If inversion stress test is positive, or patient has limited functional WB activities, try this technique! Mulligan postulated that some inversion sprains that test painful and lax are as a result of the lateral malleolus getting pulled anteriorly by the ATF.
- foot in resting position to start
- test inversion stress, if limited ROM and/or painful
- mobilizing hand grasps anterior lateral malleolus with thenar eminence to apply glide
- fingertips of the mob hand are grasping posteriorly
- other hand on lateral anterior forefoot to apply inversion stress or assist patient with AROM inversion and apply overpressure
- apply a constant posterior glide and retest inversion stress test
- if pain free, apply 2-3 sets of 10 reps, ending in overpressure - has to be 100% pain free other than stretch
- note, if acute, may be tender to touch at lateral malleolus, as long as it does not remain increased when done
- if not 100% pain free, try more force, less force, or changing to posterior superior glide or posterior inferior glide
- if effective, not only will the inversion stress test be improved, but functional ADLs should be as well!
I've even used this on myself immediately s/p an acute inversion sprain, it made it so that I could walk and WB the rest of the evening and most likely reduced the healing time.