The effect of talocrural joint manipulation on static balance in patients with stroke: a randomized crossover trial

Talocrural joint manipulation has been shown to enhance proprioception, potentially improving static balance.

This study investigated the immediate effects of talocrural joint manipulation on postural stability and ankle mobility in patients with chronic stroke.

A randomized crossover study included 32 patients with chronic stroke. Each participant received a single session of both placebo and actual talocrural joint manipulation, alongside a conventional treatment program, with order randomized. Manipulation was applied in a high-velocity, low-amplitude manner, whereas the placebo involved 20 seconds of passive contact. Postural stability and ankle mobility assessed using a Biodex® Balance System and a smartphone's spirit level before and after interventions. Safety was monitored by recording adverse events.

In the placebo group, improvements in ankle mobility (r = 0.35-0.51; p = .004-0.046) and overall postural stability (d = 0.38; p = .039) were observed, although these changes were small and not supported by confidence intervals. In contrast, talocrural joint manipulation produced significant gains across all outcomes (d = 0.78-0.87; p <.001). Intergroup analyses confirmed greater benefits with manipulation, particularly for overall postural stability (r = 0.45-0.52; p <.001, d = 0.78; p = .002), including the primary outcome of overall postural stability (r = 0.47; p <.001; CI = 3.00 to 9.00 points). No significant carryover effects were detected (f = 0.26-2.80; p = .10-0.61). Participants with audible cavitation showed greater improvements in both outcomes (r = 0.411-0.720; p <.001-0.034).

These preliminary findings suggest that talocrural joint manipulation may induce immediate improvements in postural stability and ankle mobility in patients with chronic stroke, without any adverse events.