Ankle Mobilization for Knee Pain

Recruiting in Palo Alto (17 mi)

Overseen by Everett Lohman, Dsc

Age: 18 - 65

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Loma Linda University

Disqualifiers: Musculoskeletal surgery, Fractures, Knee effusion, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial aims to see if improving ankle movement can help people with knee pain perform squats better. Participants will do exercises to increase ankle flexibility and then test their knee function.

Do I need to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Mobilization with Movement for knee pain?

Research shows that mobilization with movement can improve knee strength, ankle range of motion, and walking speed in stroke patients, and reduce pain in people with knee osteoarthritis. This suggests it might help with knee pain by improving joint function and reducing discomfort. ^{1 2 3 4 5}

Is ankle mobilization for knee pain safe for humans?

Research on joint mobilization, including techniques like Mobilization with Movement (MWM), generally shows it is safe for humans, as studies have not reported significant adverse effects when used for conditions like knee osteoarthritis and ankle sprains. ^{1 3 6 7 8}

How does the treatment 'Mobilization with Movement' for knee pain differ from other treatments?

Mobilization with Movement (MWM) is unique because it combines manual joint mobilization with active or passive movement, which can help improve joint function and reduce pain. This approach is different from standard treatments that may not incorporate movement during mobilization, potentially offering more immediate and widespread pain relief. ^{1 2 3 9 10}

Research Team

Everett Lohman, Dsc

Principal Investigator

Loma Linda University

Eligibility Criteria

This trial is for women aged 18-59 with Patellofemoral Pain lasting at least 6 months, who haven't had clinic treatments in that time. They must have limited ankle movement (<45 degrees on a lunge test) and no knee swelling, abnormal limb structures, severe resting pain, or past surgery/fractures affecting leg/spine biomechanics.

Inclusion Criteria

History of active Patellofemoral Pain for at least 6 months

No clinic based therapeutic interventions for a 6-month period prior to testing

Females aged 18-59 years' old

Exclusion Criteria

Current knee effusion

You have had bone or muscle problems in the limb being tested before.

You have severe pain at rest, rated greater than 5 out of 10.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Baseline Assessment

Participants complete self-reported questionnaires and undergo initial measurements of dorsiflexion and hip abductor strength

1 day

1 visit (in-person)

Intervention

Experimental group receives interventions to increase dorsiflexion; minimal intervention group reads an infographic and walks on a treadmill

1 day

1 visit (in-person)

Post-Intervention Assessment

Participants undergo post-intervention measurements and complete additional trials of the Lateral Step Down test

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any changes in dorsiflexion and functional outcomes

1 week

Treatment Details

Interventions

• Mobilization with Movement (Behavioural Intervention)
• No mobilization with movement and education (Behavioural Intervention)

Trial Overview The study examines how limited ankle flexibility affects single-leg squats in those with knee pain. Participants will either receive 'Mobilization with Movement' therapy or just education without mobilization to see which method better improves squat performance.

Participant Groups

Group I: Primary Intervention Group Experimental Treatment 1 Intervention

The experimental group will receive two interventions to increase dorsiflexion range of motion.

Group II: Minimal Intervention Group Active Control 1 Intervention

The minimal intervention group will read and infographic and complete 5 minutes of treadmill walking.

Who Is Running the Clinical Trial?

Loma Linda University

Lead Sponsor

Trials

322

Recruited

267,000+

Adrian Cotton

Loma Linda University

Chief Medical Officer since 2020

MD

Richard H. Hart

Loma Linda University

Chief Executive Officer since 2015

MD, DrPH

Findings from Research

Mobilization with movement (MWM) significantly reduces pain and improves ankle mobility and function in patients with acute and sub-acute grade I and II inversion ankle sprains, as shown in a randomized placebo-controlled trial with 32 participants.

At one and six months follow-up, those receiving MWM reported a mean pain reduction of 1.7 and 0.9 points respectively on a Numeric Rating Scale, along with improvements in disability and balance, indicating its effectiveness as a treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of mobilization with movement on pain, balance and function following acute and sub acute inversion ankle sprain - A randomized, placebo controlled trial. Gogate, N., Satpute, K., Hall, T.[2021]

Accessory knee joint mobilization significantly increased pressure pain threshold (PPT) by 27.3% in individuals with knee osteoarthritis, indicating a strong local pain relief effect compared to manual contact and no-contact interventions.

The mobilization technique also improved functional performance, as evidenced by a significant reduction in 'up and go' time, suggesting that it can enhance mobility in patients with knee pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Moss, P., Sluka, K., Wright, A.[2022]

In a study of 41 subjects with acute ankle inversion sprains, adding anteroposterior joint mobilization to the standard RICE protocol resulted in fewer treatment sessions needed to achieve pain-free dorsiflexion.

The experimental group also showed greater improvements in stride speed compared to the control group, indicating that this specific joint mobilization can enhance recovery outcomes in ankle sprain rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Green, T., Refshauge, K., Crosbie, J., et al.[2022]

Joint mobilization is effective in improving dynamic balance immediately after treatment for ankle sprains, based on a meta-analysis of 11 studies involving various grades of sprains.

In the short term, joint mobilization significantly enhances weight-bearing dorsiflexion range, although its effects on other outcomes like static balance and pain intensity were not statistically significant.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis. Weerasekara, I., Osmotherly, P., Snodgrass, S., et al.[2019]

In a study involving 30 chronic stroke patients, ankle joint mobilization with movement (MWM) significantly improved ankle range of motion and gait velocity compared to weight-bearing exercises (WBE).

Both MWM and WBE increased knee strength, but only MWM showed notable benefits in improving gait speed, highlighting its effectiveness for stroke rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study. An, CM., Won, JI.[2020]

A single session of Maitland Grade III anterior-to-posterior joint mobilization significantly improved dorsiflexion range of motion (DF ROM) and time-to-boundary (TTB) in individuals with chronic ankle instability (CAI), suggesting immediate mechanical benefits.

The study, involving 20 participants (9 males and 11 females), indicates that joint mobilization can help address sensorimotor function impairments and arthrokinematic restrictions associated with CAI, although some measures showed only trends rather than significant changes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. Hoch, MC., McKeon, PO.[2022]

In a randomized clinical trial involving 40 men aged 18-40 with chronic ankle dorsiflexion rigidity, neither Mulligan Mobilization with Movement (MWM) nor Osteopathic Mobilization (OM) showed significant immediate improvements in ankle range of motion or musculoarticular stiffness after a single session.

The study found small effect sizes for both interventions, indicating that neither technique was effective in enhancing ankle mobility or reducing stiffness in the short term, with only a significant interaction noted for viscous stiffness in relation to injury history.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The immediate effects of two manual therapy techniques on ankle musculoarticular stiffness and dorsiflexion range of motion in people with chronic ankle rigidity: A randomized clinical trial. Hidalgo, B., Hall, T., Berwart, M., et al.[2018]

Mobilization with movement (MWM) significantly improved pain and function in patients with knee osteoarthritis compared to sham MWM, with benefits observed immediately after treatment and lasting for at least 2 days.

MWM enhanced various measures including pain reduction, pressure pain threshold, walking speed, knee flexor and extensor strength, and knee flexion range of motion, indicating its efficacy as a therapeutic intervention for knee OA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. Alkhawajah, HA., Alshami, AM.[2020]

In a study of 40 individuals with grade two lateral ankle sprains, both Maitland and Mulligan mobilization techniques significantly reduced pain and improved range of motion after two weeks of treatment.

Mulligan's mobilization with movement technique was found to be more effective than Maitland's technique, leading to greater reductions in pain and increases in range of motion, likely due to its combination of active and passive mobilization forces.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of mobilization and mobilization with movement on pain and range of motion in people with lateral ankle sprain: A randomized clinical trial. Norouzi, A., Delkhoush, CT., Mirmohammadkhani, M., et al.[2021]

A history of ankle sprains is the primary risk factor for future sprains, leading to recurrent instability and decreased functional capacity due to mechanical and functional deficits, such as reduced dorsiflexion range of motion.

Mobilization with movement (MWM) techniques may effectively improve ankle joint function and reduce the risk of future sprains by addressing these deficits during rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of mobilization with movement at improving dorsiflexion after ankle sprain. Hoch, MC., McKeon, PO.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

The effectiveness of mobilization with movement on pain, balance and function following acute and sub acute inversion ankle sprain - A randomized, placebo controlled trial. [2021]

2. Scotland pubmed.ncbi.nlm.nih.gov

The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis. [2019]

5. Japan pubmed.ncbi.nlm.nih.gov

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

The immediate effects of two manual therapy techniques on ankle musculoarticular stiffness and dorsiflexion range of motion in people with chronic ankle rigidity: A randomized clinical trial. [2018]

8. England pubmed.ncbi.nlm.nih.gov

The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

A comparison of mobilization and mobilization with movement on pain and range of motion in people with lateral ankle sprain: A randomized clinical trial. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

The effectiveness of mobilization with movement at improving dorsiflexion after ankle sprain. [2019]