We've all seen this. A parent or coach approaches you and says, "I read on the internet or saw on the news that ____is the best treatment for ____". My answer is always...but can you measure that? Does it pass the acid test? Can I pull out my tape measure or goniometer and prove it increased painfree ROM? I could care less that it elevated the temperature of some tendon a half a degree centigrade. Did this athlete walk out better than the day before?
Here is an example. The athlete above had a severe grade 2 inversion ankle sprain right after school got out in June. He spent almost a month non weight bearing on crutches. He came to me because he could not sprint without posteromedial ankle pain. The picture on the right represents his L ankle dorsiflexion. The strip of tape closest to the wall is pre intervention, the second is post. The position he is in now is his new pain free ROM.
The whole thing took me about 12 minutes. The pic on the L is me doing some posterior talar glides, along with some tibia ER mobes. 4 sets of 20 reps. In between sets, I had him doing L SLB RLE anterolateral reaches @ ankle height, 20 reps. While he was doing the exercises, I taped one kids ankle, and took care of a soccer player's nose bleed. I then re-tested him. His sagittal plane knee excursion improved 3.25cm, 1.2cm pain free. I sent him outside to do 6x20 meters each of shuffle steps, galloping with LLE leading, and tapioca stepping to the right.
I'm often asked how I have the time to do manual therapy. The total hands on time of this treatment was about 5 minutes. If you see a dysfunction, then why choose an indirect approach? Why was this technique more effective than the silly one on TV? Because the athlete really corrected it all by himself. All I did was provide the scaffolding.