The next technique is a progression to work on medial posterior talar glide. I have found over the years that the medial talus often loses posterior glide, while the lateral talus glides posteriorly with dorsiflexion. This causes eversion and pronation in WB positions. Passively measuring for this, if you do not put the forefoot in neutral and slight supination, you will often measure in the everted position. If there is talocrural dysfunction, the end feel will change to hard in the neutral/supinated from firm in the everted position.
Pt:
- half kneeling, standing, or lunging
- May squat or single leg squat to perform the movement
PT
- standing in front of patient
- Tech 1
- Stab hand: webspace over anterior talus
- Mob hand on posterior distal tibia
- Tech 2
- Stab hand dummy thumb pushes anterior tibialis tendon medially, thumb contact on medial anterior talus
- Mob hand pisiform over dummy thumb
Tech
- pt lunges in half kneel, lunge, single leg or double squats
- Tech 1 mob hand helps guide tibia and pulls it anteriorly, make sure to guide patella over 2nd MT
- for both techniques, the webspace or thumb/mob hand pushes posteriorly on the talus to improve dorsiflexion
- Tech 1 should be 100% pain free - perform 3-4 sets of 10 reps
- Tech 2 is VERY uncomfortable and used as a progression when needed, proper warmup and STM/IASTM recommended, perform again 3-4 sets of 10 reps
- Remeasure dorsiflexion/function
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