When the patient initially reported to her athletic trainer at the team bench, she stated that her pain was a 7 out of 10 on the Numeric Rating Scale (NRS). The purpose of this case report is to present the use of a modified Mobilization‐with‐Movement to treat a patient diagnosed with a LAS. Therefore, a modification of the MWM joint mobilization and taping technique that allowed for earlier pain‐free application of the technique would be beneficial. 5, 6 Tenderness to pressure may delay the use of this intervention and, in turn, delay healing and return to function. Additionally, padding may be applied to help alleviate point tenderness at the distal fibula. The principles of MWM application require pain‐free application of the technique and guide the clinician in adjusting hand placement, force application, and the line of drive of the mobilization to produce the desired outcome. With acute LASs, however, a patient may be too tender to allow performance of the traditional MWM technique. 5 The resolution of the patient's symptoms during the MWM application would be the clinical indication of a positional fault and would guide the clinician in choosing to apply this intervention. The entire application of the technique should be pain‐free for the patient and should produce immediate and long‐lasting benefits. Following the MWM, the glide is maintained with a specific tape application applied in the direction of the MWM to help maintain the corrected position of the fibula. With the glide maintained, the patient then performs active PF and IV with clinician overpressure at end range. 5, 6 The technique consists of a pain‐free sustained anterior‐posterior (AP) cranial glide of the lateral malleolus on the tibia. Under this hypothesis, Mulligan proposed that the Mobilization with Movement (MWM) treatment for LASs corrects the positional fault that may occur as a result of the PF and IV mechanism. The positional fault, as opposed to the ligament sprain, is the main source of pain, dysfunction, and decreased range of motion. According to his theory, the ATFL pulls on the fibula at the distal tibiofibular joint creating a positional fault between the tibia and fibula. Brian Mulligan has theorized, however, that this MOI may result in a positional fault of the fibula, instead of a LAS. 2, 4 The combined motion of PF and IV is a common mechanism of injury (MOI) and routinely leads to the diagnosis of a lateral ankle sprain (LAS). 3ĭue to the anatomical structure of the ankle, the anterior talofibular ligament (ATFL) is the most commonly injured ligament and is most susceptible to injury during a plantarflexion (PF) and inversion (IV) mechanism. 2 In basketball, it has been reported that approximately 60% of all injuries involve the lower extremity and approximately 25% of these injuries are ankle sprains. Approximately 49.3% of ankle sprain occur during athletic related activities, with basketball contributing up to 41.1%.
1 Based on recent literature reports, ankle sprains occurs at an incidence rate of 2.15 per 1,000 person‐years in the United States. Ankle sprains, a common pathology suffered during physical activity, occur at an estimated rate of more than 23,000 per day in the United States.
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