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

Abstract

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

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

Methods: 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.

Results: 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).

Conclusion: 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.