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The relative effectiveness of the Activator Adjustment Instrument versus diversified manipulation technique in Chronic Ankle Instability Syndrome (CAIS) in terms of objective and subjective findings

Background: Lateral ankle sprains and the sequelae of Chronic Ankle Instability Syndrome (CAIS) are common, reaching a peak prevalence of 85%. Manual joint manipulation is an intervention utilised for CAIS. Manipulations are applied either manually or via a mechanical device. The Activator Adjustment Instrument (AAI) is commonly applied to extremities; however, a paucity of research exists, in respect of extremity conditions. Thus this study compared an AAI manipulation with a manual long-axis distraction manipulation (diversified technique) in the treatment of CAIS. Method: This ethics approved, quantitative, randomised controlled clinical trial, of 40 participants allocated between two groups. After receipt of informed consent participants were evaluated against the inclusion criteria and baseline measures were taken. One treatment of either manual or activator manipulation was followed by a measurements-only consultation within 48 hours. A p-value <0.05 was considered statistically significant. Intra- and inter-group analyses were done utilising repeated measures ANOVA tests. Results: Both groups showed a statistically significant improvement on all outcome measures over time, but neither group showed a significant improvement over the other. A trend in the inter-group comparisons reflected parallel improvements in the Algometer, Berg Balance Scale and the dorsiflexion range of motion (objective measures) and non-parallel improvements in the Numerical Pain Rating Scale and Foot and Ankle Disability Index. Conclusion: The results suggested a trend towards subjective improvement in the AAI group, which may have been influenced by the novelty of the AAI. Further research with larger sample sizes and more homogenous participant groups are needed to verify this outcome.