Fibula mobilisation for increasing ankle joint ROM

Bruce Williams · Nov 6, 2009

drdebrule said: ↑

Bruce,

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?

Thanks!
Dr. Mike DeBrule
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Mike;
i use the three manipulation techniques primarily for lack of AJ rom. I will see this in most patients with plantar fascia symptoms, plus neuroma, metatarsalgia, PTTD early stages, etc.

Basically anything that affects the foot or that is effected by increased rom in the midfoot. Increased AJ rom tends to lead to more normal action or activation of the PT, achilles adn Peroneal tendons.

I will manipulate at first visit with taping, second visit at casting and then maybe one more time if necessary. I usually don't have to do it anymore unless the symptoms are persisting.

Bruce

drdebrule · Nov 6, 2009

Bruce,

Bruce,

Thanks. Your answer is similar to my personal experience and practices. I believe we are using manipulation and mobisiliation mostly as an adjucntive therapy in addition to orthotics, taping, heel lifts, surgery, physical therapy etc.

Your answer differs from Ted's anwer probably because Ted is using manipulation and mobilisation as a primary stand alone treatment plan. Am I right Ted? I think so.

Thanks and keep up the great work!

Mike

TedJed · Nov 7, 2009

Mike,

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)
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The technique you describe is for the release of trigger points/hypertension in muscles. This differs from mobilisation or manipulation of joint connective tissue restrictions in capsules or ligaments. I use both methods for each objective where indicated.

Your suggestion that I use manual therapies as a primary treatment option is correct. I will also combine manual therapies with orthotic therapy to maximise the functional capabilities of hypomobile joints in the foot and leg.

This is the field I find most fulfilling professionally and so I choose to specialise in it. I'm also happy to refer cases on that don't meet my chosen field of practice.

Hope this makes sense?

Cheers,
Ted.

NewsBot · Jan 9, 2010

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?
Manual Therapy Volume 15, Issue 1, February 2010, Pages 117-121

Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30 N force was applied 1000 times to the lateral malleolus at a speed of 15 N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 times of cyclic loading, the tibia was displaced 0.44 ± 0.30 mm and 0.75 ± 0.36 mm, respectively, and the fibula was displaced 0.44 ± 0.28 mm and 0.92 ± 0.39 mm, respectively. The average dorsiflexion angle increased from 14.36 ± 7.51° to 16.74 ± 7.21° after cyclic loading (P < 0.05). Movement of the distal tibiofibular joint led to a significant increase in the range of ankle dorsiflexion. These results suggest that tibiofibular JM would be effective for limitation of ankle dorsiflexion.
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mike weber · Jan 14, 2010

NewsBot said: ↑

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?
Manual Therapy Volume 15, Issue 1, February 2010, Pages 117-121
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Does anyone have a copy of the full article they can post up or email me with?

TedJed · Jan 19, 2010

Foot Mobilisation Techniques (FMT) Courses will be conducted in England in April 2010.
Further information available at www.footmobilisation.com

TedJed · Jan 19, 2010

Foot Mobilisation Techniques (FMT) Courses will be conducted in England in April 2010.
Further information available at www.footmobilisation.com

mike weber · Jan 19, 2010

m weber said: ↑

Does anyone have a copy of the full article they can post up or email me with?
Click to expand...

Here the full article for anyone who wants to read it. Thanks to Björn.

NewsBot · Jan 24, 2013

Immediate Effects on Dorsiflexion of Gong’s Mobilization Applied to Ankle Joints
Misuk Cho, Wontae Gong, Sungbum Ju
Journal of Physical Therapy Science; Vol. 24 (2012) No. 4 May p. 315-317

[Purpose] The objective of this study was to verify the immediate effects of Gong’s mobilization on the ankle dorsiflexion range of motion (ROM).

[Subjects] The subjects of this study were 40 health adult males and females who were divided epuallt into a Gong’s mobilization group (Gong’s group) and mobilization with movement group (MWM group).

[Methods] Gong’s mobilization and MWM were implemented about 10 times. The ankle dorsiflexion ROM was measured with a goniometer.

[Results] Both Gong’s Mobilization and MWM were effective at increasing ankle dorsiflexion ROM. However, neither Gong’s Mobilization nor MWM can be said to better than the other at increasing ankle dorsiflexion ROM.

[Conclusion] We recommend use of MWM to increase ankle dorsiflexion ROM in closed kinetic chains and use of Gong’s Mobilization to increase ankledorsi flexion ROM in open kinetic chains.
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NewsBot · Dec 31, 2014

The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability
David Marrón-Gómez, Ángel L. Rodríguez-Fernández, José A. Martín-Urrialde
Physical Therapy in Sport; February 2015 Volume 16, Issue 1, Pages 10–15

Objective
To compare the effect of two manual therapy techniques, mobilization with movement (WB-MWM) and talocrural manipulation (HVLA), for the improvement of ankle dorsiflexion in people with chronic ankle instability (CAI) over 48 h.

Design
Randomized controlled clinical trial.

Setting
University research laboratory.

Participants
Fifty-two participants (mean ± SD age, 20.7 ± 3.4 years) with CAI were randomized to WB-MWM (n = 18), HVLA (n = 19) or placebo group (n = 15).

Main Outcome Measures
Weight-bearing ankle dorsiflexion measured with the weight-bearing lunge. Measurements were obtained prior to intervention, immediately after intervention, and 10 min, 24 h and 48 h post-intervention.

Results
There was a significant effect × time (F4,192 = 20.65; P < 0.001) and a significant time × group interactions (F8,192 = 6.34; P < 0.001). Post hoc analysis showed a significant increase of ankle dorsiflexion in both WB-MWM and HVLA groups with respect to the placebo group with no differences between both active treatment groups.

Conclusion
A single application of WB-MWM or HVLA manual technique improves ankle dorsiflexion in people with CAI, and the effects persist for at least two days. Both techniques have similar effectiveness for improving ankle dorsiflexion although WB-MWM demonstrated greater effect sizes.
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NewsBot · Feb 25, 2015

Increased treatment durations lead to greater improvements in non-weight bearing dorsiflexion range of motion for asymptomatic individuals immediately following an anteroposterior grade IV mobilisation of the talus
Christopher James Holland, MSc Sports Therapy, PGDip Education, PGCE Secondary PE, BA (Hons), (Coach Education and Sports Development), Kevin Campbell, MSc Sports Science, PGCE Higher Education, BSc (Hons) (Sports Therapy), Kim Hutt, MSc Dance Science, PGCE Higher Education, BSc (Hons) (Sports Therapy)
Manual Therapy; Available online 19 February 2015

Manual therapy aims to minimise pain and restore joint mobility and function. Joint mobilisations are integral to these techniques, with anteroposterior (AP) talocrural joint mobilisations purported to increase dorsiflexion range of motion (DF-ROM). This study aimed to determine whether different treatment durations of single grade IV anteroposterior talocrural joint mobilisations elicit statistically significant differences in DF-ROM. Sixteen asymptomatic male football players (age = 27.1 ±5.3 years) participated in the study. Non-weight bearing (NWB) and weight bearing (WB) DF-ROM was measured before and after 4 randomised treatment conditions: control treatment, 30 seconds, 1 minute, 2 minutes. NWB DF-ROM was measured using a universal goniometer, and WB DF-ROM using the weight-bearing lunge test. A within-subjects design was employed so that all participants received each of the treatment conditions. A 4x4 balanced Latin square design and 1 week interval between sessions reduced any residual effects. Two-way repeated measures ANOVA revealed a significant improvement in DF-ROM following all AP mobilisation treatments (p < 0.001). The within subjects contrasts showed that increases in treatment duration was associated with statistically significant improvements in DF-ROM (NWB DF-ROM control=0.01%, 30s=14.2%, 1min=21.6%, 2min=32.8%; WB DF-ROM control=0.01%, 30s=5.0%, 1min=7.6%, 2min=10.9%; p < 0.05). However, WB DF-ROM improvements were below the minimal detectable change scores needed to conclude that improvements were not a consequence of measurement error. This research shows that single session mobilisations can elicit NWB DF-ROM improvements in asymptomatic individuals in the absence of pain, whilst increases in treatment duration confer greater improvements in NWB DF-ROM within this population.
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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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Fibula mobilisation for increasing ankle joint ROM

Bruce Williams Well-Known Member

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Does distal tibiofubular joint mobilization decrease limitation of ankle dorsiflexion.pdf

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Anatomy of the Tibiofibular Syndesmotic

Fractured tibia and fibula

Fibularis Intersection Syndrome

Communications between the superficial and deep fibular nerves in the foot

Fibula stress fractures

Number of fiber bundles of the anterior talofibular ligament and differences in the angle of the cal

Subfibular Impingement

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Fibula mobilisation for increasing ankle joint ROM

Bruce Williams Well-Known Member

drdebrule Active Member

TedJed Active Member

NewsBot The Admin that posts the news.

mike weber MVP

TedJed Active Member

TedJed Active Member

mike weber MVP

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