A Novel Ankle Mobilization for the Sensitive Patient | Modern Manual Therapy Blog

A Novel Ankle Mobilization for the Sensitive Patient


Try this alternate method for ankle dorsiflexion with the sensitive patient.


Recently I have been treating a young former college athlete who was involved in a motor vehicle accident. Following ultra conservative care for her left ankle sprain the patient has severely restricted ankle dorsiflexion. 

Objective goniometric ankle rom test measures found -8 degrees dorsiflexion and 40-50 degrees plantarflexion, with subtalar motion normal. Joint play of the talocrural joint found painful hypomobile posterior gliding secondary to excessive anterior talocrural positioning. 

Gait as you can imagine for this patient was quite painful and compensated. 

The patient responded with relief when taken provided clinician traction to the TC joint and was able to perform active rom nearly pain free. As progression went on weight-bearing has improved but when applying the Functional Mobilization in standing or kneeling, the patient was unable to tolerate either position due to pain.  

A non-weight-bearing WMW method was applied as seen here which the patient was able to tolerate pain free.

Ankle Dorsiflexion Unloaded Functional Mobilization



Following application of alternate method the patient was able to tolerate standing and kneeling variations quite well. 

We often have excellent tools in the tool box to use, but get stuck when the one size fits all approach doesn’t work. Try this alternate method with the more sensitive patient and progress them to a more functional mobilization when ready. Education plays such a vital role in establishing the patient/clinician alliance to treatment. 

So get creative. 

Teach while they ride the bike, provide videos for them during manual therapy and use the topic to open further discussion. Wouldn’t you better understand your journey with a map? So do our patients. Give them the tools and guidance to stick to the plan and realistically achieve their goals.


Dr. Novo out…



Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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