From the Guidelines
The most appropriate osteopathic manipulative technique for this patient is D. muscle energy. Muscle energy technique is ideal for treating the restricted left tibiofibular joint in this 30-year-old man with a lateral ankle sprain. This technique involves having the patient actively contract specific muscles against a precisely controlled counterforce applied by the physician. For a tibiofibular joint restriction, the practitioner would position the ankle appropriately, ask the patient to push against resistance in a specific direction, and then take advantage of post-isometric relaxation to restore normal joint mobility. According to the study by 1, functional treatment in the form of exercise and functional support is preferred over immobilisation, and mobilisation therapy may provide help in case of ROM restriction. Although the study does not specifically mention osteopathic manipulative techniques, muscle energy technique can be considered a form of mobilisation therapy that can help restore normal joint mobility and promote healing. Muscle energy is particularly beneficial in this acute injury case because it's gentle, controlled, and allows the patient to actively participate in the treatment, minimizing the risk of further injury to the already damaged lateral ankle ligaments. This technique helps restore proper joint mechanics, reduce pain, improve range of motion, and promote healing by enhancing lymphatic drainage and circulation to the injured area. As stated in the study by 1, manual mobilisation is only advised in combination with other treatment modalities to enhance the treatment effect, and exercise therapy should be started as soon as possible to recover joint functionality. Muscle energy technique can be used in conjunction with exercise therapy to promote optimal recovery and prevent future injuries. In terms of treatment modalities, the study by 1 recommends functional support, exercise, and manual mobilisation, but does not provide specific guidance on osteopathic manipulative techniques. However, based on the principles of functional treatment and mobilisation therapy, muscle energy technique can be considered an appropriate treatment option for this patient. Key benefits of muscle energy technique in this case include:
- Gentle and controlled treatment
- Active patient participation
- Restoration of normal joint mobility
- Reduction of pain and improvement of range of motion
- Promotion of healing and prevention of future injuries.
From the Research
Osteopathic Manipulative Techniques for Ankle Sprains
The patient presents with a mild lateral ankle ligament sprain and restriction of the left tibiofibular joint. Considering the evidence, the most appropriate osteopathic manipulative technique for this patient would be:
- High velocity, low amplitude (HVLA) technique, as it has been shown to improve hip abductor strength in individuals with a history of ankle sprain and unilateral weakness during a tensor fascia latae (TFL) muscle test 2.
Rationale for Choosing HVLA Technique
The HVLA technique is a suitable choice for this patient because:
- It can help improve joint mobility and reduce stiffness in the ankle and tibiofibular joints 2.
- It has been shown to increase force output and muscle activation of hip musculature in individuals with a history of ankle sprain 2.
- Other techniques, such as articulatory technique, counterstrain, muscle energy, and Still technique, may not be as effective in addressing the specific needs of this patient.
Considerations for Treatment
When treating the patient with HVLA technique, it is essential to:
- Conduct a thorough assessment of the patient's ankle and tibiofibular joints to identify any mechanical or sensorimotor impairments 3.
- Develop an individualized treatment plan that addresses the patient's specific needs and goals 4.
- Consider combining HVLA technique with other evidence-based interventions, such as weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy 4, 5.