Talus
Key Concept: You must draw the Inferior Calcaneus Anteriorly when you are mobilizing the Talus posteriorly.
This will engage the Talus and Calcaneus and will enhance the rotational aspect of Talar mobility. You cannot just glide the Talus posteriorly, the Talus must also rotate with the Calcaneus. Talar posterior glide/slide the also had a component of roll. Roll is only provoked when you apply an anterior drawer to the Calcaneus with gliding the anterior Talus posteriorly. I will post pictures soon that will reinforce this. Furthermore, it maximizes contact of Talus and Calcaneus also called Closed-Pack position. Note that the dome of the Talus which articulates with the Tibia is convex. Being convex means that rotation is a very relevant motion as opposed to only glide/slide.
Letter to the Editor: Talus Talus (Talocrural Joint) Mobilization
(Not published, I never completed it, so did not submit in a timely manner)
RE: Landrum E, Kelln Cdr B.M., Parente W. R., Ingersoll C. D., Hertel J. Immediate Effects of Anterior-Posterior Talocrural Joint Mobilization After Prolonged Ankle Immobilization: A Preliminary Study. J Man & Manip Ther 16(2):100-105.
Dear Editor,
RE: Landrum E, Kelln Cdr B.M., Parente W. R., Ingersoll C. D., Hertel J. Immediate Effects of Anterior-Posterior Talocrural Joint Mobilization After Prolonged Ankle Immobilization: A Preliminary Study. J Man & Manip Ther 16(2):100-105.
This study is very encouraging for a variety of reasons. I am delighted that it is a preliminary study, as there is so much potential for enhancements with future studies. While I am not a researcher, I do enthuse about the topic of the study.
Future study with the use of a control group that receives only the instrumented ankle arthrometer (IAA) would allow determination of whether or not the IAA had a treatment effect in enhancing ankle dorsiflexion.
The IAA could be applied to the posterior calcaneus only, in order to tease out some data on the role of anterior glide of the calcaneus. It is my belief that anterior glide of the calcaneus is a very important part of the procedure used to restore posterior glide of the talus with the end result of increased ankle dorsiflexion. It appears to add a sagittal rotational element to the calcaneus and therefore the talus.
The IAA seems to be a relevant tool that can be applied to many structures throughout the body to research appropriate forces for optimal joint mobilization. It might also be used to evaluate joint laxity and hypomobility throughout the body.
The treatment applied to the talus is described as Anterior to Posterior Glide of the Talus (APGT). It is referenced in 6 studies mentioned in the above article. I have recently struggled over this terminology. The term APGT seems appropriate if one is describing what they are performing directly to the talus alone. Yes, the specific force I apply to the talus is appropriately called APGT. It also seems appropriate when one looks at the anatomy of the distal tibia, which articulates with the dome of the talus. In the sagittal plane, the distal tibia is fairly flat, having only a mild anterior-posterior concavity. I am hard pressed to find an adequate picture demonstrating that, having looked in several clinical textbooks. I easily find pictures that demonstrate the significant convexity of the dome of the talus. My anatomical model came to the rescue and it demonstrates that the dome of the talus makes only a relatively small amount of contact with the distal tibia*, and that the contact points on each bone changes throughout the range of dorsiflexion and plantar flexion. At present, A-P or P-A glide of the talus is a theoretical construct lacking hard data. Perhaps glide and roll would be more appropriate. In time I hope to pursue this question via literature research. I submit that mobilizing the distal tibia on the talus can be described as a glide, when the force is A-P or P-A.
*Neumann made this point in a brief general statement comparing contact surface areas for the ankle, knee and hip.
Sincerely Yours,
Jerry Hesch
This will engage the Talus and Calcaneus and will enhance the rotational aspect of Talar mobility. You cannot just glide the Talus posteriorly, the Talus must also rotate with the Calcaneus. Talar posterior glide/slide the also had a component of roll. Roll is only provoked when you apply an anterior drawer to the Calcaneus with gliding the anterior Talus posteriorly. I will post pictures soon that will reinforce this. Furthermore, it maximizes contact of Talus and Calcaneus also called Closed-Pack position. Note that the dome of the Talus which articulates with the Tibia is convex. Being convex means that rotation is a very relevant motion as opposed to only glide/slide.
Letter to the Editor: Talus Talus (Talocrural Joint) Mobilization
(Not published, I never completed it, so did not submit in a timely manner)
RE: Landrum E, Kelln Cdr B.M., Parente W. R., Ingersoll C. D., Hertel J. Immediate Effects of Anterior-Posterior Talocrural Joint Mobilization After Prolonged Ankle Immobilization: A Preliminary Study. J Man & Manip Ther 16(2):100-105.
Dear Editor,
RE: Landrum E, Kelln Cdr B.M., Parente W. R., Ingersoll C. D., Hertel J. Immediate Effects of Anterior-Posterior Talocrural Joint Mobilization After Prolonged Ankle Immobilization: A Preliminary Study. J Man & Manip Ther 16(2):100-105.
This study is very encouraging for a variety of reasons. I am delighted that it is a preliminary study, as there is so much potential for enhancements with future studies. While I am not a researcher, I do enthuse about the topic of the study.
Future study with the use of a control group that receives only the instrumented ankle arthrometer (IAA) would allow determination of whether or not the IAA had a treatment effect in enhancing ankle dorsiflexion.
The IAA could be applied to the posterior calcaneus only, in order to tease out some data on the role of anterior glide of the calcaneus. It is my belief that anterior glide of the calcaneus is a very important part of the procedure used to restore posterior glide of the talus with the end result of increased ankle dorsiflexion. It appears to add a sagittal rotational element to the calcaneus and therefore the talus.
The IAA seems to be a relevant tool that can be applied to many structures throughout the body to research appropriate forces for optimal joint mobilization. It might also be used to evaluate joint laxity and hypomobility throughout the body.
The treatment applied to the talus is described as Anterior to Posterior Glide of the Talus (APGT). It is referenced in 6 studies mentioned in the above article. I have recently struggled over this terminology. The term APGT seems appropriate if one is describing what they are performing directly to the talus alone. Yes, the specific force I apply to the talus is appropriately called APGT. It also seems appropriate when one looks at the anatomy of the distal tibia, which articulates with the dome of the talus. In the sagittal plane, the distal tibia is fairly flat, having only a mild anterior-posterior concavity. I am hard pressed to find an adequate picture demonstrating that, having looked in several clinical textbooks. I easily find pictures that demonstrate the significant convexity of the dome of the talus. My anatomical model came to the rescue and it demonstrates that the dome of the talus makes only a relatively small amount of contact with the distal tibia*, and that the contact points on each bone changes throughout the range of dorsiflexion and plantar flexion. At present, A-P or P-A glide of the talus is a theoretical construct lacking hard data. Perhaps glide and roll would be more appropriate. In time I hope to pursue this question via literature research. I submit that mobilizing the distal tibia on the talus can be described as a glide, when the force is A-P or P-A.
*Neumann made this point in a brief general statement comparing contact surface areas for the ankle, knee and hip.
Sincerely Yours,
Jerry Hesch
