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Continuing Education2 Credits

Joint Manipulation: Ankle, Midfoot and Tibiofibular Joint

Joint manipulations for the ankle, midfoot, and tibiofibular joint. Types of manipulations, manipulations vs. mobilizations of the cuboid, talonavicular, and proximal tibiofibular joint. Optimal intervention for chronic ankle instability, balance, ankle sprains, vertical jump height, heel pain, knee bow in, knee bow out, feet flatten, feet turn out, excessive forward lean, and asymmetrical weight shift. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of ankle, midfoot, and tibiofibular manips.

Course Description: Ankle, Midfoot, and Tibiofibular Joint Manipulation

Introduction

This course describes joint manipulation techniques for the ankle (tibiotalar or talocrural joint, and talocalcaneal or subtalar joint), midfoot (cuboid, talonavicular, cuneonavicular, etc.), and proximal tibiofibular joints. Various synonyms and definitions have been used to describe the term "manipulation". The Brookbush Institute uses one conventional definition of the term "manipulations;" implying low-amplitude (relatively small motions), high-velocity (quick) techniques, intended to target and reduce the stiffness of specific joints or segments, that exhibit a decrease in passive accessory range of motion (a.k.a. stiffness during arthrokinematic motion; specifically glide). Research does imply that manipulations affect multiple joints simultaneously; however, the Brookbush Institute asserts that efforts to target the stiffest joints or segments will increase the likelihood that the stiffest segments are included in the "multiple joints" affected.

The Brookbush Institute has carefully selected manipulation techniques with the intent to increase the probability of practitioner success. That is, techniques have been chosen that are relatively easy to teach, reliably improve outcomes, and are the most commonly used. The Brookbush Institute does not wish to assert that these manipulation techniques are the only techniques that are effective, and/or that these are the best techniques for every outcome measure. It is possible that a highly complex, and/or advanced technique, may result in better outcomes, or that a particular pathology is better addressed with a rarely used technique.

Note, that the term "mobilization" is reserved for low-velocity techniques that are taught in a separate set of courses.

This course includes manipulation techniques that intend to reduce excessive stiffness of the tibiofibular joints, ankle joints, and transverse tarsal joints, improve dorsiflexion range of motion, medial longitudinal arch height, and normalize altered lower extremity muscle activity. For example, research demonstrates that ankle sprain may result in long-term loss of posterior glide of the talus on the tibia (anterior position fault), resulting in failure to regain optimal dorsiflexion, loss of invertor strength, and chronic ankle instability, and ankle manipulation are an effective treatment for improving arthrokinematic dysfunction. These techniques may also be used in an integrated approach for improving lower extremity dysfunction (LED) including Achilles tendinopathy, plantar fasciitis, pes planus, knee valgus, iliotibial band syndrome (ITBS), patellofemoral pain syndrome (PFPS), etc. Additionally, due to the relationship between ankle motion and hip internal rotation during gait, these techniques may aid in the treatment of femoroacetabular impingement (FAI), psoas tendinitis, hip osteoarthritis, etc.

The techniques in this course are recommended for all clinical human movement professionals (physical therapists, physical therapy assistants, athletic trainers, massage therapists, chiropractors, occupational therapists, etc.) to develop an evidence-based, systematic, integrated, patient-centered, patient-centered, and outcome-driven approach.

Techniques Covered in this Course

Sample Intervention - "Feet Flatten (Functional Pes Planus)

Related Courses

Additional Joint Mobilization Courses

For an introduction to joint mobilizations and manipulations:

Introduction

Research Summary

Research Corner: Ankle Joint (tibiotalor/talocrural) Manipulation

4 sub-categories

Research Corner: Additional Manipulations

3 sub-categories

Video Demonstrations

4 sub-categoriesvideo

Bibliography

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1. Introduction

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