A Randomized, Clinical Trial Comparing the Efficacy of a Fascia Release Technique for the Treatment of Acute Ankle Sprains

Abstract

Acute ankle sprains are treated with ice, elevation, immobilization, and non-steroidal anti-inflammatory drugs. Resolution typically takes days. Osteopathic physicians utilize manipulation for a variety of joint disorders and injuries. Few have been studied in randomized controlled trials and many allopathic physicians are unaware of their utility. One manipulation, a modified muscle energy release technique, appears to offer promise for the treatment of acute ankle injuries, potentially returning patients to function more quickly than standard treatment alone. This study involved a comparison of a modified muscle energy release technique with standard treatment to standard treatment alone in the emergency department (ED) setting for patients with acute ankle injuries. This is an IRB approved, randomized single-blind sham-controlled study on a convenience sample of ED patients with pain from acute inversion injury. The study was set in a suburban ED with a 3-year Emergency Medicine Residency and an annual volume of 80,000. Inclusion criteria were patients aged 18-55 years; a Grade I or II acute ankle sprain less than 48 hours old; initial VAS scores ≥ 35; and being able to take 4 steps in the ED. We excluded fractures and Grade III injuries. The experimental manipulation technique involved placing the ankle into position of injury (inversion) for over 90 seconds and then bringing the ankle back to a neutral position over 90 seconds against mild hand resistance. The sham manipulation was similar but with plantar-flexion manipulation instead Patients were evaluated pre and 5 minutes after manipulation and 2 days later with a 100mm VAS pain scale completed by the patient after taking 4 steps. 17 patients were enrolled, 7 in the experimental (E) and 10 in the sham (S) group; 7 (41%) were female. There was no difference between groups for age (E=32; S=32 years p=0.9), gender (p=0.9), time from injury (E=7 vs S=11 hours; p=0.4) or initial VAS (E= 51 mm (SD 27); S= 57 mm (SD 20) (p=0.7). Both groups had similar distributions of pain (see schematic). There was no difference in mean pain relief between groups immediately after manipulation E=2.4mm (-11.0-15.88, 95%CI) vs S= 7.2mm (0.08-14.8, 95%CI) (p=0.4) or 2 days later E=29.1mm 1mm (8.5-49.7, 95%CI) S=26 (7.7 95%CI (p=0.8). Muscle energy release for acute ankle sprain does not improve pain immediately or in 2 days compared to standard treatment.