Joint mobilization strategies for chronic ankle instability: comparing active and passive approaches in a randomized controlled trial

Aim: This study aimed to evaluate the differential effects of active joint mobilization (AJM) versus traditional passive joint mobilization (PJM) in individuals with chronic ankle instability. We hypothesized that the integration of active components may yield superior outcomes through enhanced proprioceptive feedback and neuromuscular recruitment patterns. Methods: In this single-blind, parallel-group randomized controlled trial, thirty participants with chronic ankle instability were randomly assigned to either AJM (n = 15) or PJM (n = 15) groups. Interventions were administered by certified physical therapists three times per week for four weeks, with each session lasting 10 minutes. Primary outcome measures included the Cumberland Ankle Instability Tool (CAIT) and dorsiflexion range of motion (DFROM). Secondary outcomes focused on neuromuscular control parameters including joint position sense (JPS) and static balance, assessed at baseline and post-intervention. Results: Both groups demonstrated significant within-group improvements in multiple parameters. The PJM group showed significant improvements in CAIT (p < 0.001), DFROM (p < 0.001), and JPS (p < 0.01). Similarly, the AJM group exhibited significant improvements in CAIT (p < 0.01), DFROM (p < 0.001), and JPS (p < 0.001). Between-group comparison revealed no significant differences in any outcome measures (p > 0.05). Conclusions: Both AJM and PJM demonstrated effectiveness in improving functional ankle stability, range of motion, and proprioceptive function in individuals with chronic ankle instability. While both techniques can serve as viable therapeutic approaches, the slightly larger effect sizes observed in AJM for DFROM and proprioceptive function suggest potential additional benefits of active components (ClinicalTrials.gov identifier: NCT04630899).