Big hitters come first, then we get into the nitty gritty of the mechanics. The above video crushes most dorsiflexion issues by giving the ankle mortise joint space to roam. In passively testing how that ankle moves we often come upon bony end ranges, or pinching, before we get complaints of tissue “tightness”. Quite often even during a single kneeling test of dorsiflexion the range of motion isnt stopped by a tight calf, so how do we account for lack of ROM? You may have gathered as much already, but I would argue tibial rotation impinges flexion moreso than the tissue length. Again though, as a clinician you have to address the tissue length of the posterior shin musculature, but if that isnt the primary cause of loss of dorsiflexion simply treating out the posterior side wont get you very far.
If you are finding that your work wont hold, that your patient leaves and a day or two later their symptoms return, then it’s time to look elsewhere. I should also mention that it’s also a mistake to completely neglect those things that got your client relief. So now that you know what works, hit it really quickly once again, then bring some other friends to the party. These are two great tools to have in your bag:
Bill Hartman does a great job of explaining himself through the video so the add-ons are minimal. If you catch the end or little bits in the middle, he backs up that these ‘moves’ are by no means a stand alone treatment. He does some ART to the post-lateral calf to compliment the mobs. These are simple add-ons that make a big difference in a thorough treatment of a foot/ankle issue. If you need a better explanation for the first met-head mob check out this older post of mine.
Once you achieve that extra ROM in the ankle it’s wildly important to load the foot and ankle to make sure you maintain the results you just got. There have been too many times that we have helped the patient achieve a better range of motion and then a couple steps down the hall and its completely lost. Not all systems are this sensitive, but covering your basis by doing a quick exercise or two on the table before they walk helps a lot. Traditional inversion/eversion are fine, but the more specific you can be the better. This from Aaron Swanson is a pretty straight forward one that is actually pretty challenging
Loading that movement under some body weight helps a ton too. Here’s that first one again:
The simple tweaks with this one are to play with the direction of the knee. Ideally moving over the 2nd toe is great, but exploring dorsiflexion with the tibia rotated and moving medially or laterally will quickly show a directional preference. This is pretty deep here so maybe read it twice… but find the direction that’s a bummer and keep moving it that way until it’s not. Make the rotation and flexion over the 2nd toe a priority, but do not neglect some medial or lateral translation.
Id be remiss if i didnt show my favorite progression from dre. If you can get down there safely, this one is a winner
Those bands are all over the place these days, but if you dont have one you can find them at Edge Mobility Systems. Dr. E has a bunch of other great tools too on the site, and a blog behind it to give you some ideas on how to use them.
Also, another big thanks to Chris Johnson PT (the first video) who has the largest bank of quality videos out there.
The best way to contact me for questions or comments is at NominalistDC@gmail.com
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POST UPDATE!!!!
This post was discussed at length (30 minutes in) by the Gait Guys on podcast #90. Always grateful to learn from their expertise and this episode is no different. I highly suggest you subscribe and get out your notepad, it’s a great way to keep yourself accountable as a clinician. Ill certainly be taking their advice and putting it to work tomorrow.
Thanks!
The Nominalist 