Joint Manipulation: Ankle, Midfoot and Tibiofibular Joint

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

• Proximal Tibiofibular Joint Manipulation
• Cuboid Manipulation
• Talonavicular and Cuneonavicular Joint Manipulation
• Talocalcaneal Joint Manipulation

Related Courses

Additional Joint Mobilization Courses

• Joint Manipulation: Cervical Spine
• Joint Manipulation: Thoracic Spine
• Joint Manipulation: Lumbar Spine, Sacroiliac Joint, and Pubic Symphysis
• Joint Manipulation: Elbow (Radial Head) and Wrist
• Joint Manipulation: Ankle, Midfoot, and Tibiofibular Joint

For an introduction to joint mobilizations and manipulations:

• Joint Mobilization and Manipulation: Introduction
• Joint Mobilization and Manipulation: Reliability
• Joint Mobilizations and Manipulations: Effects
• Joint Mobilization and Manipulation: Risk of Adverse Effects
• Joint Mobilizations and Manipulations: Evidence-based Teaching and Learning

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Study Guide
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Sample Routine
• Practice Exam
• Pre-approved Final Exam

Ankle Manipulation (Efficacy)

1. Nield, S., Davis, K., Latimer, J., Maher, C., & Adams, R. (1993). The effect of manipulation on range of movement at the ankle joint. Scandinavian journal of rehabilitation medicine, 25(4), 161-166.
2. Fryer, G. A., Mudge, J. M., & McLaughlin, P. A. (2002). The effect of talocrural joint manipulation on range of motion at the ankle. Journal of manipulative and Physiological Therapeutics, 25(6), 384-390.
3. Andersen, S., Fryer, G. A., & McLaughlin, P. (2003). The effect of talo-crural joint manipulation on range of motion at the ankle joint in subjects with a history of ankle injury. Australasian Chiropractic & Osteopathy, 11(2), 57.
4. Köhne, E., Jones, A., Korporaal, C., Price, J. L., Brantingham, J. W., & Globe, G. (2007). A Prospective, Single-Blinded, Randomized, Controlled Clinical Trial of the Effects of Manipulation on Proprioception and Ankle Dorsiflexion in Chronic Recurrent Ankle Sprain. Journal of the American Chiropractic Association, 44(5).
5. Pellow, J. E., & Brantingham, J. W. (2001). The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. Journal of manipulative and physiological therapeutics, 24(1), 17-24.
6. Whitman, J. M., Cleland, J. A., Mintken, P., Keirns, M., Bieniek, M. L., Albin, S. R., … & McPoil, T. G. (2009). Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. journal of orthopaedic & sports physical therapy, 39(3), 188-200.
7. Hedlund, S., Nilsson, H., Lenz, M., & Sundberg, T. (2014). Effect of chiropractic manipulation on vertical jump height in young female athletes with talocrural joint dysfunction: a single-blind randomized clinical pilot trial. Journal of manipulative and physiological therapeutics, 37(2), 116-123.
8. Kamali, F., Sinaei, E., & Bahadorian, S. (2017). The immediate effect of talocrural joint manipulation on functional performance of 15–40 years old athletes with chronic ankle instability: A double-blind randomized clinical trial. Journal of bodywork and movement therapies, 21(4), 830-834.
   • Comparing Interventions
9. Dananberg, H. J., Shearstone, J., & Guillano, M. (2000). Manipulation method for the treatment of ankle equinus. Journal of the American podiatric medical association, 90(8), 385-389.
10. Joseph, L. C., de Busser, N., Brantingham, J. W., Globe, G. A., Cassa, T. K., Korporaal, C., & Bonello, R. (2010). Research & Science. The Comparative Effect of Muscle Energy Technique vs. Manipulation for the Treatment of Chronic Recurrent Ankle Sprain. Journal of the American Chiropractic Association, 47(7).
11. Marrón-Gómez, D., Rodríguez-Fernández, Á. L., & Martín-Urrialde, J. A. (2015). The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability. Physical Therapy in Sport, 16(1), 10-15.
    • Combining Interventions
12. Lubbe, D., Lakhani, E., Brantingham, J. W., Parkin-Smith, G. F., Cassa, T. K., Globe, G. A., & Korporaal, C. (2015). Manipulative therapy and rehabilitation for recurrent ankle sprain with functional instability: a short-term, assessor-blind, parallel-group randomized trial. Journal of manipulative and physiological therapeutics, 38(1), 22-34.
13. Shim, Y. S., & Song, H. S. (2013). Effect of manipulation complex therapy on ankle sprain with ankle pain. Journal of Acupuncture Research, 30(2), 65-71.
14. Eisenhart, A. W., Gaeta, T. J., & Yens, D. P. (2003). Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. The Journal of the American Osteopathic Association, 103(9), 417-421.
15. Truyols-Domínguez, S., Salom-Moreno, J., Abian-Vicen, J., Cleland, J. A., & Fernández-De-Las-Peñas, C. (2013). Efficacy of thrust and nonthrust manipulation and exercise with or without the addition of myofascial therapy for the management of acute inversion ankle sprain: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(5), 300-309.
16. Heggannavar, A., & Gupta, R. K. (2015). Effectiveness of Subtalar Joint Mobilization in Plantar Heel Pain. Indian Journal of Physiotherapy and Occupational Therapy, 9(2).
17. López-Rodríguez, S., de-las-Penas, C. F., Alburquerque-Sendín, F., Rodríguez-Blanco, C., & Palomeque-del-Cerro, L. (2007). Immediate effects of manipulation of the talocrural joint on stabilometry and baropodometry in patients with ankle sprain. Journal of manipulative and physiological therapeutics, 30(3), 186-192.
    • Systemic Effects
18. Fisher, B. E., Piraino, A., Lee, Y. Y., Smith, J. A., Johnson, S., Davenport, T. E., & Kulig, K. (2016). The effect of velocity of joint mobilization on corticospinal excitability in individuals with a history of ankle sprain. journal of orthopaedic & sports physical therapy, 46(7), 562-570.
    • Tibiofibular Joint Manipulation
19. Beazell, J. R., Grindstaff, T. L., Sauer, L. D., Magrum, E. M., Ingersoll, C. D., & Hertel, J. (2012). Effects of a proximal or distal tibiofibular joint manipulation on ankle range of motion and functional outcomes in individuals with chronic ankle instability. journal of orthopaedic & sports physical therapy, 42(2), 125-134.
20. Chae, Y. W., Park, J. W., & Nam, K. S. (2017). The Effect of a Proximal and Distal Tibiofibular Joint Manipulation on Dorsiflexion and Balance in Individuals with a History of Lateral Ankle Sprain. The Journal of Korean Physical Therapy, 29(2), 95-100.
21. Grindstaff, T. L., Beazell, J. R., Sauer, L. D., Magrum, E. M., Ingersoll, C. D., & Hertel, J. (2011). Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability. Journal of Electromyography and Kinesiology, 21(4), 652-658.
    • Midfoot Mobilizations
22. Govender, N., Kretzmann, H., Price, J. L., Brantingham, J. W., & Globe, G. (2007). A Single-Blinded Randomized Placebo-Controlled Clinical Trial of Manipulation and Mobilization in the Treatment of Morton's Neuroma. Journal of the American Chiropractic Association, 44(3).
23. Cashley, D. G., & Cochrane, L. (2015). Manipulation in the treatment of plantar digital neuralgia: a retrospective study of 38 cases. Journal of chiropractic medicine, 14(2), 90-98.
24. Shashua, A., Flechter, S., Avidan, L., Ofir, D., Melayev, A., & Kalichman, L. (2015). The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial. journal of orthopaedic & sports physical therapy, 45(4), 265-272.
25. Fraser, J. J., Saliba, S. A., Hart, J. M., Park, J. S., & Hertel, J. (2020). Effects of midfoot joint mobilization on ankle-foot morphology and function following acute ankle sprain. A crossover clinical trial. Musculoskeletal Science and Practice, 46, 102130.
26. Melkersson, C., Nasic, S., Starzmann, K., & Boström, K. B. (2017). Effect of foot manipulation on pregnancy-related pelvic girdle pain: a feasibility study. Journal of chiropractic medicine, 16(3), 211-219.
    • Calcaneus Manipulation (Subtalar)
27. Chevutschi, A., D'Houwt, J., Pardessus, V., & Thevenon, A. (2015). Immediate effects of talocrural and subtalar joint mobilization on balance in the elderly. Physiotherapy Research International, 20(1), 1-8.
28. Smila, B., Fernāte, A., & Zaļaiskalna, V. (2016, May). THE EFFECT OF ANKLE AND SUBTALAR JOINT SOMATIC DYSFUNCTION CORRECTION TO IMPROVE ORIENTEER STATIC BALANCE. In Proceedings of the International Scientific Conference. Volume III (Vol. 553, p. 562).