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

Sample Intervention - "Feet Flatten (Functional Pes Planus)

• Manual Release
  • Gastrocnemius and Soleus Static Manual Release
  • Fibularis Muscle Static Manual Release
  • Extensor Hallucis Longus (EHL) and Extensor Digitorum Longus (EDL) Static Manual Release
  • Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) Static Manual Release
• Mobilization or Manipulation
  • Ankle Mobilization
  • Proximal Tibiofibular Joint Manipulation
  • Cuboid Manipulation
  • Talonavicular and Cuneonavicular Joint Manipulation
  • Talocalcaneal Joint Manipulation
• Manual Lengthening
  • Manual Calf Stretch
• Instrument Assisted Soft Tissue Mobilization
  • Crural Fascia
  • Plantar Fascia
• Activation
  • Tibialis Posterior Activation
  • Tibialis Anterior Activation
• Stability Integration
  
  • Resisted Single-Leg Balance and Reach
• Reactive Activation:
  • Lateral Hops to Balance

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