A recent study showed the effects of manual therapy to the ankle improved balance activities. Here are 5 common ankle patterns I see and treat across a myriad of conditions.
I thought I would go old school pathoanatomic and take a look at some arthrokinematic patterns that I still find useful now and then. Here are 5 Common Dysfunctional Ankle Patterns.
1) Active and passive dorsiflexion is accompanied by excessive eversion
- initially I was taught to measure ankle df passively with the forefoot in slight supination to mimic gait by Dr. Patla from St. Augustine
- this prevents the newbie mistake of actively and passively measuring dorsiflexion and letting the forefoot excessively evert and pronate, which is a movement of compensation
- sometimes this is motor control, more often than not it's restrictions in the talocrural joint accompanied by genu valgus with closed chain activities
- make sure to check not only posterior glide of the talus, but more specifically medial posterior glide of the talus
- have the patient perform a MWM while you are holding the talus still as the tibia glides anteriorly over it during a lunge or squat
- bias pressure toward the medial side of the talus and make sure their forefoot is not everted greater than 5 degrees
2) Recurrent lateral ankle sprains have a neurodynamic component
- remember to check neurodynamic mobility in problems that appear to be chronic and otherwise seem to have good ROM
- a chronically painful lateral ankle often has positive peroneal or saphenous nerve biased test
- chicken or egg, pattern #1 from this post often causes tibial ER with closed chain activities resulting in a loss of tibial IR
- not coincidentally, I'm sure, is this is also a common pattern in your "PFS" otherwise known as knee pain
- with true ankle dysfunction, or slow responders, you need to mobilize and manipulate quite a bit more for the eventual improvements in ROM
- it definitely helps to have distal areas to work on that may be much less threatening than working on the proximal DP
- there is often increased tone in the lateral tibial bony contours to the proximal lateral calf, as well as the lateral thigh
- I don't pretend I'm releasing these "muscles" only changing tone through a myriad of plausible mechanisms
- working on these patterns, however, often improves tibial IR, thus improving ankle df
Just for good measure, he is my video on Eclectic Strategies for Improving Ankle Mobility
Keeping it Eclectic...