Effectiveness of manual therapy with and without exercise in chronic ankle instability for pain, mobility, and function: a systematic review and meta-analysis.

Abstract

To determine the effectiveness of manual therapy with or without exercise therapy in chronic ankle instability (CAI). MEDLINE, Pubmed, Scopus, PEDro, EBSCOhost and Cochrane CENTRAL were searched from January 2000 to 13^th of January 2025 for studies on the manual therapy in the treatment of CAI. The studies with primary outcome measures of ankle range of motion (ROM), pain and self-perceived function were included. A minimal clinically important difference (MCID) was used for each outcome measure to define smallest meaningful change. Meta-analysis with random-effect model was performed for studies with similar outcome measures and GRADE analysis for performed for certainty of evidence. Manual therapy interventions were compared with exercise therapy, sham therapy or control group. The final review included 13 randomized clinical trials and a total of 497 patients. Meta-analysis of ROM, FAAM and CAIT included four, four and five studies, respectively, of which ROM and CAIT were significantly effective compared to comparison groups. Manual therapy is effective for ankle ROM and self-perceived function (CAIT), although effectiveness remained below the MCID values and certainty of evidence was low.