FEATURE TECHNIQUE NOBILITY IN MOBILITY Exploring joint mobilizations in the lower extremity BY JONATHAN MAISTER A JONATHAN MAISTER is a certified athletic therapist, RMT and sport massage therapist based in Markham, Ont. He has presented across Canada at numerous conferences and is a regular contributor to newsletters and publications for the athletic therapy and massage therapy professions. 22 Massage Therapy Canada Fall 2017 massagetherapycanada.com Photo credit: Jonathan Maister ll too often joint mobilizations are dismissed as a modality worthy of being merely a footnote. During RMT schooling they are covered in techniques class. However, they are often relegated to the proverbial back pocket – to the therapist’s and patient’s detriment. This should not be the case. Used correctly and in the appropriate circumstances, joint mobilizations may be the miracle method of changing the patient’s health status. Key to this is recognizing the indications and following through appropriately. Massage therapists are rightly recognized as the kings and queens of soft tissue work. Soft tissue work can facilitate a significant improvement in a patient’s condition. However, a fixation on soft tissue can distract the therapist from the bigger picture. This became painfully obvious to me as an instructor of massage therapy students, but this is also a ubiquitous shortcoming for many long practicing massage therapists. Joint mobilizations are purported to achieve a number of objectives: • Augment joint function, thereby increasing range of movement • Re-establishing accessory movements • Loosen adhesions • Nourish articular cartilage by stimulating flow of synovial fluid • Decrease pain by stimulating mechanoreceptors • Reduce edema in the joint-space by pumping local fluid in/around the joint Joint distraction/mobilization (left); Articular pumping (top, right); Gluteal release (bottom, right) My objective is to discuss joint mobilizations in a number of common scenarios where soft tissue work plays a role, but in the absence of articular work, success will be limited. ANKLE In our first instance, let’s consider plantar fasciitis. One of the most common causes of plantar fasciitis is a restricted triceps surae – in essence, insufficient dorsiflexion. The body requires at least 10 degrees of dorsiflexion for normal ankle movement. In the absence of sufficient dorsi-flexion, the fulcrum of the movement migrates anteriorly from the talocrural joint to the midfoot. Consequently, the arch collapses upward as the forefoot is forced superiorly in order to attain adequate dorsiflexion. Tissues spanning the arch, in particular the plantar fascia, are stressed, hence, the tearing and inflammatory response to the plantar fascia. Logic indicates manual soft tissue work to the triceps surae, and this would be absolutely correct. However, functional dorsiflexion of the talocrural joint also requires correct ar-throkinematics between these bones. Soft tissue work, regardless of how much, will ultimately have finite results. In order to maximize dorsiflexion, both the soft tissue and articular component must be addressed.