Effectiveness of manual therapy with and without exercise in chronic ankle instability for pain, mobility, and function: a systematic review and meta-analysis.

Study Summary

13 randomized controlled trials (RCTs) involving 497 adults with chronic ankle instability (CAI) were included in this systematic review and meta-analysis comparing manual therapy, with or without exercise therapy, against exercise therapy alone, sham treatment, or no intervention. Pooled outcomes included ankle dorsiflexion (DF) range of motion (ROM), assessed using the weight-bearing lunge test (WBLT), and self-reported function, assessed using the Foot and Ankle Ability Measure (FAAM) and Cumberland Ankle Instability Tool (CAIT). Pain was also evaluated using the Visual Analogue Scale (VAS), although pooling was not feasible. Manual therapy significantly improved WBLT and CAIT outcomes compared with controls, while improvements in FAAM scores were not statistically significant. However, the pooled improvements did not exceed established thresholds for clinically meaningful change. Overall, manual therapy appeared beneficial for ankle mobility and perceived stability, although the clinical relevance of these improvements remained uncertain due to the low certainty of evidence.