OF ROM), functional testing ankle OF ROM will position the talocru­ and lower extremity functional behavior ral joint in plantar flexion during weight in nondisabled individuals. Method: Six INTRODUCTION bearing activities. This position is notable nondisabled individuals (age range: 31-50 Ankle sprains are the most common because the most common mechanism of years) received the main outcomes measure­ injury to the ankle joint, affecting up to 2 injury for ankle sprains involves plantar flex­ ments of this study, before and after long million people and approximately 53 per ion and inversion of the ankle and foot. The 1 2 axis distraction manipulation of the talc­ 10,000 individuals per year. • Ankle sprains injury mechanism places excessive load on crural joint. Main outcomes measures were are common in younger and active individu­ the anterior talofibular ligan1ent (ATFL). motor evoked potential (MEP) amplitude als.H Certain sports and work activities may With failure of ATFL, secondary restraint of gastrocnemius (GN) and tibialis anterior result in an even higher incidence and risk to inversion occurs by way of the calcaneo­ 15 (TA) using transcranial magnetic stimula­ for injury. 9- Ankle sprains are a clinically fibular and posterior talofibular ligaments, tion, ankle OF ROM with the knee Hexed important problem because they result in placing them at similar risk for injury. Thus, and extended using standard goniometric a substantial number of missed work days8 limited ankle OF ROM may result in injury 3 5 techniques, and unilateral anterior squat and participation in sports activity, • as well and consequent structural and functional reach (ASR) distance. All subjects received as lead to potential early arthritic changes compromise of the ankle lateral collateral the main outcomes measures. Results: Sig­ in the talocrural joint. 16 The prognosis for ligaments. nificant increase in GN MEP amplitude (P functional recovery following ankle sprain Physical therapists use mobilization and < .05), but not TA MEP amplitude, were typically includes a rapid clinical improve­ manipulation to improve ankle OF ROM documented following intervention. Sig­ ment within the first rwo weeks after following ankle sprains. Despite the intui­ nificant improvements also were noted in injury.17 However, a series of recent srudies tive appeal of applying these procedures to ankle OF ROM with knee extended and indicate a subgroup of individuals appears promote parallel improvements in talocru­ ral OF ROM and functioning in individu­ Hexed (P< .001) andASRdistance (P< .05) predisposed to continued pain, functional als following ankle sprains, this notion has Significant correlations were found berween deficits, and prolonged risk for additional been the focus of relatively few prospective standardized change in GN MEP amplitude rein jury berween 6 weeks and 3 years postin­ srudies.31 Pellow and Brantingham32 were and ankle dorsiflexion with knee flexed (p = jury.t7-25 The prolonged disability associated among the first to report reduced pain and .582, p2 = .339, P < .01), and standardized with ankle sprains represents the possibility improved function in individuals with ankle changes in GN MEP amplitude and ASR of increased direct and indirect health care sprains receiving an ankle mortise distrac­ distance (p = .601, p2 .361, P< .01). Con­ costs associated with ankle sprains, and may tion technique. Whitman and colleagues" clusions: Increased corticospinal excitability be reduced through identification of optimal reported rapid functional improvement appears to mediate improvements in ankle approaches to clinical management. OF ROM and lower extremity function fol­ One reason for continued pain and ele­ after talocrural manipulation in a competi­ lowing long axis distraction manipulation vated risk for reinjury may be limited ankle tive volleyball player with a mild unilateral Orthopaedic Practice \ml 25;2: 13 97 ~------ ---·- ankle sprain. More recently, Whitman and and potential alteration in functional behav­ Transcranial magnetic stimulation coworkers34 documented favorable clinical ior using valid and reliable measurements. measurement outcomes in approximately 75% of their The purpose of this pilot study was to deter­ All the TMS assessments were carried sample with post-acute ankle sprains fol­ mine the effect of talocrural manipulation out with a single-pulse magnetic stimulator 2 lowing two sessions of mobilization and on gastrocnemius and tibialis anterior MEP, (Magstim 200 ). A Double Cone 110 mm manipulation directed at joints distal to the ankle DF ROM, and unilateral anterior coil was used to generate the TMS pulse. knee. Although initial results are promising, squat reach (ASR) distance in nondisabled This pulse provides stimuli of sufficient mechanisms underlying the clinical effects individuals. depth of penetration to activate the corti­ of manual therapy in individuals with ankle cal representational areas of lower extrem­ sprains remain unclear. METHOD ity muscles. The skin over the designated Through further study of the poten­ Subjects muscles of the right lower extremity was tial role for neuroplasticity to mediate the Participants prepared with cleansing gel and alcohol to relationship between brain activity and Six nondisabled individuals (2 females, decrease impedance for applying surface behavior in people with ankle sprains, it 4 males) ranging in age from 30-51 years electromyography (EMG) electrodes. Sur­ may be possible to better understand those participated in this study. Subjects were face EMG electrodes (Ag-AgCl, 12 mm mechanisms that result in a symptomatic excluded if they experienced a lower extrem­ diameter, interelectrode distance: 17 mm) and behavioral benefit. Various central and ity injury in the past 12 months, a history of were attached over the muscle belly of TA spinal sensorimotor mechanisms of manual lower extremity or low back surgery, lower