Joint Mobilization: Ankle and Tibiofibular Joints

Introduction

This course describes joint mobilizations for the ankle joint (a.k.a. tibiotalar, talocrural, mortise joint of the ankle, etc.) and tibiofibular joints (a.k.a. proximal tibiofibular joint and distal tibiofibular joints). Several terms and definitions have been used to describe the "mobilizations" (e.g. mobilisations) that are taught in this course. The Brookbush Institute uses a conventional definition of "mobilization" that includes low amplitude, low-velocity, oscillatory techniques intended to reduce the stiffness of joints exhibiting a decrease in passive accessory range of motion (a.k.a. arthrokinematic motion and specifically glide or slide). Note, the term "manipulation" is reserved for high-velocity techniques taught in a separate set of courses.

This course includes several of the techniques most commonly used to address ankle joint stiffness and improve dorsiflexion range of motion (ROM). For example, anterior to posterior tibiotalar (talocrural) mobilizations may be used to address a loss of dorsiflexion following ankle sprain, as research has demonstrated that a history of ankle sprain is correlated with a loss of posterior glide of the talus on the tibia, incomplete recovery of dorsiflexion, and potentially a higher recurrence of ankle sprains (e.g. development of chronic ankle instability). These techniques may also be used in an integrated approach for lower extremity dysfunctions including plantar fasciitis, patellofemoral pain syndrome (PFPS), and hip impingement syndrome, and postural dysfunctions including pes planus, knee valgus, knee varus, and asymmetrical weight shift. Some evidence and clinical outcomes even suggest that addressing ankle dysfunction can have a significant effect on low back pain outcomes.

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.) with the intent of developing an evidence-based, systematic, integrated, patient-centered, and outcome-driven approach.

Techniques Covered in this Course

• Ankle Mobilization
• Distal Tibiofibular Joint Mobilization
• Proximal Tibiofibular Joint Mobilization

Related Courses

Additional Joint Mobilization Courses

• Joint Mobilizations: Ankle and Tibiofibular Joints
• Joint Mobilizations: Knee and Hip Joints
• Joint Mobilizations: Lumbar Spine and Sacroiliac Joints
• Joint Mobilizations: Cervical and Thoracic Spine
• Joint Mobilizations: Shoulder, Sternoclavicular, and Acromioclavicular Joints
• Joint Mobilizations: Elbow and Proximal Radioulnar Joints

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
• Occupational Therapists - Intermediate
• 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 Dysfunction and Altered Kinematics

1. Hubbard, T. J., Olmsted-Kramer, L. C., Hertel, J., & Sherbondy, P. (2005). Anterior–posterior mobility of the talus in subjects with chronic ankle instability. Physical Therapy in Sport, 6(3), 146-152.
2. Denegar, C. R., Hertel, J., & Fonseca, J. (2002). The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. Journal of Orthopaedic & Sports Physical Therapy, 32(4), 166-173.
3. Wikstrom, E. A., & Hubbard, T. J. (2010). Talar positional fault in persons with chronic ankle instability. Archives of physical medicine and rehabilitation, 91(8), 1267-1271.
4. Basnett, C. R., Hanish, M. J., Wheeler, T. J., Miriovsky, D. J., Danielson, E. L., Barr, J. B., & Grindstaff, T. L. (2013). Ankle dorsiflexion range of motion influences dynamic balance in individuals with chronic ankle instability. International journal of sports physical therapy, 8(2), 121.
   • Mobilization Changes Talus/Fibula Position
5. Koh, E. K., & Jung, D. Y. (2016). Effects of mulligan’s mobilization with movement on talofibular interval in subjects with chronic ankle instability. The Journal of Korean Physical Therapy, 28(5), 303-307.
6. Vicenzino, B., Branjerdporn, M., Teys, P., & Jordan, K. (2006). Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. Journal of Orthopaedic & Sports Physical Therapy, 36(7), 464-471.
7. Merlin, D. J., McEwan, I., & Thom, J. M. (2005). Mulligan’s mobilization with movement technique for lateral ankle pain and the use of magnetic resonance imaging to evaluate the ‘positional fault hypothesis. In XIC International Congress on Sports Rehabilitation and Traumatology.
   • Healthy Individuals
8. Gong, W., Park, G. D., & Ma, S. (2011). The influence of ankle joint mobilization on ROM of the ankle joint and maintenance of equilibrium in elderly women. Journal of Physical Therapy Science, 23(2), 217-219.
9. Pertille, A., Macedo, A. B., Dibai Filho, A. V., Rêgo, E. M., de Figueiredo Arrais, L. D., Negri, J. R., & Teodori, R. M. (2012). Immediate effects of bilateral grade III mobilization of the talocrural joint on the balance of elderly women. Journal of manipulative and physiological therapeutics, 35(7), 549-555.
10. Guo, L. Y., Yang, C. H., Tsao, H., Wang, C. Y., & Liang, C. C. (2006). Initial effects of the ankle dorsiflexion mobilization with movement on ankle range of motion and limb coordination in young healthy subjects. 物理治療, 31(3), 173-181.
11. Tomruk, M., Tomruk, M. S., Alkan, E., & Gelecek, N. (2019). Immediate Effects of Ankle Joint Mobilization With Movement on Postural Control, Range of Motion, and Muscle Strength in Healthy Individuals: A Randomized, Sham-Controlled Trial. Journal of sport rehabilitation, 1(aop), 1-9.
    • Inversion Sprain
12. Green, T., Refshauge, K., Crosbie, J., & Adams, R. (2001). A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Physical therapy, 81(4), 984-994.
13. Yeo, H. K., & Wright, A. (2011). Hypoalgesic effect of a passive accessory mobilisation technique in patients with lateral ankle pain. Manual therapy, 16(4), 373-377.
14. Cosby, N. L., Koroch, M., Grindstaff, T. L., Parente, W., & Hertel, J. (2011). Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain. Journal of Manual & Manipulative Therapy, 19(2), 76-83.
15. Collins, N., Teys, P., & Vicenzino, B. (2004). The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains. Manual therapy, 9(2), 77-82.
    • CAI
16. Yoon, N. M., Seo, Y. S., & Kang, Y. H. (2016). Effects of Joint Mobilization on Foot Pressure, Ankle Moment, and Vertical Ground Reaction Force in Subjects with Ankle Instability. 한국운동역학회지, 26(2), 153-159.
17. Cruz-Díaz, D., Lomas Vega, R., Osuna-Pérez, M. C., Hita-Contreras, F., & Martínez-Amat, A. (2015). Effects of joint mobilization on chronic ankle instability: a randomized controlled trial. Disability and rehabilitation, 37(7), 601-610.
18. Hoch, M. C., & McKeon, P. O. (2011). Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. Journal of Orthopaedic Research, 29(3), 326-332.
19. Kim, B. H., Kim, C. Y., Kang, T. K., Cho, Y. J., & Lee, S. Y. (2018). Immediate Effects of Joint Mobilization Techniques on Clinical Measures in Individuals with CAI. Korean Journal of Sport Biomechanics, 28(4), 219-225.
20. Hoch, M. C. (2011). The effect of joint mobilization on functional outcomes associated with chronic ankle instability.
21. Hoch, M. C., Andreatta, R. D., Mullineaux, D. R., English, R. A., Medina McKeon, J. M., Mattacola, C. G., & McKeon, P. O. (2012). Two‐week joint mobilization intervention improves self‐reported function, range of motion, and dynamic balance in those with chronic ankle instability. Journal of orthopaedic research, 30(11), 1798-1804.
22. Gilbreath, J. P., Gaven, S. L., Van Lunen, B. L., & Hoch, M. C. (2013). The effects of Mobilization with Movement on dorsiflexion range of motion, dynamic balance, and self-reported function in individuals with chronic ankle instability. Manual Therapy, 30, 1e6.
23. Gilbreath, J. P., Gaven, S. L., Van Lunen, B. L., & Hoch, M. C. (2014). The effects of mobilization with movement on dorsiflexion range of motion, dynamic balance, and self-reported function in individuals with chronic ankle instability. Manual therapy, 19(2), 152-157.
24. Harkey, M., McLeod, M., Van Scoit, A., Terada, M., Tevald, M., Gribble, P., & Pietrosimone, B. (2014). The immediate effects of an anterior-to-posterior talar mobilization on neural excitability, dorsiflexion range of motion, and dynamic balance in patients with chronic ankle instability. Journal of sport rehabilitation, 23(4), 351-359.
    • Ankle Dysfunction
25. An, H. J., Kim, J. S., & Choi, J. H. (2018). Influence of Talocrural Joint Mobilization on Balance and Proprioception of Adults with Limited Ankle Joint Dorsiflexion. Journal of International Academy of Physical Therapy Research (JIAPTR), 9(4), 1651-1656.
26. Landrum, E. L., Kelln, B. M., Parente, W. R., Ingersoll, C. D., & Hertel, J. (2008). Immediate effects of anterior-to-posterior talocrural joint mobilization after prolonged ankle immobilization: a preliminary study. Journal of Manual & Manipulative Therapy, 16(2), 100-105.
27. Reid, A., Birmingham, T. B., & Alcock, G. (2007). Efficacy of mobilization with movement for patients with limited dorsiflexion after ankle sprain: a crossover trial. Physiotherapy Canada, 59(3), 166-172.
28. Gong, W. T., Ma, S. Y., & Kim, T. H. (2009). The effect of ankle joint mobilization technique on equilibrium ability in the individuals with supinated foot. Journal of the Korean Data and Information Science Society, 20(3), 527-539.
29. Silva, R. D., Teixeira, L. M., Moreira, T. S., Teixeira-Salmela, L. F., & de Resende, M. A. (2017). Effects of anteroposterior talus mobilization on range of motion, pain, and functional capacity in participants with subacute and chronic ankle injuries: a controlled trial. Journal of manipulative and physiological therapeutics, 40(4), 273-283.
30. 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).
31. Teixeira, L. M., Pires, T., Silva, R. D., & de Resende, M. A. (2013). Immediate effect of a single anteroposterior talus mobilization on dorsiflexion range of motion in participants with orthopedic dysfunction of the ankle and foot. Journal of manipulative and physiological therapeutics, 36(6), 369-375.
    • Comparing Interventions
32. Gopal Nambi, S., & Shah, B. T. (2012). Kinesio taping versus Mulligan's mobilization with movement in sub-acute lateral ankle sprain in secondary school Hockey players-comparative study. Int J Pharm Sci Health Care, 2(2), 136e149.
33. Sivakumar, C., Sudhakar, S., & Sudhan, S. G. (2017). Effectiveness of Proprioception training and Mulligan’s mobilization in subjects with lateral ankle sprain. International Journal of Research in Pharmaceutical Sciences, 8(4), 754-758.
34. Wikstrom, E. A., & McKeon, P. O. (2017). Predicting manual therapy treatment success in patients with chronic ankle instability: improving self-reported function. Journal of athletic training, 52(4), 325-331.
35. Wikstrom, E. A., & McKeon, P. O. (2017). Predicting balance improvements following STARS treatments in chronic ankle instability participants. Journal of science and medicine in sport, 20(4), 356-361.
    • Comparing Mobilization
36. Cho, M., Gong, W., & Ju, S. (2012). Immediate Effects on Dorsiflexion of Gong’s Mobilization Applied to Ankle Joints. Journal of Physical Therapy Science, 24(4), 315-317.
37. Powden, C. J., Hogan, K. K., Wikstrom, E. A., & Hoch, M. C. (2017). The effect of 2 forms of talocrural joint traction on dorsiflexion range of motion and postural control in those with chronic ankle instability. Journal of Sport rehabilitation, 26(3), 239-244.
38. 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.
    • Mobilization and Taping
39. Abd Elaal, A. K., Ayad, K. E., ELazizi, H. M., & Abdelgalil, A. A. (2015). Efficacy of mobilization with movement in treatment of chronic ankle sprain.
40. Kotteeswaran, K., Manikumar, M., Muthukumaran, J., & Swetha, K. EFFECTIVENESS OF MAITLAND MOBILIZATION TECHNIQUE (TALOCRURAL GLIDES) AND KINESIO TAPING ON POSTERIOR ANKLE IMPINGEMENT SYNDROME IN DANCERS.
41. Ghadi, P., & Verma, C. (2013). Study of the efficacy of the Mulligan's Movement with Mobilization and Taping Technique as an Adjunct to the Conventional Therapy for Lateral Ankle Sprain. Indian Journal of Physiotherapy and Occupational Therapy, 7(3), 167.
42. Jeong, Y. W., & Yang, S. H. (2016). Effect of MWM and taping on balance and jump performance in soccer player with functional ankle instability. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 22(1), 43-49.
    • Mobilization and Exercise
43. Cleland, J. A., Mintken, P., McDevitt, A., Bieniek, M., Carpenter, K., Kulp, K., & Whitman, J. M. (2013). Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(7), 443-455.
44. Shih, Y. F., Yu, H. T., Chen, W. Y., Liao, K. K., Lin, H. C., & Yang, Y. R. (2018). The effect of additional joint mobilization on neuromuscular performance in individuals with functional ankle instability. Physical Therapy in Sport, 30, 22-28.
45. Plaza-Manzano, G., Vergara-Vila, M., Val-Otero, S., Rivera-Prieto, C., Pecos-Martin, D., Gallego-Izquierdo, T., … & Romero-Franco, N. (2016). Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial. Manual therapy, 26, 141-149.
46. Sivakumar, C., Sudhakar, S., Sudan, S. G., & Nandakumar, R. (2017). Effectiveness strengthening exercises and Mulligan’s mobilization in patients with unilateral ankle sprain. International Journal of Research in Pharmaceutical Sciences, 8(4), 555-559.
47. Hernández-Guillén, D., Sanoguera-Torres, A., Martínez-Pérez, C., Igual-Camacho, C., & Blasco, J. M. (2019). Balance training versus balance training and foot and ankle mobilization: a pilot randomized trial in community-dwelling older adults. Physiotherapy theory and practice, 1-10.
    • Mobilization and Stretching
48. Kang, M. H., Lee, D. K., Kim, S. Y., Kim, J. S., & Oh, J. S. (2015). The influence of gastrocnemius stretching combined with joint mobilization on weight-bearing ankle dorsiflexion passive range of motion. Journal of physical therapy science, 27(5), 1317-1318.
49. Kang, M. H., Oh, J. S., Kwon, O. Y., Weon, J. H., An, D. H., & Yoo, W. G. (2015). Immediate combined effect of gastrocnemius stretching and sustained talocrural joint mobilization in individuals with limited ankle dorsiflexion: a randomized controlled trial. Manual therapy, 20(6), 827-834.
50. Yoon, K. S., & Park, S. D. (2013). The effects of ankle mobilization and active stretching on the difference of weight-bearing distribution, low back pain and flexibility in pronated-foots subjects. Journal of exercise rehabilitation, 9(2), 292.
51. Feldbrugge, C. M., Pathoomvanh, M. M., Powden, C. J., & Hoch, M. C. (2019). Joint mobilization and static stretching for individuals with chronic ankle instability–A pilot study. Journal of bodywork and movement therapies, 23(1), 194-201.
52. Celik, D., Kuş, G., & Sırma, S. Ö. (2016). Joint mobilization and stretching exercise vs steroid injection in the treatment of plantar fasciitis: a randomized controlled study. Foot & ankle international, 37(2), 150-156.
53. 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.
    • Combination of Mobilizations
54. 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.
55. Cho, B., Ko, T., & Lee, D. (2012). Effect of ankle joint mobilization on range of motion and functional balance of elderly adults. Journal of Physical Therapy Science, 24(4), 331-333.
56. Hoch, M. C., Mullineaux, D. R., Andreatta, R. D., English, R. A., Medina-McKeon, J. M., Mattacola, C. G., & McKeon, P. O. (2014). Effect of a 2-week joint-mobilization intervention on single-limb balance and ankle arthrokinematics in those with chronic ankle instability. Journal of sport rehabilitation, 23(1), 18-26.
    • Miscellaneous Combinations
57. Vaillant, J., Rouland, A., Martigné, P., Braujou, R., Nissen, M. J., Caillat-Miousse, J. L., … & Juvin, R. (2009). Massage and mobilization of the feet and ankles in elderly adults: effect on clinical balance performance. Manual therapy, 14(6), 661-664.
58. Baidya, P., & Wadhwa, M. (2017). Efficacy of Muscle Energy Technique and Contract Relax with Mulligan’s Movement with Mobilization Technique in Subacute Ankle Sprain (Doctoral dissertation, Lovely Professional University).
59. Baidya, P., Prabhakar, R., & Wadhwa, M. (2018). Efficacy of muscle energy technique and contract relax with mulligan’s mobilization with movement technique in subacute ankle sprain. MOJ Yoga Physical Ther, 3(1), 7-12.
60. Rashid, S., & Salick, K. (2013). To evaluate the efficacy of Mobilization Techniques in Post-Traumatic stiff ankle with and without Paraffin Wax Bath. Pakistan journal of medical sciences, 29(6), 1406.
    • Systemic Changes
61. 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.
    • Muscle Activity
62. Jung, S. M., Lee, J. N., & Jeon, J. H. (2018). The Effect of Ankle stability exercise and Mobilization on Hip Muscle Strength and Gait in Patients with Acute Ankle Sprain. The Journal of Korean Academy of Orthopedic Manual Physical Therapy, 24(1), 39-46.
63. Ersoy, U., Kocak, U. Z., Unuvar, E., & Unver, B. (2019). The Acute Effect of Talocrural Joint Mobilization on Dorsiflexor Muscle Strength in Healthy Individuals: A Randomized Controlled Single-Blind Study. Journal of sport rehabilitation, 28(6), 601-605.
    • Performance
64. Delahunt, E., Cusack, K., Wilson, L., & Doherty, C. (2013). Joint mobilization acutely improves landing kinematics in chronic ankle instability. Medicine & Science in Sports & Exercise, 45(3), 514-519.
    • Self-Administered
65. Cruz-Díaz, D., Hita-Contreras, F., Martínez-Amat, A., Aibar-Almazán, A., & Kim, K. M. (2020). Ankle-Joint Self-Mobilization and CrossFit Training in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. Journal of Athletic Training.
    • Tibiofibular Biomechanics
66. Scott, J., Lee, H., Barsoum, W., & Van Den Bogert, A. J. (2007). The effect of tibiofemoral loading on proximal tibiofibular joint motion. Journal of anatomy, 211(5), 647-653.
67. Koh, E. K., Weon, J. H., & Jung, D. Y. (2014). Effect of direction of gliding in tibiofibular joint on angle of active ankle dorsiflexion. Journal of Korean Society of Physical Medicine, 9(4), 439-445.
68. Kavanagh, J. (1999). Is there a positional fault at the inferior tibiofibular joint in patients withacute or chronic ankle sprains compared to normals?. Manual Therapy, 4(1), 19-24.
69. Hubbard, T. J., Hertel, J., & Sherbondy, P. (2006). Fibular position in individuals with self-reported chronic ankle instability. Journal of Orthopaedic & Sports Physical Therapy, 36(1), 3-9.
70. Hubbard, T. J., & Hertel, J. (2008). Anterior positional fault of the fibula after sub-acute lateral ankle sprains. Manual therapy, 13(1), 63-67.
71. Fukuhara, T., Sakamoto, M., Nakazawa, R., & Kato, K. (2012). Anterior positional fault of the fibula after sub-acute anterior talofibular ligament injury. Journal of Physical Therapy Science, 24(1), 115-117.
    • Efficacy
72. Fujii, M., Suzuki, D., Uchiyama, E., Muraki, T., Teramoto, A., Aoki, M., & Miyamoto, S. (2010). Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?. Manual therapy, 15(1), 117-121.
73. 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.
74. Douillet, L., Benkirane, M., & Hidalgo, B. The immediate effect of inferior tibio-fibular mobilization with movement and Mulligan taping on patients with chronic ankle dorsiflexion stiffness: a clinical randomized and placebo controlled study.
75. Nisha, K., Megha, N. A., & Paresh, P. (2014). Efficacy of weight bearing distal tibiofibular joint mobilization with movement (mwm) in improving pain, dorsiflexion range and function in patients with postacute lateral ankle sprain. Int J Physiother Res, 2(3), 542-48.
76. Pradesh, U., & Pradesh, U. EFFECT OF PROXIMAL & DISTAL FIBULAR GLIDE IN THE SUBJECTS WITH KNEE OSTEOARTHRITIS.
    • Systemic Effects
77. 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.
    • Performance
78. Goto, M., Shiga, Y., Mizuno, Y., Nakamura, M., & Jung, H. S. (2014). Effect of the Adjustment of the Tibiofibular Joint on the Range of Motion in the Ankle Joint and Exercise Performance. 보완대체의학 연구소 연구논총, 5, 61-69.