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Posterior
capsule of the STJ mobilisation/manipulation
Instructions: part (a) 1. OK - keep your patient in the same position as before, with their knee flexed at 90°. 2. Cup one hand around the medial/lateral aspect of the patient's calcaleus. 3. Take a firm hold of the midfoot again with your other hand. 4. Dorsiflex and plantarflex (relatively rapidly) at the ankle joint about 30 times. 5. You're done.
part (b) 1. The patient stays prone, but make sure that their feet just dangle off the edge of the examination couch (see below). ie. for this manipulation, both legs will be fully extended. 2. Wrap one hand around the dorsal ankle, just proximal to both malleoli. You should be able to lift the leg up from this position. Hold on to the ankle. 3. Your other hand should then be placed on the posterior aspect of the calcaneus, at the level of the STJ. Make a 'trigger hand' where your lesser three fingers are flexed and clenched, and your thumb/index finger are outstretched. Place your hand so that the thumb is lateral, and the index finger is around the medial aspect of the foot. This can most easily be visualised by looking at the pictures below 4. Set yourself up with both elbows extended, and a relatively vertical orientation of your shoulders/elbows/hands. 5. Make a quick thrust downwards with the trigger hand, whilst simultaneously pulling slightly upwards with your other hand (the one that's cupping around the midfoot). 6. Move onto the next mobilisation!  
Two views of the above test (b). |
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