Short-term effects of manual therapy in patients after surgical fixation of ankle and/or hindfoot fracture: A randomized clinical trial

Stephanie R. Albin, Shane L. Koppenhaver, Robin Marcus, Lee Dibble, Mark W Cornwall, Julie M. Fritz

Research output: Contribution to journalArticle


U BACKGROUND: Patients with surgical fixation of ankle and/or hindfoot fractures often experience decreased range of motion and loss of function following surgery and postsurgical immobilization, yet there is minimal evidence to guide care for these patients. U OBJECTIVES: To assess whether manual therapy may provide short-term improvements in range of motion, muscle stiffness, gait, and balance in patients who undergo operative fixation of an ankle and/or hindfoot fracture. U METHODS: In this multisite, double-blind randomized clinical trial, 72 consecutive patients who underwent open reduction internal fixation of an ankle and/or hindfoot fracture and were receiving physical therapy treatment of exercise and gait training were randomized to receive either impairment-based manual therapy (manual therapy group) or a sham manual therapy treatment of light soft tissue mobilization and proximal tibiofibular joint mobilizations (control group). Participants in both groups received 3 treatment sessions over 7 to 10 days, and outcomes were assessed immediately post intervention. Outcomes included ankle joint range of motion, muscle stiffness, gait characteristics, and balance measures. Group-by-time effects were compared using linear mixed modeling. U RESULTS: There were no significant differences between the manual therapy and control groups for range of motion, gait, or balance outcomes. There was a significant difference from baseline to the final follow-up in resting gastrocnemius muscle stiffness between the manual therapy and control groups (–47.9 N/m; 95% confidence interval: –86.1, –9.8; P = .01). There was no change in muscle stiffness for the manual therapy group between baseline and final follow-up, whereas muscle stiffness increased in the control group by 6.4%. U CONCLUSION: A brief course of manual therapy consisting of 3 treatment sessions over 7 to 10 days did not lead to better short-term improvement than the application of sham manual therapy for most clinical outcomes in patients after ankle and/or hindfoot fracture who were already being treated with exercise and gait training. Our results, however, suggest that manual therapy might decrease aberrant resting muscle stiffness after ankle and/or hindfoot surgical fixation.

Original languageEnglish (US)
Pages (from-to)310-319
Number of pages10
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number5
StatePublished - May 1 2019



  • Ankle
  • Balance
  • Calcaneus
  • Fracture
  • Gait
  • Manual therapy
  • Talus

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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