Ankle Flashcards
Acute Phase Interventions for Ankle (4 items)
Level of Evidence
Evidence Level B
1 - Active mobilization (muscle energy)
2 - Oscillatory graded
3 - Strain-counterstrain
4 - Manual lymph drainage
Manual therapy
Location to apply soft tissue to the gastrocnemius
Pressure applied to posterior medial tibia
Manual therapy to the Soleus
Medial portion of the posterior tibia.
Manipulation for patients with lateral and lateral mid-foot symptoms
Tarsal Manipulation
Plantar Flexion / Inversion
Later in rehab phase
Cuboid Manipulation
Follow with heel raises.
Tenderness in what area of the foot is a contraindication for joint mobilization?
Involving what bones?
Mid-foot tenderness involving cuboid and navicular.
Need for plain films per Ottawa Rules for the Ankle.
X-rays are important at this point.
Appropriate manual technique to gain ankle DF in Progressive loading phase/ Sensorimotor training
Talocrural long axis distraction (manipulation)
Cuboid Whip is indicated in which situation and in which phase
Residual tenderness and lack of dorsal mobility of the cuboid bone.
Pain is present with heel-raise movements.
Best exercises for Acute phase
Evidence Level
Active range of motion
Seated exercises
Hip and trunk exercises (example bridging and trunk progression)
(Evidence Level A)
What are “foot tripod” exercises used for?
Core of the foot
Fibularis Muscle
Exercise for lateral ankle sprains in Post Acute Phase Intervention
What is the level of evidence?
D - Conflicting evidence
F - Expert Opinion
Post Acute Phase
What should you watch for during exercises?
No reproduction of symptoms during or after the exercise.
No swelling should be seen.
Progression from ankle tripod
8:16
Squat/Lunges/Heel raises
What should watch for during a calf stretch and how to solve that problem?
Watch for navicular drop.
Solve that by using a little roll under the forefoot.
What are the best exercises for balance deficits during
“Progressive Loading/Sensorimotor Training” phase?
Dynamic exercises conducted on single limb
What should be the advice in regards to weight bearing during acute protected phase?
Progressively weight bear with assistance of external supports.
Crutches and other devices.
Casting and braces can be used.
Ankle taping
Open basket weave
Lateral ankle support
Is therapeutic ultrasound recommended on ankle sprains?
The evidence suggests it has a placebo effect only.
What modalities should be use for ankle sprains and their level of evidence?
Level A - Cryotherapy / No Ultrasound
Level D - Electrotherapy/low level laser therapy
Level C - Shortwave diathermy
Which patients are more likely to benefit from manual therapy with ankle pain?
Patients with:
- Worse symptoms with standing
- Worse symptoms in the evening
- Navicular drop more than 5mm
- Hypomobility of the talucrural joint
What are the 4 times of applications of CPGs
1 - Risk factors
2 - Differential diagnosis
3 - Intervention (Clinically effective interventions and patient subgrouping)
4 - Prognosis
What are 5 risk factors for ankle injuries?
1 - Hx of previous injury
2 - No external support
3 - No warm ups (static or dynamic)
4 - No normal ankle DF ROM
5 - No participation in balance/proprioception program
What is the difference between the acute and chronic ankle sprain presentation?
Acute: Pain and swelling
Chronic: Instability
What is a grade A functional measure for ankle assessment?
FAAM - Foot and ankle ability measure
