Manual Therapy Ankle 2023 (6).pdf

Manual Therapy of the Foot and Ankle: DPT 691 Clinical Management of the Musculoskeletal System 2 Manual Assessment and Treatment of the Foot and Ankle Assessment of the Talocrural joint Assessment of the subtalar joint Assessment of the Midfoot Assessment of the forefoot Assessment of end feel Asse...

Manual Therapy of the Foot and Ankle: DPT 691 Clinical Management of the Musculoskeletal System 2 Manual Assessment and Treatment of the Foot and Ankle Assessment of the Talocrural joint Assessment of the subtalar joint Assessment of the Midfoot Assessment of the forefoot Assessment of end feel Assessment of pain Contraindications Suspected fracture Significant swelling/erythema Talar Posterior Glide Assessment AP Glide to the Talus Associated with DF restrictions Commonly seen with ankle sprains, ankle impingement, possible plantar fasciitis In a loose packed position with the foot over the edge of the table apply a posterior pressure on the talus assessing for end feel and pain https://app.physiou.com/view/Y3ByX 29ydGhvOnQ0MDY1 Manual Therapy Interventions Posterior talar glide Mobilization with the Movement Apply a AP glide of the talus and while a DF ROM is applied Indications: to improve DF of the ankle Posterior Talar Glide with movement Talocrural Joint Mobilization with Movement to Increase Dorsiflexion Place a mobilization belt around the posterior inferior tibia and fibula. Anchor the belt around therapist at hip level. Place the web space of the therapists hand on the anterior talus. Have the patient squat (if performed in standing) or move anteriorly over the foot (if in tall kneeling). A posterior glide is applied to the talus during the motion of the patient. Mobilization with Movement Ankle Dorsiflexion Progress from non weight bearing to weight bearing Block the talus and provide overpressure with the belt Collins, N., et al. (2004). "The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains." Man Ther 9(2): 77-82. Manual Therapy Interventions Talocrural Distraction Graded Distraction mobilizations Indications: Overall decrease in ROM in the Talocrural joint Possible conditions: Ankle Sprain Impingement syndrome Plantar Fasciitis Impairments: Decreased PF and DF Decreased Closed Chain DF Test Martin, R. L., Davenport, T. E., Paulseth, S., Wukich, D. K., & Godges, J. J. (2013). Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther, 43(9), A1-40. doi:10.2519/jospt.2013.0305 Manual Therapy Interventions Talocrural Distraction: Alternative Technique Figure out belt around the talus. Secure the belt around your chest/sternum Stabilize above the joint Manual Therapy Interventions High Velocity Low Amplitude Thrust Technique (Talocrural Joint) Indications: General ankle mobility deficits Grasp around the ankle with both hands Apply DF and slight eversion until a barrier is felt. Apply a quick thrust technique in a short amplitude https://app.physiou.com/view/Y3ByX29ydG hvOnQ0MDQ5 Talocrural Anterior Glide of Talus Apply an anterior force through the calcaneus driving the talus in an anterior direction Indications: limited Talocrural mobility plantarflexion https://app.physiou.com/vie w/Y3ByX29ydGhvOnQ0MDQ2 Plantarflexion mobilization Physiological Mobilization to improve plantarflexion Push anterior through the calcaneus and plantaflex the forefoot Self Management of Limited Plantarflexion Self Physiological Plantarflexion mobilization: Ankle sprains Post ankle fracture Ankle PF stiffness Can progress to a seated position with foot under leg to provide over-pressure into plantarflexion Distal tibiofibular glide assessment Posterior glide of the tibiofibular joint. Use thenar eminence of hand to apply pressure to the distal tibiofibular joint Indications: Ankle sprains Difficulty with dorsiflexion/inversion/eversion Distal tibiofibular mobilization with movement Mobilization with movement Pain with inversion post ankle sprain Apply a posterior/superior glide of distal talofibular joint Distal tibiofibular glide assessment Anterior glide of the tibiofibular joint. Indications – hypomobility Decreased ROM in the ankle Subtalar Joint glides Lateral Subtalar glides Indications: hypomobility of the subtalar joint, limited pronation/eversionof the foot and ankle. If ankle Talocrural ROM is limited assess the subtalar joint Subtalar Joint glides (laterally & inferiorly) To improve ankle eversion Cross the involved leg over the uninvolved leg Apply a lateral force through the calcaneus with a distraction force A second technique is to pull the great toe into extension while simultaneously inferiorly gliding/tractioning the calcaneus Subtalar Joint Glides Medial Joint Glide Apply a glide of the calcaneus into the medial direction Indications: limited Talocrural joint mobility Limitations in Inversion and supination ***Realize this looks just like the lateral glide but the difference is if you are working on the top leg or the bottom leg. Alternatively twist the heel laterally while pulling the navicular up/medially (similar motion to wringing out a towel). Then switch and perform the mobilization in the opposite direction. Soft Tissue Mobilization To improve soft tissue extensibility and to improve DF ROM From a prone position apply traction of the ankle while applying a superior direction pressure to the gastroc/soleus complex For deeper pressure apply a force through the elbow/forearm Soft Tissue Mobilization To improve DF and soft tissue extensibility Applying a “kneading” movement to the soft tissue of the gastroc/soleus complex A “bending” motion of the muscle belly Self Soft Tissue Mobilization to the gastroc/soleus Home program may include self management of soft tissue mobilization Manual therapy effects are usually short term 10-20 minutes. Some evidence that it improves ROM and decreases soreness Casanova, N., et al. (2018). "Effects of roller massager on muscle recovery after exercise-induced muscle damage." J Sports Sci 36(1): 56-63. de Souza, A., et al. (2017). "Acute Effect of Two Self-Myofascial Release Protocols on Hip and Ankle Range of Motion." J Sport Rehabil: 1-21. Grabow, L., et al. (2017). "Unilateral Rolling of the Foot did not Affect Non-Local Range of Motion or Balance." J Sports Sci Med 16(2): 209-218 Halperin, I., et al. (2014). "Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters." Int J Sports Phys Ther 9(1): 92-102. Kelly, S. and C. Beardsley (2016). "SPECIFIC AND CROSS-OVER EFFECTS OF FOAM ROLLING ON ANKLE DORSIFLEXION RANGE OF MOTION." Int J Sports Phys Ther 11(4): 544-551. Skarabot, J., et al. (2015). "Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes." Int J Sports Phys Ther 10(2): 203-212. Soft tissue mobilization to the plantar fascia Indications for plantar fasciitis https://app.physiou.com/ view/Y3ByX29ydGhvOnQ0 MTE1 Can be done as self treatment Manual Physical Therapy Interventions for the Midfoot Intertarsal Mobilizations in the midfoot. Piano key up and down the metatarsals. Assess for hypomobility and treat Re-test the patient for changes in pain and range of motion Metatarsal mobilizations Piano key mobilization of metatarsals First Metatarsal Glides https://app.physiou.com/v iew/Y3ByX29ydGhvOnQ0 MDAx First toe mobilizations for limited mobility AP glides Medial-Lateral Glides Traction glides Hallux rigidus Hallux valgus Manual Therapy Interventions Traction for the treatment of hallux limitus Treatment of hallux valgus Treat and re-test the patient for improvement in movement. Self Mobilization to the first toe First toe MTP limitation The patient with the legs crossed can perform toe extension stretch, traction and glides in anterior/posterior direction, and lateral/medial direction Questions?