Joint mobilization is a technique that is often used in the rehabilitation of foot and ankle injuries. It involves the passive movement of a joint by a trained professional, often a physical therapist or a doctor. Joint mobilization is generally categorized into five different types of mobilization. The five grades of joint mobilization are classified based on the mechanoreceptors being activated.
Grade I joint mobilization is directed towards cutaneous mechanoreceptors, and the motion involves a minimal amount of tension on the joint through oscillation. Grade II is similar to Grade I, but has a higher amount of tension placed through the joint and affects a greater amount of mechanoreceptors. Grade III selectively activates more of the joint and muscle mechanoreceptors and less of the cutaneous receptors. Grade IV has a sustained movement at the end range of motion at the joint, and is targeted more towards the slow adapting mechanoreceptors of the joints and tendons. Grade V joint mobilization is also referred to as a manipulation, and involves a more rapid movement of the joint at its end range of motion.
Often times there is a limitation in motion at the ankle joint as a result of injury or prolonged immobilization secondary to surgery or casting. Limited range of motion in the direction of dorsiflexion is referred to as equinus, and is often the cause of foot problems and pain. Research has shown that joint mobilization at the ankle joint can help improve range of motion. A study by Green et al. in 2002 showed that patients who sustained an acute inversion ankle sprain, when treated with certain types of mobilizations of the ankle showed improvement in pain levels and functional outcomes. Similarly, Landrum et al. showed an improvement in range of motion following prolonged immobilization of the ankle. Dorsiflexion following joint mobilization was improved.
Joint mobilization of the ankle joint is typically done in combination with the subtalar joint, as these two joints work closely together during movement of the ankle and rearfoot, and are commonly both injured in strains and sprains. It is generally combined with muscle strengthening and stretching exercises that will also help to improve range of motion and lead to a better functional outcome. A rehabilitation program is typically devised between the doctor and the patient following an injury to the foot and ankle, or in cases of surgical reconstruction following trauma or a chronic condition.
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