The Tarsal Twist Manipulation: A Case Report

Abstract

Background and Purpose: Ankle joint injuries account for up to 34% of all athletic related injuries, with lateralankle sprains comprising up to 85% of these ankle injuries. Clinical practice guidelines for ankle sprains are wellestablishedand should be utilized in the management of lateral ankle sprains; however, it is unknown how lowerextremity joint manipulation may add to the management of lateral ankle sprains. The purpose of this case reportis to describe the outcomes of a 14-year-old male basketball player with a lateral ankle sprain who respondedfavorably to a Tarsal Twist manipulation.Case Description: A 14-year-old male basketball player was seen in physical therapy for the management of alateral ankle sprain. The patient experienced localized pain and swelling at the lateral ankle, pain with activity,decreased range of motion, weakness, and decreased balance. Treatment included standard of care, with theinclusion of a Tarsal Twist manipulation.Outcomes: A test-retest method was utilized to determine the outcomes of the Tarsal Twist manipulation.Immediate improvements in the Star Excursion Balance Test and a decrease in pain with activity occurred after theTarsal Twist manipulation. Following seven visits of physical therapy utilizing standard of care with the additionof the Tarsal Twist manipulation, the patient was able to return to basketball.Discussion: A meaningful change in the Star Excursion Balance Test and pain during activity occurred immediatelyafter the Tarsal Twist manipulation, suggesting that this manipulation was helpful for this patient.