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Effect of Manual Therapy Techniques on Ankle Dorsiflexion Range of Motion: A Systematic Review With Meta-Analysis and
Alice Loures de Paula1, Bruna de Castro Moreira1, Isabella Cristina Moreira Baião1
1Universidade Federal de Juiz de Fora, Brazil.
Objective:
The purpose of this review was to summarize findings from randomized controlled trials on the immediate and short-term efficacy of manual therapy techniques ankle dorsiflexion range of motion.
Methods:
RCTs published in any language were identified through systematic searches in MEDLINE/PubMed (via the National Library of Medicine), Scopus (Elsevier), CINAHL (EBSCO), LILACS, EMBASE (Elsevier), and Web of Science (Clarivate Analytics), covering literature up to December 2024. Search terms included combinations of "range of motion," "ankle joint," and "musculoskeletal manipulations." Two reviewers independently screened records, extracted data, and assessed risk of bias using the PEDro scale, with a third reviewer resolving disagreements. Random-effects meta-analyses were conducted to calculate standardized mean differences. Certainty of the evidence was assessed using the GRADE approach.
Results:
Four trials (191 participants; mean age range = 22.3-72.6 years; 54% women) met the inclusion criteria. Compared to sham interventions, manual therapy showed a statistically significant improvement in ankle dorsiflexion (SMD = 0.62; 95% CI [0.31-0.94]; I² = 87%; P < .01), with very low-quality evidence due to heterogeneity and imprecision according to the GRADE approach. There was a limited number of included studies and participants, and methodological heterogeneity across trials.
Conclusions:
Manual therapy applied to the ankle joint may enhance weight-bearing dorsiflexion range of motion. However, the certainty of evidence supporting these effects was very low.
Registration:
PROSPERO CRD42024555987.
