Ankle sprain: pathophysiology, predisposing factors, and management strategies.

48 – 50 A recent systematic review 51 indicated that multiple HVLA thrusts delivered over several treatment sessions resulted in a statistical trend towards improving pain pressure scores and self-report levels of pain. 52 Further, a single treatment session, which involved multiple osteopathic and manipulative techniques, immediately reduced self-reported pain relative to a control group in patients with acute LAS. 53 Similarly, studies that used multiple manipulative techniques 54 , 55 delivered over several treatment sessions reported significant improvements in pain outcome measures.

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