Post Joint Mobilization Recommendations

What is mobility without control?  A recipe for injury and loss of training time.

The purpose of this blog post is to highlight the need for more of us to follow through with the process of restoring function after gaining mobility.   Specifically, I want to highlight that the goal after gaining mobility is to achieve the neuromuscular control and  tissue resilience to handle the load demands placed upon the body in that increased joint range.

Joint mobility can be achieved through stretching, repeated movements, or manual techniques.  Phyical Therapists will use manual (hands on) joint mobilization techniques to improve joint accessory motions and physiological motions so a client can perform a desired task without pain or pathologic movement.  Physiological motions refer to gross movement such as flexion, extension, and rotation movements. An example is bringing the thigh toward the chest to create hip flexion.  Accessory motions refer to how the joint surfaces move against one another.  For example, when the head of the femur is laterally rotated on the acetabulum (hip socket)  in an open kinetic chain (when the leg is not in contact with the ground), an accessory anterior and superior glide of the femur on the acetabulum occurs.  In a healthy movement system, accessory motion should be held in check by passive structures such as ligaments and cartilage (labrums, meniscus, etc.) and controlled by precise coordination of muscles around the joint.  In theory and clinical application, maintaining a precise center of rotation is desirable.  Though not a perfect example, consider a suspension bridge without sufficient control to limit excessive motion. (See Tacoma Narrows Bridge collapse below).

*Skilled assessment should always be performed prior to attempting self administered forceful joint mobilization techniques.  Hypermobility is contraindicated.  Remember that just because a structure feels “tight” does not mean that the structure needs mobilization.  “Tightness” is a sensation! 

I am a prime example for this blog post.  3 years ago, I enjoyed a gnarly grade II inversion ankle sprain overstretching my left lateral ankle ligaments.   Recently I have had midfoot pain with running or hopping on one foot and it was increased on for 24-48 hours after long runs.  A few colleagues assessed my ankle and foot finding key findings limited active/passive dorsiflexion and restricted mid foot pronation (functional and passive) among other impairments.  Following manual joint and soft tissue mobilization techniques, I had no pain with repeated single leg hopping and my percieved ability pronate the foot improved.  With improved pronation, my lower extremity should more effectively absorb impact forces compared to my baseline at initial assessment.  However, my lower extremity needs to do this in a coordinated fashion.

My simple post mobilization regimen has been

1. Activity modification (reduction in volume and intensity of runs for 2 weeks)   2.  Single limb balance on level and uneven surfaces, with single limb squat .  3. Low load eccentric calf strengthening x1 to fatigue 4.  Single leg hopping x1 to fatigue