PT Classroom - A Review of Ankle Joint Mobilization Techniques ׀ by Chai Rasavong, MPT, MBA

 

An ankle injury is quite commonly treated by a physical therapist. As a result of an injury, inflammation and tissue damage may occur at the ankle which may restrict range of motion and result in deficits to strength, stability, proprioception/somatosensory, flexibility, gait and function. Should immobilization of the ankle be required, further range of motion limitations and deficits may occur. If not corrected, this limited range of motion will disturb normal joint arthrokinematics and could affect a patient’s performance (1).

 

The lower leg/ankle/foot is composed of the tibia and fibula along with 26 bones in the foot. The ankle joint (talocrural joint) is shaped like a mortise and consists of a bony fit between the talus and the tibia proximally and medially and the talus and the fibula laterally (2). The distal tibia and fibula are concave and sit on top of the convex talus. The ankle joint is a synovial hinge joint with a joint capsule and associated ligaments, and is generally considered to have a single oblique axis with 1 of freedom: dorsiflexion/plantarflexion (3). (image work of the United States Federal Government)

Should there be restrictions at the ankle joint as a result of an injury or immobilization, accessory joint mobilization techniques can be utilized to assist with restoring normal ankle/foot arthrokinematics. In a study conducted by Green et al (4), they found that treatment which included AP mobilizations for patients who haves sustained acute ankle inversion ankle sprains resulted in improved pain-free ankle range of movement in dorsiflexion, as well as the functional outcome of stride speed.

In a preliminary study conducted by Landrum et al (5), they found that a single application of Grade III anterior-to-posterior talocrural joint mobilizations appears to increase ankle dorsiflexion ROM in a population with dorsiflexion ROM restrictions resulting from prolonged ankle immobilization.

The study conducted by Olson, V (6) also supports the findings of other researchers that joint mobilization is important to restoring function to a hypomobilie joint. In this study Olson immobilized the right carpal joint of 12 dogs and divided the dogs into a control group and a treatment group which received mobilization therapy. The results that he obtained showed that the treatment group demonstrated improve passive ROM and motion during gait. Human subjects were not utilized in this study because of the ethics involved of immobilizing a joint.

 

A review of some ankle mobilization techniques to the ankle joint can be found below (please note that there are alternative methods to performing these mobilizations):

Posterior-Anterior (PA) On Talus - Stabilize the Tibia of the Talocrural Joint with one hand and push Posterior-Anterior on the talus with the other hand.

 

Anterior-Posterior (AP) On Talus - Stabilize the Tibia of the Talocrural Joint with one hand and push Anterior-Posterior on the talus with the other hand.

 

Distraction of the Subtalar Joint - One hand fixates on the talus while the other hand grasps the calcaneus and applies a pull distally.

 

Inferior Tibiofibular Joint Anterior-Posterior (AP) - With the patient in a sidelying position and the ankle supported, an anterior-posterior mobilization is applied on the inferior tibiofibular joint.

 

Inferior Tibiofibular Joint Posterior-Anterior (AP) - With the patient in a sidelying position and the ankle supported, an posterior-anterior mobilization is applied on the inferior tibiofibular joint.

 

Cephalad Glide - Utilize ankle eversion to indirectly piston the inferior fibula.

 

Caudad Glide - Utilize ankle inversion to indirectly piston the fibula.

 

Last revised: June 7, 2009
by Chai Rasavong, MPT, MBA

 

References
1. Loudon J, Bell S. The Foot and Ankle: An Overview of Arthrokinematics and Selected Joint Techniques. Journal of Athletic Training. 1996;31(2):173-178.
2. Riegger C. Anatomy of the Ankle and Foot. Physical Therapy. 1988;68(12): 1802-1814.
3. Norkin CC, Levangie PK. (1992). Joint Structures & Function - A Comprehensive Analysis - Second Edition. Philadelphia, PA: F.A. Davis Company.
4. Green T, Refshauge K, et al. A Randomized Controlled Trial of Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains. Physical Therapy. 2002;81(4): 984-994.
Landrum E, Kelln B, et al. Immediate Effects of Anterior-to-Posterior Talocrural Joint Mobilization after Prolonged Ankle Immobilization: A Preliminary Study. The Journal of Manual and Manipulative Therapy. 16(2): 100-105.
6. Olson, V. Evaluation of Joint Mobilization Treatment. Physical Therapy. 1987;67(3); 351-356.


Terms & Conditions

Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.



 
 
       Advertisement
....
.