Mulligan Mobilization With Movement for Acute Lateral Ankle Sprains

NCT07849374 | Recruiting

• 2 other identifiers: MULLIGANB4032024000105
• Study Type: interventional
• Target: 110
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial evaluates the effects and clinical specificity of Mulligan Mobilization With Movement (MWM) in adults with grade I or II lateral ankle sprains occurring less than 6 weeks before enrollment. The primary study population consists of participants enrolled within 2 weeks of the index lateral ankle sprain. Participants with an injury occurring between 2 and less than 6 weeks before enrollment are also eligible. Approximately 110 participants will be allocated to a Mulligan MWM intervention group or a control group receiving usual-care rehabilitation without Mulligan treatment. In the intervention group, three MWM techniques targeting the inferior tibiofibular, talocrural, and cubometatarsal joints are tested in a randomized order and adapted according to the participant's immediate pain-free response. Treatment includes up to six sessions provided twice weekly. Clinical outcomes are assessed at baseline, 3 weeks, and 3 months. The primary outcomes are ankle dorsiflexion range of motion, ankle joint arthrokinematics, and pain during weight-bearing dorsiflexion.

Conditions

Lateral Ankle Sprain

Keywords

Acute Lateral Ankle Sprain; Mulligan Mobilization With Movement; Manual Therapy; Ankle Dorsiflexion; Weight-Bearing Lunge Test; Posterior Talar Glide; Foot and Ankle Ability Measure; Ankle Rehabilitation

Outcome Measures

Primary Outcomes (3)

• Ankle Dorsiflexion Range of Motion Measured With the Weight-Bearing Lunge Test

  Ankle dorsiflexion range of motion is measured in centimeters (hallux-to-wall distance) and degrees (tibial inclination) using the Weight-Bearing Lunge Test performed against a wall. Higher values indicate greater weight-bearing ankle dorsiflexion.

  Throughout the entire study, during approximately 24 months

• Posterior talar glide range of motion

  Posterior talar glide range of motion is assessed using the Posterior Talar Glide Test (tibial inclination in degrees). Higher values indicate greater posterior talar glide range of motion.

  Throughout the entire study, during approximately 24 months

• Patient-Reported Sensations During the Weight-Bearing Lunge Test

  Patient-reported sensations are assessed using the Weight-Bearing Lunge Test sensory-mapping process. During the end-range Weight-Bearing Lunge Test position, participants report the type(s) and anatomical localization(s) of the sensation(s) perceived.

  Throughout the entire study, during approximately 24 months

Secondary Outcomes (14)

• Static Postural Control During Single-Leg Stance

  Throughout the entire study, during approximately 24 months

• Dynamic postural control using the Modified Y-Balance Test

  Throughout the entire study, during approximately 24 months

• Eversion strength

  Throughout the entire study, during approximately 24 months

• Inversion strength

  Throughout the entire study, during approximately 24 months

• Dorsiflexion strength

  Throughout the entire study, during approximately 24 months

Study Arms (2)

Mulligan Mobilization With Movement

EXPERIMENTAL

Participants receive Mulligan Mobilization With Movement for lateral ankle sprain. Three MWM techniques targeting the inferior tibiofibular, talocrural, and cubometatarsal joints are tested according to a randomized sequence. Treatment is adapted according to the participant's immediate pain-free response. Treatment is provided for up to six 15-minute sessions, twice weekly, and may be stopped earlier if symptoms resolve.

Other: Mulligan Mobilization With Movement; Other: Usual-Care Rehabilitation for Lateral Ankle Sprain

Usual-Care Rehabilitation

ACTIVE COMPARATOR

Participants receive usual-care rehabilitation for lateral ankle sprain without Mulligan Concept treatment. The rehabilitation provided by the treating physiotherapist is documented during the study.

Other: Usual-Care Rehabilitation for Lateral Ankle Sprain

Interventions

Mulligan Mobilization With Movement OTHER

A physiotherapist trained in the Mulligan Concept applies Mobilization With Movement while the participant actively performs ankle dorsiflexion. Three techniques targeting the inferior tibiofibular, talocrural, and cubometatarsal joints are tested according to a randomized sequence. The intervention is performed without pain and is evaluated for an immediate response. According to the protocol, an immediate clinically relevant response is defined as a 2-point improvement in pain on the numerical rating scale or an improvement greater than 1.9 cm in ankle dorsiflexion measured with the Weight-Bearing Lunge Test. If the response criterion is not met, the next MWM technique in the randomized sequence is tested. Up to six treatment sessions are provided twice weekly.

Mulligan Mobilization With Movement

Usual-Care Rehabilitation for Lateral Ankle Sprain OTHER

Participants receive traditional rehabilitation for lateral ankle sprain without Mulligan Mobilization With Movement. Rehabilitation is adapted to the participant's clinical presentation and is documented by the treating physiotherapist.

Mulligan Mobilization With Movement; Usual-Care Rehabilitation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Grade I or II lateral ankle sprain Index lateral ankle sprain occurring less than 6 weeks before enrollment Age 18 years or older No fracture associated with the index lateral ankle sprain No immobilization in a plaster cast Able to provide written informed consent

You may not qualify if:

• Grade III lateral ankle sprain Index lateral ankle sprain occurring 6 weeks or more before enrollment Additional lower-limb musculoskeletal disorder or injury incompatible with study participation Neurological disorder Severe hypertension Renal disease Cardiorespiratory disorder Sickle cell disease Arterial calcification Varicose veins Current anticoagulant treatment Current risk of or history of deep-vein thrombosis Fragile skin Previous surgery affecting sports performance

Sponsors & Collaborators

• Université Catholique de Louvain: lead
• The Mulligan Concept Teachers Association (MCTA) : 2023 Mulligan Concept Award (Grant).: collaborator

Study Sites (1)

FYKI Sports

Gistoux, Chaumont-Gistoux, 1325, Belgium

RECRUITING

Related Publications (4)

• Powden CJ, Hoch JM, Hoch MC. Reliability and minimal detectable change of the weight-bearing lunge test: A systematic review. Man Ther. 2015 Aug;20(4):524-32. doi: 10.1016/j.math.2015.01.004. Epub 2015 Jan 29.

  PMID: 25704110 BACKGROUND

• Picot B, Lopes R, Rauline G, Fourchet F, Hardy A. Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain. Sports Health. 2024 Jan-Feb;16(1):47-57. doi: 10.1177/19417381231183647. Epub 2023 Jul 11.

  PMID: 37434508 BACKGROUND

• Delahunt E, Bleakley CM, Bossard DS, Caulfield BM, Docherty CL, Doherty C, Fourchet F, Fong DT, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Remus A, Verhagen E, Vicenzino BT, Wikstrom EA, Gribble PA. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018 Oct;52(20):1304-1310. doi: 10.1136/bjsports-2017-098885. Epub 2018 Jun 9.

  PMID: 29886432 BACKGROUND

• Nguyen AP, Pitance L, Mahaudens P, Detrembleur C, David Y, Hall T, Hidalgo B. Effects of Mulligan Mobilization with Movement in Subacute Lateral Ankle Sprains: A Pragmatic Randomized Trial. J Man Manip Ther. 2021 Dec;29(6):341-352. doi: 10.1080/10669817.2021.1889165. Epub 2021 Feb 26.

  PMID: 33634747 RESULT

MeSH Terms

Interventions

Movement

Intervention Hierarchy (Ancestors)

Physiological Phenomena; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Anh Phong Nguyen, PhD

  CIRRIS ULaval

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Hugo Bogaerts, MSc

CONTACT

+32473954283; hugo.bogaerts@uclouvain.be

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants and outcome assessors are blinded to treatment allocation. Participants are not informed whether they are assigned to the Mulligan Mobilization With Movement intervention group or the control group. Outcome assessors performing the clinical measurements are blinded to treatment allocation and do not participate in treatment delivery. Treating physiotherapists are not blinded because they deliver the allocated intervention. They have access to the clinical assessment results to guide the individualized background rehabilitation provided to participants in both groups.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants are randomized in parallel to a Mulligan Mobilization With Movement intervention group or a usual-care rehabilitation control group. Within the Mulligan intervention group, the order in which three MWM techniques are tested is also randomized.

Study Record Dates

• First Submitted: September 24, 2026
• First Posted: September 30, 2026
• Study Start: January 1, 2025
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): March 30, 2027
• Last Updated: September 30, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

BE (1)