QUESTION: Can manual therapy improve functional outcomes for individuals with chronic ankle instability? DESIGN: Systematic review with meta-analysis of randomized controlled trials. PARTICIPANTS: Individuals with chronic ankle instability. INTERVENTION: Manual therapy is defined as an intervention that involves joint mobilization, and mobilization with movement. OUTCOME MEASURE: The primary outcome is patient reported function (PRF) questionnaires scores, the secondary outcomes are ankle dorsiflexion range of motion (DFROM) and balance control. RESULTS: Four studies were included (n = 208, mean age 24.4) in the meta-analysis, with moderate to high quality on the PEDro scale (range 6 to 8). For patient reported function (PRF) questionnaires, two studies reported significant improvement after six-session manual therapy measured by foot and ankle ability measures sport subscale (FAAMS) and Cumberland ankle instability tool (CAIT), respectively. For DFROM, one session manual therapy had no significant effect on the weight-bearing lunge test (WBLT) (3 studies n = 147, SMD 1.24 (95%CI -0.87 to 3.36), I2 = 96%) or non-weight-bearing inclinometer test (2 studies n = 47, MD 3.41 degrees (95%CI -0.26 to 7.09), I2 = 43%), while six-sessions manual therapy showed, a significantly positive effect on WBLT (2 studies n = 80, SMD 2.39 (95% CI 0.55 to 4.23), I2 = 93%). For the SEBT, one-session manual therapy had no significant effect on overall star excursion balance test (SEBT) score (3 studies n = 137, MD 2.05 (95%CI -0.96 to 5.05), I2 = 75%), while qualitative analysis of 2 included studies showed significant improvement both on the SEBT score and single limb balance test (SLBT). CONCLUSIONS: Six sessions rather than one session of manual therapy improves ankle functional performance for individuals with CAI. TRIAL REGISTRATION NUMBER: PROSPERO CRD42017054715.

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