Ankle sprains are common sports injuries that occur when the ankle rolls in a lateral motion, doing damage to muscle and connective tissue. Forty percent of patients suffering a lateral ankle sprain develop chronic ankle instability (CAI), which can impede performance, cause ongoing foot and ankle pain, and lead to more injuries down the road.
A suspected catalyst for CAI is peripheral nerve damage that occurs with a lateral ankle sprain. Inflammation and scar tissue at the injury site can reduce the space around a nerve structure, putting pressure on the nerve and interfering with optimal neural function. Remember that your nerves send and receive information to and from your brain, telling your muscles what to do, so a compressed or damaged nerve can undermine normal joint movement and cause instability.
Manual nerve mobilization is a therapeutic technique applied to the injury site to increase space around an entrapped neural structure, relieving pressure to restore optimal function and reduce foot and ankle pain. Nervous tissue is sensitive and must be mobilized gently. When done correctly, manual nerve mobilization can enhance the outcomes of traditional therapies by helping entrapped nerves function freely.
Traditional therapy for CAI includes strengthening and balance exercises, along with proprioceptive training. A 2016 study by Plaza-Manzano et al. sought to test the efficacy of manual nerve mobilization treatment when added to conventional therapies.
Fifty-six physically active subjects with CAI were randomly assigned to one of two groups. One group of 28 subjects received a progressive balance program and a progressive strengthening program of the ankle evertors over the course of four weeks. The second group of 28 received the same balance and strengthening programs, but also received manual therapy consisting of grade 3 joint mobilizations and peroneal nerve mobilizations.
Subjects were assessed before and at the end of the four week intervention, and again after one month of treatment. A battery of assessment instruments was used to assess pain, ankle stability, joint range of motion and strength. While both groups improved in all assessment categories, the researchers observed greater improvement in the group who received manual therapy.
The results of this study make a compelling case for the inclusion of manual peroneal nerve mobilization therapy in rehab protocols in the treatment of ankle pain caused by CAI. Combined with therapeutic strengthening and balance exercises, manual nerve mobilization can be a powerful tool to improve ankle stability and relieve foot and ankle pain.
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