Restoring Ankle Strategy With Manual Therapy and Hip Strengthening

Research from UCD across the acute phase, six months post-injury and chronic ankle instability shows a shift from an efficient ankle strategy of postural balance to a less efficient hip strategy, with the ankle tending to freeze. Eamonn recommends training the uninjured side early, since balance work on one limb carries over to the other through the sensorimotor system. To unfreeze the foot and ankle, Eamonn demonstrates manual therapy: an anterior to posterior glide of the inferior tibiofibular joint for inversion and eversion, posterior talar glides, dorsiflexion mobilization with movement, and mobilizations of the cuboid and cuneiforms, which often become hypomobile and limit pronation and supination. Dorsiflexion range is closely linked to single leg balance. Early exercises on a wobble board and a BOSU, done barefoot, let the patient move over the base of support in all three planes. Hip hitches and the figure 4 exercise build abductor and external rotator strength to reduce reliance on the hip strategy.