Mobilisation and ankle joint range of motion

NewsBot · Oct 12, 2018

The immediate effects of two manual therapy techniques on ankle musculoarticular stiffness and dorsiflexion range of motion in people with chronic ankle rigidity: A randomized clinical trial.
Hidalgo B et al
J Back Musculoskelet Rehabil. 2018;31(3):515-524. doi: 10.3233/BMR-170963.

OBJECTIVE:
Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity.

DESIGN:
A randomized clinical trial with two arms.

METHODS:
Patients were recruited by word of mouth and via social network as well as posters, and analyzed in the neuro musculoskeletal laboratory of the "Université Catholique de Louvain-la-Neuve", Brussels, Belgium.

PARTICIPANTS:
67 men (aged 18-40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM.

INTERVENTIONS:
Two modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients.

MAIN OUTCOME MEASURES:
Comprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann's device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well.

RESULTS:
A two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p= 0.37), viscous-stiffness (p= 0.83), total-stiffness (p= 0.58). For WBADF-ROM: toe-wall distance (p= 0.58) and angular ROM (p= 0.68). Small effect sizes between groups were determined with Cohen's d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d= 0.003-0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the effect of each intervention on the sample categorized according to injury history status, and demonstrated a significant interaction between groups and time only for viscous stiffness (p= 0.04, d=-0.55).

CONCLUSION:
A single session of MWM and OM targeting the talocrural joint failed to immediately improve all measures in.
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NewsBot · Oct 31, 2018

Relationship of Ankle Dorsiflexion and Gastrocnemius Tightness and Posterior Talar Glide
Min Hyeok Kang
Journal of International Academy of Physical Therapy Research 2018

It has been reported that gastrocnemius tightness and posterior talar glide are crucial factors influencing ankle dorsiflexion. However, the relationship of ankle dorsiflexion and these factors is not identified in previous studies. The purpose of this study was to identify the relationship of ankle dorsiflexion passive range of motion and gastrocnemius tightness and posterior talar glide. Twenty-five male subjects participated in this study. Bilateral weight-bearing ankle dorsiflexion passive range of motion and amount posterior talar glide of participants were measured using an inclinometer. Change in myotendinous junction of medial gastrocnemius was measured using ultrasonography to identify gastrocnemius tightness. Pearson product moment correlations were performed to examine correlations between ankle dorsiflexion passive range of motion and gastrocnemius tightness and posterior talar glide. Present findings revealed significant correlation between ankle dorsiflexion passive range of motion and gastrocnemius tightness (p=0.017, r=0.336). Also, ankle dorsiflexion passive range of motion was correlated with posterior talar glide (p=0.001, r=0.470). The present findings provide experimental evidence for factors influencing weight-bearing ankle dorsiflexion.
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NewsBot · Jan 22, 2019

The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals
Stephanie R.AlbinaShane L.KoppenhaverbBrookeBaileyaHilaryBlommelaBradFenteraChrisLowrimoreaAndrew C.SmithaThomas G.McPoila
The Foot; Volume 38, March 2019, Pages 70-75

Highlights
•MyotonPRO is a reliable tool to assess gastrocnemius stiffness in weightbearing.
•A single measure of the MyotonPRO is reliable.
•Individuals receiving manual therapy demonstrated changes in muscle stiffness
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Design
Randomized clinical trial.

Background
Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals.

Objectives
The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state.

Methods
Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients.

Results
There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p < .01), but not contracted state (p = .54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between .898 and .986.

Conclusion
The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements.
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NewsBot · Nov 22, 2019

AN INVESTIGATION INTO THE IMMEDIATE EFFECTS OF ANKLE JOINT MOBILISATION IN PEOPLE WITH ANKLE EQUINUS
AARON J. WHOLOHAN
B.Hlth.Sc (Pod), M.Hlth.Sc (Pod), Grad.Cert.Ed (Higher Ed)
Submitted in fulfilment of the requirements for the degree of
Doctor of Philosophy
Queensland University of Technology

Ankle equinus (AE) is a common condition that, by definition, occurs when the ankle
displays limited or reduced ankle dorsiflexion. It has been suggested that over 24% of
the population may exhibit AE, which is commonly assessed through several clinical
measures including non-weight-bearing passive measures. Despite its high prevalence,
there is no consensus regarding the magnitude of restriction required to define this
condition; however, clinically, an ankle restriction of less than 10° is commonly used
to define AE. Several studies have shown AE to be associated with pathology and
deficiencies. The goal of treatment for AE is to regain adequate ankle dorsiflexion.
Limited research has been conducted on the conservative management of AE and
whether such treatment can ameliorate the pathology or reduce the functional deficits
associated with the condition. To date, studies have focused mainly on improving
ankle dorsiflexion range through the use of stretching, with limited evidence
investigating functional changes associated with AE, such as impaired balance or
increases in forefoot plantar pressures.
Ankle mobilisation therapy (AMT) is one management option that is used to improve
ankle range of motion (AROM). This treatment option has also been used for the
management of musculoskeletal pain, although its mechanisms of action are unclear
and thus the proposed mechanisms have been assumed from spinal research. Some
AMT studies have shown significant improvements in AROM, pain and functional and
balance measures in people with ankle instability and healthy populations; however,
limited research has been performed in people with AE and using measures such as
plantar pressures, muscle activity and dynamic ankle dorsiflexion. The primary aim of
this thesis was to investigate the immediate effects of AMT in people with AE.
To investigate the immediate effects of AMT in people with AE, four randomised
control trials (RCTs) were conducted with volunteers recruited from the Queensland
University of Technology community. After reviewing the literature, outcome
parameters were selected including plantar pressures, balance performance, muscle
activity and dynamic AROM. Measures of the force applied during AMT were also
obtained because these have not been previously reported. AE was assessed clinically
using a passive ankle dorsiflexion measure, and volunteers who displayed an ankle
dorsiflexion measure of less than 8° were included. Participants were randomly
assigned to either a control group (sham intervention) or AMT group (2-minute AMT
protocol). Reliability was determined for each of the outcome parameters and AMT
force. All variables relating to plantar pressures, balance performance, muscle activity
and dynamic AROM displayed acceptable reliability. Only half of the force application
variables displayed adequate reliability.
RCTs were conducted to determine the immediate effects of AMT on plantar pressures
(n=30), balance performance (n=30), muscle activity (n=22) and dynamic ankle ROM
(n=18). Force application variables were compared between the four studies. Results
for the four RCTs indicated no significant difference in any outcome parameters
between the control and AMT groups. Force application varied during a single 2-
minute application and between the four RCTs.
The results of these RCTs provide evidence that AMT does not immediately affect
parameters associated with plantar pressures, balance performance, muscle activity and
dynamic AROM. At an individual level, there were too few respondents after AMT to
be able to ascertain whether participant characteristics or force application had an
effect on outcomes. Although the immediate effects of AMT may lower self-reported
ankle stiffness, AMT does not have a discernible effect on clinical measures of plantar
pressures, balance performance, muscle activity or dynamic AROM after a single
application. It is recommended that future research focus on using alternative
measurement approaches and evaluating the effects of larger AMT doses.
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NewsBot · Nov 25, 2019

Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial
Murat Tomruk, Melda Soysal Tomruk, Emrullah Alkan and Nihal Gelecek
Journal of Sport Rehabilitation

Context: Ankle proprioception is one of the crucial components contributing to postural control. Although the effects of Mulligan’s mobilization with movement (MWM) on postural control, ankle dorsiflexion range of motion (DFROM), and muscle strength in people with ankle disorders have previously been investigated, it is still unclear whether ankle MWM had ability to change postural control, DFROM, and muscle strength. Objectives: To reveal pure effects of MWM on postural control, ankle DFROM, and muscle strength in healthy individuals. Design: A prospective, randomized, double-blinded, sham-controlled study. Setting: Musculoskeletal laboratory, Dokuz Eylul University, Turkey. Participants: Forty students in good health recruited from a local university. Interventions: Mulligan’s MWM or sham application over ankle joint. Main Outcome Measures: The primary outcome was postural control and measured using limits of stability (LOS) test. The secondary outcomes were tibialis anterior muscle strength and ankle DFROM, which were measured using handheld dynamometer and weight-bearing lunge test, respectively. All outcomes were assessed before and immediately after intervention. Results: Left and right ankle DFROM and LOS overall score showed a statistically significant improvement compared with first measurement in both groups (P < .05). However, LOS time was significantly improved only in the MWM group (P < .05). Statistical analyses of between-group mean differences showed that Mulligan’s MWM provided significant improvement in the LOS in forward–right direction compared with sham application (P = .03). Conclusions: The results of this study suggest that the application of Mulligan’s MWM on ankle joint might be beneficial to improve postural control in forward right direction in individuals with healthy ankles. On the other hand, both MWM and sham application were able to increase overall postural control and DFROM, and MWM had no superiority over sham application for increasing these 2 variables.
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NewsBot · May 7, 2020

Effectiveness of clinician- and patient-applied mobilisation with movement technique to increase ankle dorsiflexion range of motion
Justin M Stanek, Alex E Pieczynski
Published Online:30 Apr 2020

Background/aims
Restricted ankle dorsiflexion has the potential to cause acute and chronic injuries. One method for increasing dorsiflexion range of motion is the application of joint mobilisation with movement. An alternative to clinician-applied mobilisation with movement is self-applied mobilisation with movement; however, this technique has not been previously studied. The objective of this study was to evaluate the effectiveness of self-applied and clinician-applied mobilisation with movement technique for improving dorsiflexion range of motion in participants with ≤34° of dorsiflexion.

Methods
A total of 42 typically healthy participants qualified and were randomly assigned to the control, self-applied, or clinician-applied mobilisation with movement group. Closed chain ankle dorsiflexion range of motion was assessed using a modified weight-bearing lunge test.

Results
Both mobilisation groups showed significant increases in standing and kneeling dorsiflexion range of motion when compared to the control group, with no differences between treatment groups.

Conclusions
These findings suggest clinicians can teach patients to apply mobilisation with movement and receive similar benefits to a clinician-applied mobilisation with movement treatment.
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NewsBot · Jul 30, 2020

Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation
Michael A. Lawrence et al
July 20, 2020

Objectives
The purpose of this study was to determine whether high-velocity, low-amplitude ankle region manipulations could increase force output and muscle activation of hip musculature in individuals with a history of ankle sprain and unilateral tensor fascia latae (TFL) weakness during muscle testing.
Methods
This investigation used a single-arm repeated measures design. Twenty-five participants’ force outputs were tested at three time points (before manipulation, immediately after manipulation, and 48 hours after manipulation), and muscle activation of the rectus femoris, gluteus medius, and TFL was measured before and immediately after manipulation. Manipulations were applied to the talocrural, subtalar, proximal, and distal tibiofibular joints of the weaker limb. No contralateral manipulations were applied. Two-way repeated measures analysis of variance was used to compare maximal and average force production for each limb. In addition, paired t tests were used to compare muscle activation before and after manipulations.
Results
There was a significant limb × time interaction. The involved limb average force increased from before manipulation (65.7 N) to 48 hours after manipulation (77.8 N; P = .014), maximal force increased (76.9 N) 48 hours after manipulation (87.8 N; P = .030), and gluteus medius activation increased (9.8% maximum, 12.2% average) immediately after manipulation. No significant differences were found in the uninvolved limb.
Conclusion
The results of this study suggest that high-velocity, low-amplitude ankle region manipulations might improve hip abductor strength in individuals with a history of ankle sprain and unilateral weakness during a TFL muscle test.
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NewsBot · Aug 31, 2020

Inferior tibiofibular joint mobilization with movement and taping does not improve chronic ankle dorsiflexion stiffness: a randomized placebo-controlled trial
Anh Phong Nguyen et al
Journal of Manual & Manipulative Therapy: 18 Aug 2020

Objective
This study compared the modification of musculoarticular stiffness (MAS) and clinical outcomes after mobilization with movement (MWM) on the inferior tibiofibular joint and a placebo MWM. Moreover, injured and non-injured ankle MAS were compared after MWM therapy.

Methods
A single-blinded randomized trial was conducted on 75 participants (mean age: 22.3 ± 2.17 years) with chronic self-reported asymmetric perception of ankle dorsiflexion stiffness. Participants were allocated to one of three groups: inferior tibiofibular MWM (ITFMWM), placebo and non-injured. Sinusoidal oscillation methods were used for experimental quantification of the MAS and clinical outcomes were assessed using the weight-bearing lunge test (WBLT), pain and stiffness perception. Three assessments were made: one pre-treatment (T0), one after the manual technique (T1) and one after taping (T2).

Results
Two-way ANOVA showed no significant differences between the groups and no interaction effect for the outcome measures. However, a significant difference for the time effect (T0-T1-T2) was found in the three groups for WBLT dorsiflexion range of motion (p < 0.001, Cohen’s d = 0.21) and stiffness perception (p < 0.001, Cohen’s d = 0.54) but the minimal clinically important differences were not reached for either value.

Discussion
The results could not support that a single session of ITFMWM modifies MAS or the clinical outcomes compared to placebo treatment. Furthermore, injured MAS does not differ from non-injured MAS in chronic ankle dorsiflexion stiffness. Further studies should assess subjects’ responsiveness concerning the Mulligan concept and focus on a medium- to long-term follow-up.
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NewsBot · Dec 20, 2020

Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial
Murat Tomruk, Melda Soysal Tomruk, Emrullah Alkan and Nihal Gelecek
Journal of Sport Rehabilitation

Context: Ankle proprioception is one of the crucial components contributing to postural control. Although the effects of Mulligan’s mobilization with movement (MWM) on postural control, ankle dorsiflexion range of motion (DFROM), and muscle strength in people with ankle disorders have previously been investigated, it is still unclear whether ankle MWM had ability to change postural control, DFROM, and muscle strength. Objectives: To reveal pure effects of MWM on postural control, ankle DFROM, and muscle strength in healthy individuals. Design: A prospective, randomized, double-blinded, sham-controlled study. Setting: Musculoskeletal laboratory, Dokuz Eylul University, Turkey. Participants: Forty students in good health recruited from a local university. Interventions: Mulligan’s MWM or sham application over ankle joint. Main Outcome Measures: The primary outcome was postural control and measured using limits of stability (LOS) test. The secondary outcomes were tibialis anterior muscle strength and ankle DFROM, which were measured using handheld dynamometer and weight-bearing lunge test, respectively. All outcomes were assessed before and immediately after intervention. Results: Left and right ankle DFROM and LOS overall score showed a statistically significant improvement compared with first measurement in both groups (P < .05). However, LOS time was significantly improved only in the MWM group (P < .05). Statistical analyses of between-group mean differences showed that Mulligan’s MWM provided significant improvement in the LOS in forward–right direction compared with sham application (P = .03). Conclusions: The results of this study suggest that the application of Mulligan’s MWM on ankle joint might be beneficial to improve postural control in forward right direction in individuals with healthy ankles. On the other hand, both MWM and sham application were able to increase overall postural control and DFROM, and MWM had no superiority over sham application for increasing these 2 variables.
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NewsBot · Nov 14, 2021

Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes
Michael E. Lehr et al
November 13, 2021

Highlights
•Closed Chain Dorsiflexion Range of Motion (CKCDFROM) and Y-Balance Test Lower Quarter (YBT-LQ™) are two reliable and valid tests that can be administered during ankle/foot management.
•Closed Chain Mobilization with Movement (CKCMWM) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are two cost-effective, non-invasive manual therapy (MT) options for a clinician managing ankle/foot pathology aimed at improving CKCDFROM.
•Neurophysiological thresholds and “overload” may be exceeded in an individual, which may be reached if MT techniques are compounded within one treatment session-thus minimizing benefits in improved osteokinematic motion at the talocrural joint.
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Introduction/purpose
Literature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement (MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions.
Methodology/sample
In this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance.
Results
ANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm.
Discussion/clinical relevance
Specifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a “low risk-high reward” clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.
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NewsBot · Feb 3, 2022

Talus mobilization-based manual therapy is effective for restoring range of motion and enhancing balance in older adults with limited ankle mobility: A randomized controlled trial.
DavidHernández-Guillén et al
Gait & Posture; Volume 93, March 2022, Pages 14-19

Highlights
•Ankle range of motion (ROM) declines with age.
•Anteroposterior talus mobilization is useful to improve ankle ROM.
•This in turn has a positive impact on dynamic balance, mobility and stability.
•No effect is observed in static standing balance.
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Background
The ankle plays a key role in balance, but ankle range of motion decreases with ageing.

Research question
To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process.

Methods
Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions.

Results
Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05).

Significance
An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility.
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NewsBot · Mar 8, 2022

Comparison of manual therapy techniques on ankle dorsiflexion range of motion and dynamic single leg balance in collegiate athletes
Michael E Lehr et al
J Bodyw Mov Ther. 2022 Jan;29:206-214

Introduction/purpose: Literature consistently identifies two key examination components when managing ankle/foot pathologies: 1) dorsiflexion range of motion (DFROM) and 2) single limb balance. Mobilizations with movement (MWM) and Instrument-Assisted Soft Tissue (IASTM) are two emerging manual therapy (MT) options in the management of ankle/foot conditions.

Methodology/sample: In this observational cohort study, 147 subjects were randomized in a block fashion as follows: 1) Control, 2) IASTM, 3) MWM, and 4) Combination of both MT interventions. Descriptive statistics of the sample were conducted with integrity checks followed by comparative analysis for mean change between the variables or DFROM and YBTLQ ™ performance.

Results: ANOVA Welch's F indicated significant differences between the treatment conditions (Welch's F (3,75.669) = 4.533, p = .006). Games-Howell post hoc tests indicated significantly more change in DFROM in the IASTM (p = .043) and CKCMOB (p = .026) conditions when they were administered as single treatments, than in the Control Condition or when the treatments were combined. Dynamic balance, as measured by the YBT-LQ™, did not yield a significant response based on the intervention arm.

Discussion/clinical relevance: Specifically, IASTM or closed kinetic chain (CKC) MWM MT techniques used in isolation can be considered a cost-effective intervention that can be administered by a skilled MT practitioner in a "low risk-high reward" clinical scenario with potential biomechanical and neurophysiological benefits for improving CKCDFROM.
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NewsBot · Apr 11, 2022

Intraclinician Variability in Force Application During Anteroposterior Mobilization of the Ankle Joint
Aaron J.WholohanPhD TedJedynakBPod
Journal of Chiropractic Medicine; 4 April 2022

Objective
The purpose of this study was to quantify the variability in the force applied during 20 cycles of Maitland's grade IV anteroposterior ankle mobilization measured on 2 occasions.

Methods
Thirteen healthy adults (mean age, 25 ± 5 years; height, 170 ± 7 cm; weight, 71 ± 16 kg) received 20 cycles of Maitland's grade IV ankle mobilization on 2 sessions separated by 1 week. A force transducer was used to measure the peak force, loading rate, and impulse applied during each load cycle. Mean within-session coefficient of variation, standard error of measurement, and 95% level of agreement were estimated during each mobilization session.

Results
The mean peak force during the anteroposterior mobilization technique was 70 ± 12 N and 58 ± 10 N during sessions 1 and 2, respectively. The mean within-session coefficients of variation in peak force, loading rate, and impulse applied during 20 loading cycles were 10% to 13%, 15%, and 21% to 43%, respectively. There was a significant difference between sessions in mean peak force (−17%, t12 = 2.445, P = .031) and impulse (−51%, t12 = 2.306, P = .040), with large 95% levels of agreement in applied peak force (±33 N) and impulse (±128 N s) compared to their mean values (approximately ±50% and 110%, respectively).

Conclusion
The peak force and loading rate applied by an experienced practitioner during a Maitland's grade IV anteroposterior talar mobilization session varied over 20 loading cycles. Variability between repeated mobilization sessions by the same practitioner was even greater, with respect to peak applied force and loading rate. The large variability in force applied during a Maitland's grade IV talar mobilization may underpin differential clinical effects reported in the joint-mobilization literature. The findings of this study highlight the need for strategies that standardize the application of force during talar mobilization.
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NewsBot · Apr 16, 2022

Effects of Mobilization With Movement Using Posterior Talus Glide Taping
Added Myofascial Release on Kinematic Data of Dynamic Balance in Individuals
With Calf Shortening
Min-A Seo et al
Phys Ther Korea. 2022;29(1):70-78

Background: Individuals with calf muscle shortening may have decreased dynamic balance.
Objects: This study aimed to investigate the effect of mobilization with movement (MWM)
and myofascial release (MFR) on kinematic changes in dynamic balance in individuals with calf
muscle shortening.
Methods: Thirteen participants were randomly assigned to the MWM or the mobilization
with movement added myofascial release (MWM-MFR) group. The MWM group received
treatment with only MWM, whereas the MWM-MFR group was treated with MWM and MFR.
Pre- and post-intervention passive range of motion (PROM), maximum reaching lengths, and
modified star excursion balance test (MSEBT) results were compared for all participants. Wilcoxon signed-rank test and Mann-Whitney U test were used for statistical analysis.
Results: The results showed significant within-group differences in ankle PROM, but no significant between-group differences. The maximum reaching length in the MWM-MFR group
in the posterolateral direction was significantly different before and after the intervention (p
= 0.005). This group also showed significantly reduced ankle abduction in MSEBT during
the posteromedial direction section 3 (p = 0.007) and posterolateral direction section 5 (p =
0.049) compared with the MWM group.
Conclusion: Combined MWM and MFR intervention improves ankle stability in the coronal
plane during the posteromedial and posterolateral forward movement in dynamic balance
compared with only MWM in individuals with calf shortening.
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NewsBot · Jun 27, 2022

Immediate Effects of Long-Axis Talocrural Thrust Manipulation on the Length of the Anterior Talofibular and Calcaneofibular Ligaments Measured With Musculoskeletal Ultrasound Imaging
Rob Sillevis, PT, DPT, PhD
June 23, 2022

Objective
The aim of the present study was to measure the immediate effect of a thrust manipulation on the length of the anterior talofibular and calcaneofibular ligaments in healthy patients.
Methods
A convenience sample of 47 healthy patients were recruited for this quasi-experimental study. The patients had an age range from 22 to 54 years, with a mean age of 30.36 years. There were 23 female patients and 24 male patients. Musculoskeletal ultrasound imaging was used to measure the length of the anterior talofibular and calcaneofibular ligaments before and immediately after a high-velocity long-axis thrust manipulation of the talocrural joint during various validated test positions.
Results
A single long-axis thrust manipulation did not result in a significant change in the length of the anterior talofibular ligament (P = .325). Additionally, there was no significant difference in calcaneofibular length after a long-axis thrust manipulation (P = .26).
Conclusion
The results indicate that the length of the anterior talofibular and calcaneofibular ligament did not significantly change after a single long-axis thrust manipulation of the talocrural joint in healthy patients. It appears that the joint capsule of the talocrural joint reached end-range during the manipulation before the ligament undergoes plastic length changes; thus, the increase in joint range of motion after a thrust manipulation was probably not due to increased plastic length changes of the anterior talofibular and calcaneofibular ligaments.
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NewsBot · Jun 6, 2023

Dose-response of talus mobilizations in weight bearing ankle dorsiflexion ROM of the older adults with limited ankle mobility: A randomized clinical trial
Catalina Tolsada-Velasco et al
International Journal of Osteopathic Medicine; 30 May 2023, 100670

Background
Although manual therapy is an effective technique for increasing ankle range of motion, the dose-response required is unclear.

Objective
To find out what number of sessions of talus mobilizations will induce a detectable change in weight bearing ankle dorsiflexion range of motion of older adults with limited ankle mobility.

Design
Four-arm randomized clinical trial.

Setting
Community-dwelling.

Methods
62 older adults; aged over 60; with ankle dorsiflexion ROM below 35°. Four groups received from one to four treatment sessions. Each session consisted of 3 mobilizations of 30 s, with of the talus in anteroposterior glide, with a rest of 30 s. Grade IV mobilizations were applied to target the accessory movement of the ankle up to the resistance offered by periarticular tissues. The Lunge test was used to measure weight bearing ankle dorsiflexion.

Results
The four groups increased their ankle mobility after one session, but two sessions were needed to overcome the established 4.7°’ threshold, regardless of group. Only those participants who received four sessions maintained the improvements for 8 weeks.

Conclusions
Two sessions of talus mobilizations are effective in improving weight bearing ankle dorsiflexion ROM. It will be necessary to deliver four sessions of treatment if these improvements are to be maintained for at least 8 weeks.
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NewsBot · Nov 9, 2023

The effects of ankle and proximal tibiofibular
manipulations on ankle ROM and squat strength and
biomechanics
Reneigh Morley-Hart
Thesis

Background: The back squat is commonly prescribed as part of strength and
conditioning programs. Squat strategies can be affected by reduced ankle dorsiflexion
range of motion (DF-ROM), leading to limited squat depth and dysfunctional
compensatory movement patterns.
Objective: The objective was to investigate the effect of high-velocity low-amplitude
lower limb manipulations on 1 repetition maximum (1RM) back squat strength, frontal
plane knee kinematics during a squat, and active DF-ROM in individuals with
asymptomatic deficits in DF-ROM.
Methods: Twenty-four resistance trained participants with asymptomatic deficits in
DF-ROM participated in this cross-over trial. Interventions involved either
manipulations targeting ankle DF-ROM, or a sham which mimicked the manipulations
using a mechanical drop mechanism. The primary outcome was change in back squat
1RM between baseline to post-intervention, and the secondary outcomes were
maximal knee valgus during the 1RM squat using 3D motion capture and change in
DF-ROM.
Results: There were statistically significant increases in 1RM after manipulation
(4.75kg, p=.001) and sham (2.75kg, p=.032), but no statistical difference between
interventions (p=.27). For maximal knee valgus during the squat, there was a
statistically significant interaction between the treatment and side during the eccentric
phase (p=.037). Post-hoc tests indicated the side with more restricted ankle ROM had
0.5° (2.7 – 3.8°) less maximal knee valgus after the manipulations compared to sham.
There were no significant interactions for maximal knee valgus during the concentric
phase (p=.10). Finally, there was no significant change in ankle DF-ROM immediately
following either intervention (p=.39).
Conclusion: The results suggest that a single session of high-velocity low-amplitude
manipulations targeting ankle DF-ROM may not result in an immediate increase in
1RM back squat strength more than sham and may not influence short-term ankle
dorsiflexion range of motion. Manipulations may change frontal plane knee kinematics
during the eccentric phase of a squat, though this may not be clinically significant.
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NewsBot · Nov 28, 2023

The effect of manual therapy on ankle dorsiflexion range of motion: A pilot crossover randomized trial
Carolyn J. Taylor, Lisa C. Hanson, Abbey Hayes, Alan Pham, Elliott Taylor, Poppy Attlesey, Gemma Stewart, Amy O'Neill, Ilana Karass, Nivan Weerakkody
Journal of Bodywork and Movement Therapies; 25 November 2023

Introduction
Restricted ankle dorsiflexion is common after lower limb injury. The aim of this pilot study was to investigate the effect of passive ankle joint mobilization and calf muscle massage on ankle dorsiflexion range of motion in adults with residual restricted dorsiflexion. The secondary aim was to assess the methodology of the pilot study to inform a larger clinical trial.

Method
The study design was a randomized cross-over trial with assessor blinding. Twenty-five healthy participants with a history of lower limb injury were included in the study. Ankle joint mobilization and calf muscle massage were applied for 5 min in a random order, one to two weeks apart. Ankle dorsiflexion was measured by using the weight-bearing lunge pre- and post-intervention (cm). Paired t-tests were used to analyze the effect of the manual therapy interventions on restricted ankles. A minimal detectable difference 95% (MMD95) was calculated. The pilot study was analyzed for suitability of inclusion criteria, blinding of assessors and the manual therapist, and the washout period.

Results
A significant increase in dorsiflexion was demonstrated for ankle joint mobilization (change score = 0.51 ± 0.76, p = 0.003) and calf muscle soft tissue massage (change score = 0.91 ± 1.07, p < 0.001). There was no difference in change scores between manual therapy techniques (mobilization 0.51 ± 0.76, massage 0.91 ± 1.07, p = 0.12). Evaluation of the pilot study revealed limitations to be modified in future studies.

Conclusion
These preliminary data indicate ankle joint mobilization and calf muscle soft tissue massage had similar effects on increasing ankle dorsiflexion range of motion in ankles with residual dorsiflexion restriction.
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Mobilisation and ankle joint range of motion

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Fibula mobilisation for increasing ankle joint ROM

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Mobilisation and ankle joint range of motion

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Fibula mobilisation for increasing ankle joint ROM

Foot and Ankle Mobilisation in Diabetic Peripheral Neuropathy

Effect of Ankle Mobilisation and Stretching on Low Back Pain

Does mobilisation of the foot and ankle change foot pressures?

Learn Foot, Knee and Hip Mobilisation in Level 1 & 2 MME (Mobilisation, Manipulation & Exercises)

Kaltenborn Mobilisations for Plantar Fasciitis

Big Debate "Foot mobilisation vs Orthotic Therapy

Share This Page

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