Systematic Review of Chuna Manipulative Treatment for Ankle Sprain

  • Kwak, Min Kyung (Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Dong-Shin University) ;
  • Kim, Min Wook (Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Dong-Shin University) ;
  • Jeong, Sang Jun (Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Dong-Shin University) ;
  • Kim, Shin Ae (Chung-Yeon Korean Medicine Hospital, Chung-Yeon Medical Institute) ;
  • Jeong, Mi Young (Department of Nursing, Dong-Shin University Gwangju Korean Medicine Hospital) ;
  • Kim, Jae Hong (Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Dong-Shin University)
  • Received : 2018.04.19
  • Accepted : 2018.05.04
  • Published : 2018.05.30


Background: This study was performed to review the efficacy of national and international randomized controlled trials (RCT) investigating Chuna manipulative treatment for ankle sprains. Methods: Online databases (PubMed, Cochrane, EMBASE, CNKI, NDSL, OASIS), were searched for studies where Chuna treatment was performed for ankle sprains up to October 12th, 2017. Only RCT were selected that fulfilled the inclusion/exclusion criteria. Data were analyzed using the Cochrane risk of bias tool. Results: There were 676 studies retrieved from the databases, resulting in analysis of 24 RCT. There was an average of 7 treatment visits over a 7 day period and the most frequent evaluation tool used was efficacy rate, with drug therapy being the most common control used in the trials. In 15 RCT, several Chuna methods were used in combination, amongst which, the osteopathic technique was most common. Statistically significant improvement in evaluation indices was reported in 19 RCT, and in 3 RCT, statistically significant improvement was reported, but not for all indices. In the remaining 2 RCT, there were no significant differences in any of the evaluation indices. No adverse reactions were reported in any of the RCT, although it was unknown whether all the trial protocols indicated that adverse reactions should be monitored, and for this reason, the risk of bias was unclear. Conclusion: The review of 24 studies suggest that Chuna manipulative treatment for ankle sprains was effective in most cases, although, potential bias in these studies was difficult to evaluate.


  1. Korean Acupuncture & Moxibustion Medicine Society Textbook Compilation Committee. Acupuncture Medicine. 4th ed. Seoul (Korea): Hanmi Medicine Publish Company; 2016. p. 558-563. [In Korean]
  2. The Society of Korean Medicine Rehabilitation. Oriental Rehabilitation Medicine. 3rd ed. Seoul (Korea): Koonja Publishing Inc.;2011. 238 p. [In Korean]
  3. Department of Orthopaedic Surgery, Seoul National University College of Medicine. Orthopaedics for medical student. 4th ed. Seoul (Korea): Koonja Publishing Inc.;2016. p.349-351. [In Korean]
  4. Lee CH, Kim B, Jung H, Lee KW, Yang DM, Oh MS. Review on the Study of Ankle Sprain Published in Korea. J Korean Med Rehabi 2015;25:71-76. [In Korean]
  5. Korean Society of Chuna manual Medicine for Spine & Nerve. Chuna manual medicine. Seoul (Korea): Korean Society of Chuna manual Medicine for Spine & Nerve;2013. p.3-5, 19. [In Korean]
  6. Han SW, Kim JW, Kim CY, Uhm BK, Ro HR, Choi HS et al. A Case Report of Prescribing Ligamentous Articular Strain Technique for the Three Patients with Chronic Ankle Pain. JKCMSN 2012;7:131-138. [In Korean]
  7. Choi YJ, Kim JH, Yoon KJ, Yeo IH, Lee CK, Lee EY et al. Comparative Study of General Oriental Medical Treatment with or without Ankle Joint Chuna Therapy on Ankle Sprain. JKCMSN 2012;7:109-117. [In Korean]
  8. Shim YS, Song HS. Effect of Manipulation Complex Therapy on Ankle Sprain with Ankle Pain. J Acupunct Res 2013;30:65-71. [In Korean]
  9. Koo CH, Lee IH, Park KL, Bae SS. The Effect of Passive Joint Mobilization and Massage on subacute Lateral Ankle Ligament Injuries. J Kor Phys Ther 2005;17:457-467. [In Korean]
  10. Lee DY, Kim SJ. Clinical Study on the Ankle Joint Traction Therapy for Ankle Sprain. J Korean Med Rehabi 2005;15:39-46. [In Korean]
  11. Lee JS, Han KW, Kim ES, Woo JH, Lee SJ, Nam JH et al. Comparison Study on the different therapy for Ankle Sprain-Using Dry Needle, Hwangryunhaedoktang Herbal Acupuncture, ankle joint traction therapy. J Oriental Sports Med 2011;11:13-20. [In Korean]
  12. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 4th ed. Chichester (UK): John Wiley & Sons;2011. p.187-241.
  13. Chen P, Yu XB, Chen HY. Application of Home Medical Treatment Using Simplify Shaking and Pulling Techniques in Acute Ankle Sprain. Chinese J Trad Med Traum & Orthop 2016;24:68-69,73. [In Chinese]
  14. Wang FG, Wen RQ. Observation of 44 Cases of Ankle Sprain Treated With Acupoint Massage. Chinese Manipulation & Qi Gong Therapy 1989;5:12-13. [In Chinese]
  15. Huang D, Pan ZX, Chen K. Efficacy evaluation of treating acute ankle sprains by Lijin technique. Clin J Chinese Med 2012;4:41-42. [In Chinese]
  16. Li X, Xu YS, Luo ML, Cao XW. Observation of 43 Cases of Acute Ankle Sprain Treated With Lin's Manipulation. J New Chinese Med 2011;43:37-38. [In Chinese]
  17. Chen B, Gao NY, Wang X, Chen YC, Li LH, Lin X et al. The Analgesic Effect of the Chinese Massage Technique for Ankle Sprain in Wushu Athletes. Chinese J Trad Med Traum & Orthop 2012;20:18-19, 22. [In Chinese]
  18. Gao B. 92 Cases of Simple Ankle Sprain Treated With Four Step Manipulations. Shaanxi J Trad Chinese Med 2014;35:873. [In Chinese]
  19. Chen ZL, Hong W. Clinical Study of Traditional Setting Manipulation with External Application of Chinese Medicine in the Treatment of Acute Ankle Sprain. China J Chinese Med 2011;26:245-246. [In Chinese]
  20. Yao SH, Yu ZN, Wu WH, He J. 64 Cases of Acute Ankle Sprain Treated With Wang Zhengzheng Manipulation and Chinese Herbs. Guangming J Chinese Med. 2013;28:299-300. [In Chinese]
  21. Gao JH, Lin ZY, Chen H, Song H, Gao CY, Ding HL. The Observation of Shake-stamp-pull Technique in Improving the Efficacy of Acute Lateral Ankle Sprain Dysfunction. Chinese J Trad Med Traum & Orthop 2013;21:14-16. [In Chinese]
  22. Gao CY, Cheng H, Lin ZY, Chen ZJ, Zhao WG, Ding HL et al. Effects of shaking-pulling-poking manipulation on relieving pain and swelling in patients with acute lateral ankle sprains. Beijing J Trad Chinese Med 2015;34:3-6. [In Chinese]
  23. Wang J. Observation of 42 Cases of Sports Ankle Sprain Treated With Comprehensive Therapy. J Shanxi College Trad Chinese Med 2011;12:41-42. [In Chinese]
  24. Ma ZR. Analysis of Effect of Osteopathic Manipulation Treatment of Chinese Medicine on Ankle Sprain. Nei Mongol J Trad Chinese Med 2017;36:22-23. [In Chinese]
  25. Wang AF. 81 Cases of Ankle Sprain Treated With Osteopathic Manipulation Treatment of Chinese Medicine. Henan Trad Chinese Med 2012;32:1494-1495. [In Chinese]
  26. Chen B, Wang X, Gao NY, Lin X, Chen YC, Li LH et al. Clinical observation on Tuina manipulation for ankle sprain in Wushu athletes. Shanghai J Trad Chinese Med 2012;46:56-58. [In Chinese]
  27. Huang YW. Clinical observation of acupuncture treatment combination of functional exercise on acute grade III ankle lateral collateral ligament injury. Modern Prevent Med 2012;39:2123-2125. [In Chinese]
  28. Yu XH. Clinical Observation on Acupuncturing and Chinese Naprapathy for the Treatment of Ankle Joint Sprain. Chinese J Tradit Med Traum & Orthop 2007;15:14-15. [In Chinese]
  29. Cao J. Clinical Research of 36 Cases of Ankle Sprain Treated With Acupuncture and Chuna Manipulation. Asia-Pacific Trad Med 2015;11:76-77. [In Chinese]
  30. Zhao M, Gao W, Zhang L, Huang W, Zheng S, Wang G et al. Acupressure Therapy for Acute Ankle Sprains: A Randomized Clinical Trial. PM R 2018;10:36-44.
  31. Cleland JA, Mintken PE, McDevitt A, Bieniek ML, Carpenter KJ, Kulp K et al. Manual Physical Therapy and Exercise Versus Supervised Home Exercise in the Management of Patients With Inversion Ankle Sprain: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2013;43:443-455.
  32. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic Manipulative Treatment in the Emergency Department for Patients With Acute Ankle Injuries. J Am Osteopath Assoc 2003;103:417-421.
  33. Salo D, Fiesseler F, Pierce J, Paley L, Eskin B, Silverman M et al. A Randomized, Clinical Trial Comparing Ankle Manipulation With Standard Treatment to Standard Treatment Alone for the Treatment of Acute Ankle Sprains. Ann Emerg Med 2012;60:S85-S86.
  34. Kim SY, Park JE, Seo HJ, Lee YJ, Son HJ, Jang BH et al. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul (Korea): NECA;2011. 65 p. [In Korean]
  35. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials. Int J Surg 2011;9:672-677.