I can mobilize a rather stiff ankle and foot, even just jiggle the ankle, subtalar joint, forefoot, for a few minutes without regard to methodology, with mild to moderate force, and measurably increase the motion. The force is far too light and too short in duration to have changed any of the supporting structures (ligaments) since the ankle ligaments are quite strong and a few minutes of joint mobilization will largely go unnoticed by those tissues.
So, the effect of the manual technique is partly the contact (the intensity of my hands on the client's body) and the reflexes associated with it, the pain reduction, and the specificity of movement. Using my hands, I can direct motion into any of the three planes or a combination of planes. The shifting of the joint can break collagen cross-link adhesions that form from a decrease in glycosaminoglycan content and improve the viscosity of the synovial fluid in the joint. The compression and distraction movements can also reduce any edema.
How could I achieve the same effects using exercise?
With a person who has a stiff ankle following immobilization (and if they have had some type of fixation, we have another set of issues), I have used a variety of drills to improve motion. Here are some of them:
- Squats supine position, on a Total Gym, at a low load (typically levels 2 or 3 on a ten rung machine). The client places his/her feet at the top of the platform. Squat to the end of motion, pause, oscillate for 10 seconds, and return to starting position. Repeat for ten minutes. Perform 3 sets.
- In this drill, you can expect about 400 to 600 mobilizations of the joint. A lot more than what you could achieve with ten minutes of manual mobilization.
- Squats supine position, on a Total Gym, at a low load (levels 2 or 3) with the symptomatic side up. Place a small wedge (this could be a folded wash cloth) under the lateral part of the foot. This increases the relative amount of eversion. The client squats and slightly adducts the limb to create a combined internal rotation and eversion in the subtalar joint. I usually use the same dosage as above.
- If the client tolerates full body weight loads, and for this example let's assume it's the left foot that is the symptomatic side, I place a small wedge under the lateral part of the foot. Step back with the right leg to create a staggered stance. Now perform a squat to about 70 degrees of knee flexion and rotate the trunk and arms to the left. This should drive the left leg into internal rotation and adduction and also stress dorsiflexion. You have to repeat this several times and often clients fatigue in the leg or foot muscles. If so, I unload them using a pulley system by attaching a waist strap to the client and then connect it to the pulley (so the pulley is pulling up and back on the client).
- Use a Pro-Stretch. Have the client sit in a chair and place both feet on a double Pro-Stretch. Now, rock the Pro-Stretch back and forth (which creates a side to side motion). This is an excellent drill for talocrural osteoarthritis or subtalar motion restrictions. The client can perform 10, 15, 20 minutes or more of the movement yielding 100's of mobilizations.
Do you have drills you like to use to increase motion of the foot?
DK
