Many times, treating the painful and limited area on a patient is threatening and you will have slow to no results with treatments that normally work rapidly.
Here are 5 areas to address that would potentially improve ankle dorsiflexion other than the talocrural joint.
1) The Calcaneus
- this is old hat to traditionally trained manual therapists, but I find myself not looking at this area as much as I should
- occasionally with a painful loss of dorsiflexion, or with an impingement like perception at the talocrural joint, a little light IASTM around the calcaneal bony contours works wonders
- if still limited in tri-planar rock, just wiggle it a little in various positions of ankle neutral, df, and pf and then recheck WB dorsiflexion
2) The Great Toe
- It's an all too common pattern to see forefoot eversion during gait as a loss of dorsiflexion compensation
- however, chicken or the egg, this is concurrent with a loss of great toe extension which is lost if no push off is occurring during gait
- if you are able to consistently restore dorsiflexion and yet it does not stay improved (with patient compliance to HEP) - look at the great toe/first ray mobility
3) Tibial IR
- again, the compensation of forefoot eversion often leads to consequences up the chain, and one of these is tibial ER, or a lack tibial IR
- that's why light IASTM along the bony contours of the tibia and and lower leg anteriorly and posteriorly plus a functional mobilization of tibial IR work so well during the half kneel ankle dorsiflexion test
4) Sidegliding in Standing
- this is my go to Repeated Motion Exam for any lower quarter presentation
- studies show both repeated extension in lying, and P/A mobilizations to the lumbar spine both improve neurodynamics
- since we cannot predict the loss of motor control or pain perceptions, we can only work on movement and loading asymmetries and see if they affect a distal portion peripherally
5) IASTM to anterior calcaneus
- I find this works better to improve ROM in painful posterior presentations
- you are still re-defining a potentially cortically smudged representation of the foot/ankle but not increasing threat by avoiding the painful area
- about 30-60 seconds of as light IASTM as possible are all that is needed to improve df in many cases
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