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Fibula mobilisation for increasing ankle joint ROM

Discussion in 'Biomechanics, Sports and Foot orthoses' started by admin, Oct 8, 2009.

  1. admin

    admin Administrator Staff Member

    Last edited: Sep 22, 2016
  2. Nicely done, Bruce......you know....there is still time for a career in television documentaries!;):eek::drinks
  3. brilliant-i wish i had been taught that stuff at college! thanks,peter mccloskey
  4. Peter1234

    Peter1234 Active Member

    I would understand this to be post-grad stuff. Does anyone know where can you go and learn how to do these maneuvers in the UK?

    I remember reading an article on these exact maneuvers but being very disappointed with the outcome - the before and after photographs were 'doctored'; the fibular angle was different on the two pictures. However this does show quite definitively that it works!! Brilliant!!
  5. Ian Linane

    Ian Linane Well-Known Member

    Hi Bruce

    Thanks for the video. Being a visual and kinesthetic learner it was good to see the technique.
    I was interested in your pre and post treatment tests and wonder if you ever include patterned muscle movement tests as part of the pre and post assesment. I ask because I tend to use a number of Maitland techniques and would include these tests as part of the pre and post asessment, especially in the case of lateral ankle injuries strains etc. Just interested if others do similar.

  6. Ian Linane

    Ian Linane Well-Known Member

    Hi Peter

    I learnt my peripheral mobilistations via the society of sports therapists in the UK. Excellent weekend course for the low limb that extended as far as hip mobilisation. I suspect that much of this stuff is underused within podiatric BMX and certainly forms part of the foot and ankle rehab part of the BMX treatment plans I do

    You could also look at the SOBART courses that are based, I think, near Nottingham. An internet search will pull them up. Actually been tempted to go and refresh the skill base again myself.
  7. Griff

    Griff Moderator


    SOBSART are running a 2 part course next year that you may be interested in.

    17 July 2010: Soft Tissue Manipulation and Mobilisation of the Foot & Ankle (Part 1)
    04 Sept 2010: Soft Tissue Manipulation and Mobilisation of the Foot & Ankle (Part 2)

    More info here

  8. Peter1234

    Peter1234 Active Member

    hi Ian,

    thanks very much,

  9. Bruce Williams

    Bruce Williams Well-Known Member

    My wife has always said I have a great face for radio!
  10. Bruce Williams

    Bruce Williams Well-Known Member


    can you explain what a patterned muscle movement test is to me please? I'm unfamiliar with that term.
  11. Ian Linane

    Ian Linane Well-Known Member

    Hi Bruce

    The term may not be the most appropriate but it relates to the capacity of a patient to achieve ranges and direction of movement in a non-weight bearing position, for example, supine with the feet over the edge of the seat. It also relates to the capacity of the foot to combine two or more of its triplanar functions at the same time.

    With the pt supine or seated upright:

    1 Ask them to dorsiflex the foot, then ask them to invert the foot.

    Enquire which of the movements seemed easier (if any). Although you may be interested in the injured foot/ankle I get them to do it bilateral (one at a time) and then bilateral (both at the same time). Note any differences in function between the two feet/ankles

    2 Then ask them to combine dorsiflexion and invertion of the foot at the sametime, one at a time and then bilateral - usually slowly. This is the patterned movement you are checking. Dorsiflexion and inversion being one of the combined movements in our gait, this test gives an insight into any possible muscular or ligamentous (?) inhibition of function.

    In pts with a history of lateral ankle injuries, performing the combined movement, I have found it common to see dorsflexion be okay but the inversion ability at the same time to be inhibited/delayed by comparison.

    Additionally I have found similar issues with the markedly pronated foot pt where they are impacting on soft tissues around the lateral ankle or S. Tarsi.

    Equally their peroneal power against resistence is frequently low.

    I would then provide either massage to the area (sometimes as little as 2 minutes brings noticable benefit) or peripheral joint mobilisation or both, usually seeing a marked improvement both in restored range of movement, regained power against resistence and improved patterned function.

    Seems to work for my folk but there may well be others who do similar under a different name.

    Hope the explaination is reasonably clear.

  12. Bruce Williams

    Bruce Williams Well-Known Member

    I have not utilized that particular array of tests in that manner. I will definitely keep in mind though. Thanks for the explanation!
  13. Ian Linane

    Ian Linane Well-Known Member

    Hi Bruce

    Be interested if you ever come across similar results. Certainly did find your video helpful though.

  14. Peter1234

    Peter1234 Active Member

    Hi Ian and Bruce,

    you say that the mobilisation/manipulation restores ankle dorsiflexion power (Bruce in video refers to increased peroneal power). Do you have any explanation for such an immediate restoration?

    Secondly I read that patients with previous ankle injuries quite often loose muscle strength if not rehabilitated due to - reduced nerve conduction and reduced proprieception due to nerve damage. Do you have any feed back on this point?

  15. phil

    phil Active Member

    hi. thanks for the video. very interesting.

    when would you do this to a patient? also, is this a one off treatment to improve ankle joint ROM or would it reqire regular repetition?

    does anyone know anyone who teaches this in AUS? any courses etc?


  16. Craig Payne

    Craig Payne Moderator

    should check for it at every orthotic issue
    most seem to be one off; but some do need it again
    normally do it as part of Boot Camps, but not recently due to an unrelated chronic pain problem I got in my arms :mad:
  17. TedJed

    TedJed Active Member

    How terrific to see footage of manual therapy techniques on YouTube. Well done Bruce.

    A search of 'foot mobilisation' offers less than 6 practical examples of techniques for practitioners and the public to view.

    Thank you too, Bruce, for inspiring me to get off my butt and adding to YouTube's storehouse.http://www.podiatry-arena.com/images/smilies/drinks.gif


    I note Bruce, that your clip is titled 'Mobilisation' but you call your techniques 'Manipulations'. Based on the definitions used in chiropractic (Michaud) and physiotherapy (Maitland) the techniques you demonstrated are actually 'mobilisations', i.e. they are performed at a force and speed that the recipient could overcome. A manipulation is performed at a force and speed that the recipient cannot overcome - usually because it happens so fast (240-280msec) that it's all over before they can do anything about it.

    I think the definitions are important because 'manipulation' often gets a bit of bad press when it is abused or not performed correctly. The public too, can raise their eyebrows at the mention of 'manipulation' let alone podiatrists.

    'Mobilisations' are certainly safer for practitioners with limited experience in manual therapies and your demonstration shows how straightforward and beneficial manual techniques are. Like any new skill, with experience comes confidence.

    www.footmobilisation.com might be a start. It is my field of interest Phil and I do have a vested interest in educating other practitioners. I don't have any other suggestions within podiatry.

    Mark Charrette (chiropractor) runs an excellent 'Extremities Adjusting' course with Foot Levellers Co. but you have to be a chiro to register for it. I found his course the most useful manual techniques course I've done this millenium.
    Paul Conneelly also runs an interesting course '2 days at the Talus'.

    Good Luck,
  18. Bruce Williams

    Bruce Williams Well-Known Member


    from my perspective I think it has as much to do with the ability of the peroneals to be stretched completely in midstance with an increase in AJ Dfion as anything else. Dr. Dananberg has a great lecture on this and talks about the sesorimotor adn pain pathways and how he thinks the manipulation effects that. I agree with him.

    Craig Payne and i talked this last weekend at PFOLA in Atlanta and Craig summed it up well. He said that once the three primary DFing muscles, also stabilizing muscles, of the foot / midfoot are functioning "normally" again, many problems associated with the achilles, PT "itis", peroneal problems and midfoot problems, seem to diminish or disappear.

  19. Bruce Williams

    Bruce Williams Well-Known Member


    I manipulate the majority of my patients who have foot, ankle complaints. I don't usually manipulate those with warts, ingrown nails, nail problems and bunions and hammertoes or corns. Almost all others, if they will be treated with a CFO, will be initially treated with manipulation and taping.

    I'll manipulate before CFO casting as well. I thnk the manipulation will help in positioning during casting. I will often manipulate at orthotic pickup as well.

    Interesting to note, that rarely do I have to do more manipulation after this except when the prescription is not correct, or the patient is not wearing the devices regularly. Anectdotal, but interesting.
  20. Bruce Williams

    Bruce Williams Well-Known Member

    thanks much for the definition education between mobilization and manipulation. I call it manipulation b/c that is what Howard Dananberg calls it. He taught me, so it sticks.

    I will note that I should probably add or send a video update to Craig b/c Howard now uses a different technique at the fibular head. He places the thenar portion of the hand on the fibular head, proximal, wiht the patients knee fully flexed adn then pushes the lower let towards the buttocks. This technique is much gentler on the practitioners hands adn wrists as I can surely attest after using the one I demonstrated in the video for the last 9-10 years or so! ;)

    Howard says that Paul Conneely is definitely one of the best at mobilization / manipulation he has ever seen. I did not have the pleasure of meeting him a few years ago and am surely the worse for that.

  21. From your site, Ted: "Looking for proven alternative treatment options for biomechanical & musculo-skeletal conditions?"

    Could you post the references for your "proof" please?

  22. TedJed

    TedJed Active Member

    Hi Bruce,
    This is the technique I prefer too. It's simple, quick, easier for the practitioner to control the application of the manipulative force and, as you've noted, easier on the practitioner.
    It can be performed with the patient sitting (Conneely) but I find this not as specific because of lateral instability of the patient's knee in the frontal plane when applying the manipulative force. It saves having to roll the patient over to a prone position though.

    My preference is to do manual mob/manip with the patient prone because I can position their foot at the optimum height for me (mid sternum). I then roll the patient over to sitting up. Our treatment tables have built in 'drop piece' mechanisms which permit the delivery of a significant manipulative force while being very easy on the practitioner. This means you don't have to be too 'buff' to manipulate and you are delivering the force in a very safe and controlled manner; most important for manipulation.

    Please see www.footmobilisation.com/01_references.html

    Last edited: Oct 10, 2009
  23. Ted, I am familiar with many of these references (many of them textbooks) but which of these references specifically prove the efficacy of manipulation / mobilisation in the treatment of biomechanical & musculo-skeletal conditions of the foot?
  24. TedJed

    TedJed Active Member

    Hi Simon,

    If we agree that 'efficacy' is defined as ability to produce the necessary or desired results then we need to clarify the 'desired results'.

    My view is that mobilisation and manipulation techniques are employed to reduce stiffness and joint hypomobility. This hypomobility resulting from connective tissue adaptation associated with reduced joint ROM is well documented as a physiological response (Akeson 1961, Woo et al 1975, Akeson et al 1977, Akeson 1980, Binkley 1982, Maitland 1991, Michaud 1993).

    The 'desired result' in treating joint stiffness/hypomobility is to reduce the joint stiffness and increase the joint mobility. In my experience, joint stiffness and hypomobility are aetiological factors in many biomechanical and musculo-skeletal conditions of the foot and leg. This is supported by the research contained in Craig Payne's Clinical Bootcamp 2009.

    Mobilisation and manipulation has been demonstrated to increase joint mobility and reduce joint stiffness in Bruce's video and in the following references; (Mennell 1970, Woo et al 1975, Wyke 1980, Lowther 1980, So 1986, Lantz 1989, Maitland 1991, Michaud 1993, Logan 1995).

    These references explain the physiological responses of connective tissues to immobilisation and mobilisation. While these were researched and documented several decades ago and I think it is unlikely that the nature of connective tissue has changed in that time to discount the findings as 'too old.'

    I do wonder though Simon, if you are more interested in research that is 'outcome based' using mobilisation and manipulation techniques for symptomatically labelled conditions. I know that many podiatrists ask me the question 'where's the research that proves that FMT works?' E.g. where's the research that FMT helps plantar fasciits?

    To my knowledge, this evidence remains anecdotal and no rigorous RCT has been completed (yet). Dananberg's work might be the closest thing so far...

    Manual therapy based professions (physiotherapy, chiropractic, remedial therapy) are largely based on the principles of immobility and mobilisation. I'm confident there's something in it and I'd like to see manual therapies employed within podiatry to a much greater degree than it is at the moment. I don't see any downside to this aim.

    Ted ;)
  25. manolomalaga

    manolomalaga Active Member

    Very good idea, it would be nice to have more videos like this.
    From Spain, thank you very much and congratulations.
    Last edited by a moderator: Sep 22, 2016
  26. Lawrence Bevan

    Lawrence Bevan Active Member

    Nice video Ted. Seeing in your recent paper in Podiatry Now you do a different talar mobilisation - can you elaborate?

    Any update on the plans to come to the UK?
  27. TedJed

    TedJed Active Member

    Thanks Lawrence.

    Each mobilisation technique usually has several options. They may involve different positions of the practitioner and/or patient. It's not that one technique is necessarily better than another, rather, I think it's important which technique is most efficient for the practitioner and safest for achieving the desired result for the patient.

    As I specialise in Foot Mobilisation Techniques (FMT) full time, I've found that some techniques can be more taxing on my body than others so I'm constantly on the lookout or experimenting with the techniques to achieve the desired result as efficiently as possible.

    I'm about to post a clip on the Arena's YouTube channel after receiving a request for vision of the cuboid manipulation. I've selected 3 techniques and gone through the pros and cons of each. Stay tuned...

    BTW, I've received a lot of interest from you gorgeous poms since the article. It seems that FMT has really struck a chord with you Brits. I'm planning on running some FMT Courses in the UK in April next year. I hope to catch up with you then for a :drinks

  28. Lawrence Bevan

    Lawrence Bevan Active Member

    Clever ! So its a case of knowing what force you want to apply to whatever joint you want to apply it to and then find the "best" way of doing so? How do you measure success?

    Some of these colonials are actually quite clever chaps - must be because you're upside down all the time - all the blood goes to the brain? ;):drinks
  29. Ted,
    Thank you for your honest and open reply. I guess that I was "looking for proven alternative treatment options for biomechanical & musculo-skeletal conditions" I understand about immobilisation and it's effects on the tissues of the body, I also recognise that reduced range of motion at various joints has been identified among the predictors of certain foot pathologies, and indeed may define certain pathologies, i.e. hallux limitus. I was hoping, given the statement on your website, that you could provide references which show that mobilisation/ manipulation could alleviate the symptoms of named foot conditions. Or, references which demonstrated an equal or better success rate in the treatment of said conditions, so that we could view this as an "alternative". It is clear to me now that this is not yet the case.

    Don't get me wrong, I have been using manual therapy in my clinical practice for many years and I do believe it is helpful as an adjunct to other therapies. I may even attend your course should you come to the UK.

    Once again, thank you for your honest replies.
  30. TedJed

    TedJed Active Member

    Hi Simon,
    What an inspirational word - 'YET'.

    There seems to be numerous practitioners who find efficacy in applying FMT in their clinical practices while the sceptical population awaits for the 'evidence' before giving it a go. :craig: I'm not saying this is a bad thing, rather, just that it can be a little frustrating not having the 'accepted' form of evidence to backup what many of us find clinically.:bang:

    I'm more of a 'hands on/put things into action' kinda guy and I always have to take a big breath before I can even consider the 'researching FMT' pathway. :boohoo:
    Oh well, maybe someone else will run with this baton?

    Precisely Lawrence! Utilising one's clinical skills, one determines where the joint hypomobility lies (that is due to connective tissue restrictions) and then devises a treatment plan to treat that region AND the related joints/tissues. It's SO important to remember the interconnectivity between different joints and their relations. E.g. in treating a subluxed cuboid, one MUST check the fibula and the head of the femur/greater trochanter because of the peroneus longus>Lat. hamstring/ITB connections.

    We use several methods of recording changes pre- and post- treatment. I haven't found one definitive method that works every time. This is the nature of working with diverse human beings I guess.

    Client's chief complaint(s)
    Foot Health Status Questionnaire (every case that we are able to accept and undertakes our service completes the FHSQ before, during and after treatment).

    Clinical exam of ROM, QOM, Foot Posture Index, Gait analysis.
    Static w/b x-ray analysis (to rule out FMT contraindications and record joint positions pre- and post- treatment. This does have some limitations though...)

    My hands. This is the 'art' of FMT. The qualitative 'feel' joints have pre- and post- treatment is just so difficult to record empirically. It's like trying to explain to someone what a banana tastes like if they have never tasted one! How do you do it??:confused:

    We don't accept every case that comes to us because we know that FMT is not indicated in every case. It's up to our practitioners to make a professional assessment of the client and then assess the best recommendation from there. If we can't help a case, the best thing we can do is refer them on to someone who can help. (BTW, it's amazing how many WOM referrals we get from people we've never treated!)

    !etam thgir ydoolb ooT :dizzy:

  31. Bruce, Ted or any others that Mobilise often, Due you use taping after a mobilisation. Say a cuboid subluxation Ive found that if I tape the foot to reduce the pull of the PL the results seem to be much better or is this over kill but the patient feels a better result because the tape is applied ie placebo effect.
    If the answer is with some but not with other techniques which ones?

    Ted can you please give early notice of when the course is on with a post on PA with the place etc as I would like to fly in from Stockholm if the timing right.
  32. TedJed

    TedJed Active Member


    Taping is a useful tool following mobs/manips because it reduces the physical loads on the tissues that have usually been under stress and compensating (due to the joint dysfunction which is why you mobilised the area in the first place.)

    I find taping especially beneficial in acute injury cases. I'll also use it in chronic conditions such as a symptomatic plantar fasciitis of >12 month hx.

    The degree to which taping can influence the 'pull' of a muscle varies but I don't think taping is 'overkill', rather, it offers potential benefit. Could placebo be playing a role? Maybe, but there's no harm in that.

  33. Funkster

    Funkster Member

    My experience with manips is that they are a useful tool but dont get carried away. There is very little evidece for use for MSK foot pathology.

    On a back to basics approach it works the opposite was to orthoses which reduce excessive motion. Manips increase restricted movement. As such I cannot see the rationale for manipulating a sagging and subluxed navicular into place. Similarly with cuboid manips.

    If the ROM is reduced especially as a resuly of orthoses give it a go but do no harm. I had an over zealous cuboid manipped on a course which redulted in a permanety unstable joint.

    The chiropractic literature talks about resetting proprioception/reflex etc but I really cant see that chronically attenuated and weak msuculature can be corrected like this being in mind the likleyhood of years of pathomechanics.

    I have found that maniping the talus posteriorly and fib head does bring about inreased AKJ dorsiflexio but that this is short lived. Good for patient compliance and effective combined with orthoses and stretches. On it's own very limited.

    Manips can cause a lot of pain if they are administered inappropriately and with too much force. Assess scruplously and send for an x-ray if necessry. History/wxam/palpation/diagnosis is key (just like anything else) If in doubt dont do it. If an orthotic is wrong you can take it out and adjust it. A manip just like an injection is potentially irreversible.

    Trust me my foot hurts!
  34. Peter1234

    Peter1234 Active Member


    thanks for that really useful post. the rationale for FMT for a subluxed joint type joint or for a foot that is rigid from years of use, would be to adjust the 'foot posture' thereby allowing enough movement for a semi rigid/flexible/functional orthoses. i see this in the context of the type of improvements you can see in joints and muscles from starting training even in the later years of life-

    My rationale is of course not based upon either evidence or experience with these types of treatments. I just fret when i think about the possibilities potentially available with orthoses therapy if joint RoM was to a certain degree restored to within normal 'limits'.

    thanks again
  35. Peter1234

    Peter1234 Active Member

    hi Ted,

    with reference to taping, i read a paper although not on plantar fasciitis, but ankle sprains that showed that apart from a slight reduced range of movement taping has on ankle movement, the authors attributed decreased time to complete rehab on the activation of proprieceptors and heightened sense of awareness of the injured ankle. If you draw this comparison to a foot taped for plantar fasciitis, the same principles would apply.
  36. TedJed

    TedJed Active Member

    Important distinction here... A sagging and subluxed navicular is generally hypERmobile, not hyPOmobile and therefore, manipulation would not be indicated. The cuboid however, usually presents in a hypomobile state. A hypermobile cuboid usually presents in a hypermobile body type that rates higher than 7+ on the 9 Point Flexibility Scale.

    Also, the 'subluxed navicular' is usually secondary to an anterior force from the talus. Any treatment for the navicular must include management of the talus too.

    This is where mobilisation would have been the recommended option. For manipulation to cause a permanent instability, the joint must have been 'wrenched' to the point of tearing the joint's capsule and ligs. That requires very aggressive forces - this is contraindicated in a clinical setting and was likely to be poor technique. This type of experience is where manipulation can get a bad name.

    The key here is 'chronic'. I agree that chronic conditions require external assistance i.e. orthoses. In acute conditions (< 90 days) the ability to affect proprioceptive pathways is very good. This is because the connective tissue cellular adaptation and proprioceptive patterns require a 90 day period of time to 'turnover'.

    Good point. Manipulation on its own is rarely a panacea for MSK pathologies. When applied, combining mobs/manips with exercises (stretching, strengthening, stabilising) and orthotic therapy is the most comprehensive way to manage those biomechanical conditions.

    This I don't understand... It sounds like your cuboid joint(s) must have been sprained. Like any sprain, healing of the injured tissue will take approx. 6 weeks. I'm interested in WHY hasn't your cuboid region recovered? Is it less than 6 weeks since the injury? What factor(s) are preventing it from healing? Joint instability? (Orthoses should help here along with strengthening the extrinsic muscles of the foot). Joint subluxation? (Continual walking will constantly 're-injure' the affected tissues unless this is addressed). Have you had any further investigations (x-ray, CT scan, MRI) to determine the cause of your pain?

    Are you old enough to remember the physiotherapy approach to lower back pain Michael in the 1970's? It was based on immobilising the region with splints and braces (then surgery if this didn't work). Since then, the value of mobilisation, early movement and core strengthening has taken over as the preferred option based on Evidence Based Practice. I wonder if podiatry is in similar place to physio in the 70's by focusing on 'immobilising' the foot?

    Until the evidence tells us otherwise, we only have anecdotal evidence that FMT may be beneficial. Then again, that's how Pilates began...

    To a point... The damage to ligaments from a sprain is different from the longer term 'strains' of the plantar fascia. Notwithstanding, taping would only be used short term (7-10 days) to minimise the impact of decreased rehab progress. Stretches, strengthening and stabilising (proprioceptive) exercises commence within the 1st 10 days to promote independent recovery,

  37. Shane Toohey

    Shane Toohey Active Member

    For those interested,

    Dr Paul Conneely does still put on mobilisation workshops in Australia.
    He has also presented in the UK and NZ and is willing to travel moree now as has cut right back on clinical work. Try www.musmed.com.au

  38. drdebrule

    drdebrule Active Member


    Excellent video. I was wondering if you or Ted Jed could outline clinical indications for the techniques you have demonstrated in the video. How do the mobilisations you choose to perform vary from patietn to patient? Also, how often do you repeat your manipulation or mobilisation techniques?

    Dr. Mike DeBrule
  39. TedJed

    TedJed Active Member

    Sure Mike. The primary clinical indication for mobilising a joint is to increase the RoM & QoM of hypomobile joints that have resulted from joint dysfunction i.e. connective tissue restrictions, not osseous blocks/distortions.

    So the scenario in my practice goes like this:
    Client presents their concerns/complaints/reason(s) for seeking assistance.
    BME performed. (Whole posture, foot posture, gait pattern, proprioceptive capacities then RoM testing.) Particular focus is on the Q & RoM of relevant joints. Each joint from the hip distally is assessed. In the foot, attention goes to each joint and not just the region i.e. navic:med.cun, navic:cub, med.cun:1st m'sl, med.cun:int.cun etc rather than just the MTJ.

    Once regions of hypomobility are established, a professional assessment is made of the relationship of these findings to the client's complaint(s) such as pl.fasciitis, shin splint syndrome, knee pain etc.

    We develop our treatment plan based on clinical and when used, diagnostic testing such as w-b x-ray.

    This depends on the findings in the BME and the client's body responses to the treatment. E.g. a classic pl.fasciitis with STJ hyperpronation usually has limited RoM in the STJ & MTJs when trying to supinate the foot toward 'neutral'. Typical manual therapies will include mobilising the talus posteriorly in the ankle mortice, manipulating the navicular laterally, manipulating the navic:1st m'sl dorsally.

    The techniques used vary from patient to patient depending on the level and quality of hypomobility from session to session. E.g. if the posterior mobilisation of the talus is slow (this is often the case due to the strong ligs and weightbearing forces of the body) a posterior manipulation may be selected. The patient's personal circumstances need to be considered too. E.g. an active athlete will require more 'input' than a sedentary office worker.

    The techniques vary depending on the presentations and 'feel' of the joints. This is very difficult to quantify empirically and objectively. It's a little bit like orthotic manufacture. Sometimes we'll add a little more plaster or shape the MLA based on our experience rather than any strict protocol.

    When the primary objective is to increase joint mobility, the best results seem to come by doing a little bit regularly, rather than trying to 'force' a joint to move. Excessive force will 'tear' the connective tissues and cause inflammation, pain/discomfort and the body's protective reflexes will resist the changes you are trying to implement.

    In my experience, I have found a frequency of treatment every 72 hrs or so initially works well when combined with home stretching and strengthening exercises. As the RoM increases and the client's concerns settle, we'll then wean them down to 1x pw, 1x per fortnight, 1x per month etc. Our maintenance check ups vary from 3 monthly to annually depending on the individual.

  40. drdebrule

    drdebrule Active Member


    Thanks for your thorough response. I noticed that the mobilisationtechniques tend to be quick and snappy as presented by Bruce on thisvideo and also your techniques found at http://footmobilisation.com (more excellent videos for those who are interested). :)

    However, there is another way to go about this. A manipulative/mobilisation technique using positional release to relax musle tension was decscribed by L.H. Jones (JNL AOA vol 72, Jan. 1973 p. 481-489). Myofascial trigger points are palpated and released by stretching the foot/ankle in the direction of relief and holding for 90 seconds. I was wondering if you or the readers of this thread have used this technique or could comment about the results?

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