Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial

56 patients with chronic ankle instability were randomized to a 4-week program of proprioception and strengthening exercises, with or without the addition of manual therapy sessions (mobilization) during the program. Patients were followed up for visual analog scale (VAS) pain, the Cumberland Ankle Instability Tool, pressure-pain threshold at the anterior talofibular ligament, calcaneofibular ligament, tibial malleolus and fibular malleolus, ankle range of motion, and ankle strength in plantar flexion and dorsiflexion at the completion of the programs and at 1 month follow-up. Both groups demonstrated significant improvement in all outcomes. The addition of manual therapy led to significantly greater improvements in all outcomes, except for PPT at the tibial malleolus compared to the control group.