Reduced ankle dorsiflexion range of motion is associated with biomechanical and functional changes, impacting daily activities such as walking. Assessing and addressing this limitation is clinically relevant, highlighting the need to investigate the outcomes used in populations with this condition.

This study aims to conduct systematic review and meta-analysis to evaluate and synthesize published randomized controlled trials (RCTs), providing conclusions on the short- and long-term efficacy of different manual therapy techniques on ankle dorsiflexion range of motion.

This systematic review and meta-analysis follow the PRISMA guidelines. Data were extracted from RCTs without language restrictions, identified through systematic searches in the following databases: MEDLINE/PubMed (via National Library of Medicine), Scopus (Elsevier), CINAHL (EBSCO), LILACS, EMBASE (Elsevier), and Web of Science (Clarivate Analytics). Statistical analysis will be conducted using R software. Random effects models with a 95% confidence interval (CI) will be estimated to analyze the study's outcome. Heterogeneity will be assessed using the I² index, and sensitivity analyses will be performed, whenever possible, in the presence of high heterogeneity (I² > 40%). All statistical comparisons assume a significance level of a = 0.05. Preliminary

A total of 194 studies were identified through database searches, with no additional studies found from other sources. After removing duplicates, 114 articles remained. Following title and abstract screening, 102 studies were excluded. The 12 remaining studies were assessed for full-text review, and eight studies were excluded. Thus, four studies were included and are currently undergoing qualitative synthesis and meta-analysis, totaling 191 participants (M: 104 / H: 87), of whom 107 underwent the intervention and 84 were in the control group. The participants' mean age ranged from 22.3 to 72.6 years, and their mean body mass index varied between 22.46 and 28.47 kg/m². Inclusion criteria included adults over 60 years old with dorsiflexion limitation below 35° measured by the weight-bearing lunge test, adults over 18 years old, with or without ankle injury, and those with asymmetric dorsiflexion stiffness during the weight-bearing lunge test; as well as students aged 18 to 35 years in good health. Exclusion criteria included neurological diseases, musculoskeletal conditions in the lower limb, musculoskeletal injury in the last three months, vestibular pathology, vascular disease, or a history of previous surgery in any lower extremity. Two clinical trials applied manual therapy to the ankle joint, while two used Mulligan mobilization with movement, with one of them associating a tibiofibular tape. The primary outcome assessed was the increase in dorsiflexion during the weight-bearing lunge test.

Although manual therapy is widely used to improve ankle mobility, further research is needed to determine the most effective approach. This systematic review and meta-analysis will provide evidence on the effectiveness of manual interventions to improve dorsiflexion.

Improving our understanding of different interventions that can improve ankle movement facilitates prevention strategies, rehabilitation protocols, and clinical decision-making.