Ankle and Foot Joints (Fig 5.57)
144 PERIPHERAL JOINT MOBILIZATION TECHNIQUES
FIGURE 5.64 Dorsal gliding of a distal tarsal on a proximal tarsal. Shown is the cuboid bone on the calcaneus.
FIGURE 5.63 Plantar glide of a distal tarsal bone on a stabilized proximal bone. Shown is the cuneiform bone on the navicular.
Patient Position
Supine, with hip and knee flexed, or sitting, with knee flexed over the edge of the table and heel resting on your lap.
Stabilization
Fixate the more proximal bone with your index finger on the plantar surface of the bone.
Patient Position
Prone, with knee flexed.
Stabilization
Fixate the more proximal bone.
Hand Placement
To mobilize the lateral tarsal joints (e.g., cuboid on calcaneus), position yourself on the medial side of the
is forced in a plantar direction. This is a relative motion of the distal bone moving in a dorsal direction.
Intermetarsal, Metatarsophalangeal, and Interphalangeal Joints
The intermetatarsal, metatarsophalangeal, and interpha- langeal joints of the toes are stabilized and mobilized in the same manner as the fingers. In each case, the articulat- ing surface of the proximal bone is convex, and the articu- lating surface of the distal bone is concave. It is easiest to stabilize the proximal bone and glide the surface of the dis- tal bone either plantarward for flexion, dorsalward for extension, and medially or laterally for adduction and abduction.
patient’s leg and wrap your fingers around the lateral side of the foot (as in Fig. 5.64).
To mobilize the medial bones (e.g., navicular on talus), position yourself on the lateral side of the patient’s leg and wrap your fingers around the medial aspect of the foot.
Place your second metacarpophalangeal joint against the bone to be moved.
Mobilizing Force
Push from the plantar surface in a dorsal direction.
Alternate Technique
Same position and hand placements as for plantar glides, except the distal bone is stabilized and the proximal bone
I N D E P E N D E N T L E A R N I N G A C T I V I T I E S
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Critical Thinking and Discussion
1.An individual is immobilized in a cast for 4 to 6 weeks following a fracture. In general, what structures lose their elasticity, and what restrictions do you feel when testing range of motion, joint play, and flexibility? 2.Describe the normal arthrokinematic relationships for
the extremity joints and define the location of the treat- ment plane for each joint.
3.Using the information from item 1, define a specific fracture, such as a Colle’s fracture of the distal forearm. Identify what techniques are necessary to gain joint mobility and range of motion in the related joints such as the wrist, forearm, and elbow joints, connective tis- sues, and muscles. Practice using each of the techniques. 4.Explain the rationale for using passive joint techniques
to treat patients with limitations because of pain and muscle guarding or to treat patients with restricted cap- sular or ligamentous tissue. What is the difference in the way the techniques are applied in each case?
5.Describe how joint mobilization techniques fit into the total plan of therapeutic intervention for patients with impaired joint mobility.
6.Explain the difference between passive joint mobiliza- tion techniques and mobilization with movement tech- niques.
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Laboratory Practice
With a partner, practice mobilizing each joint in the upper and lower extremities.
Precaution:Do not practice on an individual with a hypermobile or unstable joint.
1.Begin with the joint in its resting position and apply dis- traction techniques at each intensity (sustained grades I, II, and III) to develop a feel for “very gentle,” “taking up the slack,” and “stretch.” Do not apply a vigorous stretch to someone with a normal joint. Be sure to use appropri- ate stabilization.
2.With the joint in its resting position, practice all appro- priate glides for that joint. Be sure to use a grade I dis- traction with each gliding technique. Vary the techniques between sustained and oscillation.
3.Practice progressing each technique by taking the joint to a point that you determine to be the “end of the range” and:
• Apply a distraction technique with the extremity in that position.
• Apply the appropriate glide at that range (be sure to apply a grade I distraction with each glide).
• Add rotation (e.g., external rotation for shoulder abduc- tion) and then apply the appropriate glide.
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