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Mobilisation and ankle joint range of motion

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Nov 13, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Study of the Force Applied During Anteroposterior Articular Mobilization of the Talus and its Effect on the Dorsiflexion Range of Motion
    Journal of Manipulative and Physiological Therapeutics
    Volume 30, Issue 8, October 2007, Pages 593-597

     
  2. Admin2

    Admin2 Administrator Staff Member

  3. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    here is Howard Dananberg's 2000 paper on this:
    Manipulation method for the treatment of ankle equinus
    HJ Dananberg, J Shearstone and M Guillano
    Journal of the American Podiatric Medical Association, Vol 90, Issue 8 385-389, 2000
    and Hylton Menz's and Howard Dananberg's exchange in the letters-to-the-editor on this (subscription access required to view).
     
  4. Here is the full dialogue:


     
  5. Here is the full dialogue:

     
  6. Bruce Williams

    Bruce Williams Well-Known Member

    Are you just padding your posts now Kevin by listing this twice?

    Craig did provide a link anyway you know!:dizzy:

    Bruce
     
  7. CraigT

    CraigT Well-Known Member

    Thanks for the posting Kevin, :)
    Bruce- we don't all have JAPMA access!!!
     
  8. Yeah, Bruce, most of my posts are just done so I can try to retain my #1 position as poster on Podiatry Arena. It has nothing to do with my enjoyment in sharing my knowledge with my podiatric colleagues around the world.:bash:
     
    Last edited by a moderator: Nov 14, 2007
  9. Atlas

    Atlas Well-Known Member

    Hylton questioned the internal validity of the article; but I question the clinical significance and EV to all ankle equinus presentations.


    Danenburg's method is only applicable for a very small percentage of equinus presentations. Its the tip of the iceberg. Its the rare tool down the bottom of the tool-box that you might find useful once in a long while. Nothing more.




    References:

    None.
     
  10. musmed

    musmed Active Member

    Dear All including Axis and Atlas

    How wrong you are.

    Hopefully by Sunday aussie time, I can post the worlds first comparing foot pressure plate/ ankle dorsiflexion/ shoulder abduction pressures and CT 3D angle changes pre and post mobilisation and manipulations.

    Many may cringe but few are chozen. I like this better than Craig's mumble.

    comeon sunday!

    musmed
     
  11. Bruce Williams

    Bruce Williams Well-Known Member

    I thought everone did! my bad! I will post this twice to get the appropriate affect!:D

    Bruce
     
  12. Bruce Williams

    Bruce Williams Well-Known Member

    Atlas;

    I greatly disagree with you. So much knee pain is perpetuated by unidentified AJE on a daily basis! In general, mobilising or manipulating the AJ will help tremendously to aid that patient population as well as most other foot complaints.

    We all use different tools, but I would now be lost to achieve the outcomes I do for my patients without utilizing manipulation on a regular daily basis.

    Sincerely;
    Bruce
     
  13. Atlas

    Atlas Well-Known Member


    Bruce there are several ways to mobilise/manipulate an ankle joint. Danenburg and his superior tib-fib joint attention is not the only way. Danenburg's method as described in his article, would only improve to sufficient clinical significance a small percentage of ankle presentations. There are better, more effective means of increasing ankle joint dorsiflexion in a majority of presentations.

    If you read my posting Bruce, I am not knocking mobilisation/manipulation; so I don't know what your are greatly disagreeing about.
     
  14. Stanley

    Stanley Well-Known Member


    You have my attention. Could you expound on this?

    Regards,

    Stanley
     
  15. musmed

    musmed Active Member

    I am waiting like Stanley.

    Paul C musmed
     
  16. Atlas

    Atlas Well-Known Member



    If you have your ankle immobilised as per typical POP for 4-6 weeks, what tissues have been affected adversely (reduced length). Even a 2nd year student will rattle off "joint capsule, tib-post, peroneals, gastro-soleus etc...etc...".


    But in the clinical world, why are we foolish enough to think that one joint based technique is going to be the magic trigger of a wonderful cascade of ankle dorsi-flexion attainment?


    Come on...it aint rocket science. You have maitland mobilisations; you have mulligan mobilisations; you have chiropractic manipulation; you have distraction....and that is just for the passive tissues. I haven't even got on to addressing active tissue yet.




    These dogmatic practitioners that believe everything is caused by one thing (and solved by one thing) are deluding themselves. Many chiropractors think everything is caused by matters spinal; many physiotherapists think that everything is caused by matters core.... and so on.


    And Musmed, why wait for me? I am waiting for the 2nd coming Sunday 'aussie time'.
     
  17. moe

    moe Active Member

    What time Sunday, I want to prepare myself and hide in the walk in robe with the laptop. That way I might be able to read something to its completion before the kids find me.
    Cheers
    Iona
     
  18. musmed

    musmed Active Member

    Dear Atlas

    The paper Howard D wrote also included other procedures.

    I feel unless I have missed something that you have still not answered Stanley's question.

    I did not see anyone write about a leg in plaster....etc

    Regards

    Musmed
     
  19. Atlas

    Atlas Well-Known Member

    I remember other token work at the distal tib-fib joint; but feel free to blow me away by elaborating..


    And "leg in plaster"? You're not that simple to fail to understand the use of analogy.

    Then again...
     
  20. musmed

    musmed Active Member

    Dear Atlas

    I noted what you say,I also note that there is salt in atlas

    Paul C
     
  21. Stanley

    Stanley Well-Known Member

    Atlas,

    I still do not have the answer I requested. :(

    I think that you are saying that we should look at all the tissues around the ankle.

    The Plaster of Paris analogy is interesting, :wacko: but the problem lies in what is the affected parts and how does it affect the ankle joint.
    People that manipulate think that the joint has been knocked out of aligment:bash:, and it needs to be knocked in.
    The Plaster of Paris analogy implies an immobilization etiology to the problem.

    So do you treat all the structures around the ankle :butcher:eek:r do something else?

    Regards,

    Stanley
     
  22. Atlas

    Atlas Well-Known Member

    I also note there is 'used me' in musmed. I hope those that attend the musculo-skeletal training workshops (delivered by ST and yourself) don't feel like such.



    And Stanley, that is exactly what I am saying. Look at all structures, mainly the limiting one at the time. Regarding etiology, yes the POP analogy implies pre-existing immobilisation. However a typical impingement will not allow full ROM in a particular plane. A typical ankle sprain, with its inflammation etc around the joint will immobilise the region similarly. Here's another analogy...like a floating device that children wear around their arms; imagine this around a joint.

    Pure and simple, most musculo-skeletal pathology anywhere in the body (neck, shoulder, knee, hip) will co-exist with some degree of immobilisation. If you wake up with a sore neck, how far can you move it? If you pain and this 'limited movement' were to exist for some time (weeks-months) you will have tissue shortening in affected and previously non-affected structures.



    Ron B.
    Atlas (aka salt)
     
  23. Stanley

    Stanley Well-Known Member

    Ron,

    I see what you are trying to say:
    If I wake up with a sore neck, I should treat the tight muscle.
    Do you treat the cause of the tight muscle, or the tight muscle directly:dizzy:?

    Regards,

    Stanley
     
  24. Atlas

    Atlas Well-Known Member


    This is an acute situation Stanley. A disc pathology might need traction? Facet joint pathology might need manipulation/mobilisation? Muscular pathology....

    I was talking about the post-acute period.:bash:
     
  25. Stanley

    Stanley Well-Known Member

    So let's try again.
    You wake up with a stiff neck, and as a result there is some immobilization which causes a secondary tight muscle two months later. You then see the patient and examine him and find there to be something wrong which is a result of the immobilization phase due to the spasm of the neck muscle. You treat the pathology you see.
    My question is why did the patient develop the stiff neck, and what are you going to do to prevent it from happening again?

    Regards,

    Stanley
     
  26. Paul:

    Sunday came and went without us reading about the world's first study comparing foot pressure plate/ankle dorsiflexion/shoulder abduction pressures and CT 3D angle changes pre and post mobilisation and manipulations. What a disappointment. You build us up.....and.....nothing happened.

    I just had to spend Sunday listening to biomechanics researchers who have published extensively speaking about their experimental data and its clinical interpretation at the San Diego PFOLA meeting.

    Maybe ...... some other Aussie Sunday ....... the world will get what it has been waiting for.;)
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This ankle joint mobilisation patent was applied for in 2005, but was only granted this week:

    Method and apparatus for anterior and posterior mobilization of the human ankle
    Link to patent
     
    Last edited by a moderator: Nov 20, 2007
  28. Newsbot are you so massive that you warp time?

    Paul, just like Kevin and all following along I too was waiting for Sunday, what happened?
     
  29. 2005.....Dr. Spooner......not 3005......:pigs:;):pigs:
     
  30. Atlas

    Atlas Well-Known Member

    Stanley, we should stick to what we can control and assist; rather than sitting back and guestimating about what may have caused and contributed. Of course, when you assess and treat, underlying causes are always in your thoughts; but the time wasted on complex inaccurate theories and possibilities takes away from what we do best and with more certainty.
    If the cause is simple and one-dimensional, then yes, it makes complete sense to address it.

    If I am a patient with pain and stiffness, I don't care what your half-truth theories are; just get me right. If it returns again down the track, well, either the therapist must change tack, and/or more consideration can be given to recurrence. Common sense isn't it???


    But to appease your penchant for underlying neck causes with the hypothetical neck sufferer...who awakes with a stiff neck? Is it the pillow and/or bed not being 100%? Is it what he/she lifted last night? Is it the sustained un-ergonomic position assumed for 5 minutes the day before? Is it the motor car accident 6 months ago? Is it the way they carried their school bag 3 years ago? Is it the way they style their hair every morning by flicking their head? And that is the tip of the iceberg.


    Lets just worry about getting them as pain-free as we can, and as functional as we can. If you improve them, and they remain pain-free and fully functional, it would have been a waste of time to come up with a white-board tree diagram of 'possible' contributing factors.
     
  31. Stanley

    Stanley Well-Known Member

    Atlas,

    Thank you for not writing in your typical cryptic style.

    I agree. You should never do things you don't know about.

    I am amazed at the way you can read all that from my question. To reiterate, my question was why did the patient develop the stiff neck, and what are you going to do to prevent it from happening again? I also fail to see how that differs from what you just wrote underlying causes are always in your thoughts unless it is your intention to ignore them.

    Atlas, I don't have a problem with this. It sounds like you think I don't make my patients better. I do all that I can for them, and they leave my office "right". I have patients that need to see me more than once, even though it is not my intent.

    I am glad that you can remain so confident when you jump to errant conclusions. The only point that I was getting to was if you were to evaluate the antagonistic muscle also.

    Atlas, the whole idea is to get people better. That is why everyone is on this listserve. So if I were to reiterate your point, (in something more familiar to the rest of us) a patient comes in with a knee problem on the distal medial patella region of both knees. He runs 50 kilometers/week. You would look at the structures of the knee and not entertain the notion that the foot might be causing it, unless your knee treatment fails.


    Regards,

    Stanley
     
  32. Stanley

    Stanley Well-Known Member

    Atlas,

    Thank you for not writing in your typical cryptic style.

    I agree. You should never do things you don't know about.

    I am amazed at the way you can read all that from my question. To reiterate, my question was why did the patient develop the stiff neck, and what are you going to do to prevent it from happening again? I also fail to see how that differs from what you just wrote underlying causes are always in your thoughts unless it is your intention to ignore them.

    Atlas, I don't have a problem with this. It sounds like you think I don't make my patients better. I do all that I can for them, and they leave my office "right". I have patients that need to see me more than once, even though it is not my intent.

    I am glad that you can remain so confident when you jump to errant conclusions. The only point that I was getting to was if you were to evaluate the antagonistic muscle also.

    Atlas, the whole idea is to get people better. That is why everyone is on this listserve. So if I were to reiterate your point, (in something more familiar to the rest of us) a patient comes in with a knee problem on the distal medial patella region of both knees. He runs 50 kilometers/week. You would look at the structures of the knee and not entertain the notion that the foot might be causing it, unless your knee treatment fails.


    Regards,

    Stanley
     
  33. Atlas

    Atlas Well-Known Member

    In relation to your question "why did the patient develop the stiff neck...?"




    My response was...
    "who awakes with a stiff neck? Is it the pillow and/or bed not being 100%? Is it what he/she lifted last night? Is it the sustained un-ergonomic position assumed for 5 minutes the day before? Is it the motor car accident 6 months ago? Is it the way they carried their school bag 3 years ago? Is it the way they style their hair every morning by flicking their head? "


    So, none of the above are possible causes of neck pain?
     
  34. musmed

    musmed Active Member

    Dear Kevin
    Are you not so lucky?


    Dear Kevin et al

    On sunday last we generated some 7GIG of raw data so unfortunately not everything can appear at once

    Here in the attachment is the right foot of ONE of the 24 participants, demonstrating the changes in foot pressures comparing pre and post mobilisation

    This is the data from a 63 year old man with foot pain.

    M1, M2, M3, M4, M5 are the average MET head pressures calculated at 200Hz using the RS scan from Belgium.

    You will see the values of (M1 + M2) - (M3 + M4+ M5)

    The closer to zero shows that the pressure in the medial and lateral MET heads approach equal pressure.

    From this you can see there is a massive change towards the first MET head. The higher the value indicates that the 1st MET head is taking more pressure, as it should in normal walking.

    We also have data for elite athletes, walking, jogging and running. All this will be munched over the christmas period and probably much longer.

    Hope this is what you are looking for and I am not just making things up.


    Any comments?

    Musmed.Paul C.
     

    Attached Files:

  35. musmed

    musmed Active Member

    Dear Rob B.

    As you do not like what is posted, what do you like?

    Musmed

    ps. Musmed was shortened from muscle-medicine for the likes of some, let alone musculoskeletal medicine.
     
  36. Stanley

    Stanley Well-Known Member

    Of course they can be causes of neck pain. Did I say they weren't?

    Regards,

    Stanley
     
  37. Tom Brett

    Tom Brett Member

    Dear Podiatry Arena

    I have now written a six part course in mobilisation and manipulation as CPD for Podiatrists.

    Part 1 is The foot to the knee.
    Part 2 is The hip to the first lumbar vertebra
    Part 3 is The thorac.
    Part 4 is The cervical area.
    Part 5 is The cranium.
    Part 6 is The Upper limb including the thoracic girdle.

    In 2009 I have trained over forty podiatrists in the United Kingdom

    The learning outcomes, which every participant has attained so far, is the ability to diagnose and treat structurally correctable deformities such as fixated talocrural joints or displaced cuboid bones. And that was only Part 1.

    Part 2 provides the skill to correct a functional short leg instead of either referring the patient or fitting an unnecessary heel lift.

    This is an exciting Continuing Professional Development (CPD) course for Podiatrists, which opens a massive professional development - the ability to compete in the market place with chiropractors, osteopaths and physiotherapists.

    For those in private practise, this CPD can increase competetiveness and profitability.

    In addition:

    Parts 1 & 2 - gain between 30 and 60 CPD points.

    All parts have, included in the course documentation, a detailed portfolio for submission to the HPC, if needed.

    Graduates can obtain malpractice insurance at competetive rates.

    OTHER NEWS

    This year I was invited to speak at the Northern Ireland Branch of the Podiatry Society.

    Other invitations by various groups are on the table for 2010.

    A group of NHS Orthopaedic Podiatrists have requested training.

    Manipulation techniques are now being used within the NHS by graduates.

    There are two course places available at Holcot near Northampton for the last course of the 2009.

    The course is on Saturday 28th November and Saturday 12th December.
    The closing date for completed application forms and cheques is Thursday 12th November.

    If you or any colleague is interested, please complete email mail@brettscourses.com for the Holcot Part 1 Application Form and send with the fee as soon as possible to guarantee a place.

    More details of the courses are available from
    http://www.brettom.com and
    http://www.brettscourses.com

    Tom Brett DO, BSc(Hons) LL.M (Medical Law)
    Master Bonesetter, Podiatrist and Master of Laws.
     
  38. TedJed

    TedJed Active Member

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

    NewsBot The Admin that posts the news.

    Articles:
    1
    The acute effects of ankle mobilisations on lower extremity joint kinematics
    Louis P. Howeemail
    Journal of Bodywork and Movement Therapies; Article in Press
     
  40. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effects of posterior talar glide and dorsiflexion of the ankle plus mobilization with movement on balance and gait function in patient with chronic stroke: A randomized controlled trial.
    Kim SL, Lee BH.
    J Neurosci Rural Pract 2018;9:61-7
     
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