Essential Manual Therapy Techniques For Sports Physios For Managing Ankle Injuries
Throughout my 13 years as a physio and throughout the mentorship and return to play courses I have noticed there are always certain tissues that therapists overlook.
Today I’ll talk you through the peroneus brevis and its importance to your rock solid treatment plan.
One of the muscles I see carrying a protective tone even a year after an ankle injury is the peroneus brevis.
The peroneus brevis is going to plant the flex and evert the foot. Usually when someone inverts the foot the patient will experience some kind of lengthening which would have caused the peroneus brevis to go into protective tone.
The peroneus brevis needs to lengthen when we heel strike, when walking or accepting weight on the floor. When we do heel strike the ankle will have dorsiflexion and some kind of inversion and the peroneus brevis will need to lengthen. So if it does have some kind of protective tone this will affect the ability to dorsiflex and invert.
The peroneus brevis attaches from the distal two thirds of the fibula but where the problem is a little lower down. As we run down the fib there will be tenderness. We will also have some tertius which will dorsiflex and evert, this will need to lengthen when we evert.
If there is some tenderness you can ask your patient to dorsiflex invert, twisting their foot in whilst stipping through the tissues, decreasing the perceived threat and reassuring the system it is safe.
Once this protective tone is gone it will improve the ability to dorsiflex invert we restore as many movement options as possible.
Posterior Tibiotalar Ligament
The posterior tibiotalar and tibiotalar ligaments are usually quite tender in athletes that have protective tone or some issues with dorsiflexion and inversion. We need to decrease the sensitivity of these tissues because they also need to lengthen as the athlete dorsiflexes.
What you do is come behind the fibula and get in between the fibula and the talus. Direct away from the back of the fib head and toward the talus.
Many athletes find relief in these particular tissues when you use a Mulligan technique or putting an AAP through the talus, you will get some reflexive relaxation of the tibiotalar ligament.
Ask Yourself Why
I have seen a lot of athletes feel the positive benefits of decreasing these perceived threats and allowing the tissues to lengthen but if the ankle range keeps reducing we have to ask ourselves why.
Is there some kind of loose body in the ankle joint maybe? Are we just giving a reflexive relaxation to our protective tone? Are we actually identifying the true cause so that the system is happy to allow that tissue to lengthen time and time again, rather than just giving it a short term reflexive change.
If you want more information on how to look at the whole body and get those long-term changes you need click here.