Effect of finding-oriented manual therapy techniques on muscle activity and postural control in patients with chronic ankle instability - A randomized controlled feasibility study

Introduction
Previous studies have analyzed the effects of manual therapy techniques (MTT) in patients with chronic ankle instability (CAI). Clinicians treat patients according the finding-oriented MTT approach. This approach is seldom pursued in research. The purpose of this study was to evaluate the feasibility and efficacy of finding-oriented MTT applications in patients with CAI.

Method
In this randomized controlled, blinded assessor crossover feasibility trial, participants were randomized to receive nine finding-oriented MTT treatments or no treatment during a three-week period, followed by a six-day washout period after which participants were crossed-over. Criteria under evaluation were adherence and attrition rates, safety (adverse events (AEs)) and acceptability and preliminary effects of finding-oriented MTT on muscular activity (measured by surface Electromyography (sEMG)) and on dynamic balance (measured by time to stabilization (TTS) and the modified Star Excursion Balance Test (modified STBT)).

Results
Seven women and two men (mean age: 26 ± 6.1 years) with CAI enrolled in this feasibility study. Success criteria showed a high adherence (90%) and low attrition rate (10%). All data could be used for analysis. AEs such as tingling in the foot during a short time frame were reported after four finding-oriented MTT interventions. Preliminary effect sizes showed divergence and few statistically significant results for sEMG.

Conclusion
The participants were adherent to the finding-oriented MTT intervention. The acceptability of data recording and data analysis was good. In addition, the study protocol should be adapted by adding a 10-min warm up period, a participant familiarization to TTS and modified STBT, and test repetitions.