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"Sport Medicine Journal" No.15 - 2008
ORIGINAL PAPER – abstract


Neurodynamic techniques in the management of lateral ankle sprain

Evgeniya Dimitrova
NSA, Department of Kinesitherapy, Sofia, Bulgaria

Abstract

Intoduction: Lateral ankle sprains are common soft tissue injuries. The peroneal nerves are also at risk from ankle sprains. However there is no evidence to suggest which intervention best augments functional treatment in the presence of soft tissue and neural dysfunctions. The purpose of this study was to examine and describe the use and efficacy of neurodynamic techniques in management of patients with lateral ankle sprain. 

Material and methods: Thirty athletes with clinical diagnosis distortion of the talocrural articulation, after inversion sprains were treated for the period of three years. Patients were randomly divided into two groups. Group B underwent a traditional physiotherapy management of these injuries that include ice, active exercises, strapping and proprioceptive retraining in varying amounts and forms. Group A underwent a traditional PT program, added with neurodynamic techniques – ankle plantarflexion/inversion (PFI) and straight leg raising (SLR). Outcome measures used were the: visual analogue scale (VAS) scores for ankle pain, ankle range of motion, and the modified Lower Extremity Functional Scale (LEFS); these were recorded at baseline, discharge, and 3 months post-discharge. All patients were treated in physical therapy twice weekly for 4 weeks for a total of 8 visits. 

Results: Data recorded from the primary outcome measures, VAS scores and percentage overall improvement were considered interval level and analyzed with parametric statistics: repeated measures ANOVA (within group changes) and the independent t-test (between group changes). No baseline differences existed between the groups (P>0.05). In a baseline, we found that, compared to healthy leg, the injured leg showed a decrease in the painfree range of PFI/SLR in 26 patients (86,7%). It seems in­evitable that with inversion sprains, the peroneal nerves will be affected either directly or indirectly by pressure from blood, oedema and compressive taping or plaster casts. Data analysis showed a significant improvement in pain and disability from baseline to all follow up points for both group. At discharge, patients who received neurodynamic techniques demonstrated significantly greater improvements in disability (32.6 points on the LEFS, P < 0.001), pain (3.4 points on the VAS, P =0.001), and range of motion (P < 0.01) than patients who did not. These benefits are maintained at a 3 months follow-up. 

Conclusions: The results demonstrated that both groups improved with treatment but that additional benefit was achieved with the addition of neurodynamic techniques to the physiotherapy programme.

Key words:

 ankle sprain, neurodynamics, physiotherapy



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