Manual therapy at the ankle - prequel

The subtalar joint mobilisation, plus talonavicular joint mobilisation, plus navicula-cuneiform joint mobilisation. In the previous post, I demonstrated mobilisation at the cuboid-metatarsal joints to improve standing ankle dorsiflexion screen from 37 to 40-41 degrees. A few days earlier, I'd assessed the ankle, finding adequate talo-crural joint accessory motion in the anterior to posterior plane, but having mobility dysfunction in the subtalar joint, talo-navicular joint and navicula-cuneiform joints. I mobilise them here using direct and indirect mobilisation techniques, finally reassessing the mobility to improve from 33 degrees, where he'd been stuck for some time with a colleague, to 37 degrees. The colleague had done a great job mobilising his talo-crural joint, and had even done some midfoot mobilisations, but the resistance at 30-33 degrees persisted. I'd been asked whether class 4 laser therapy might assist with improvement in flexibility in the anterior ankle scars from his ankle reconstruction. I had done laser therapy the day before, with no change in mobility. After this mobilisation, I repeated laser, and his mobility receded from 37 degrees back to 33 degrees. I hypothesise that an increase in local blood flow may cause tissue congestion. In the previous post, the starting SADS test was 37 degrees, indicating that the two day period between that treatment and this had seen the acute effect of laser recede, and the mobilisation effect maintain. Clearly there's a possible dual effect.