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Copyright © Alastair McLoughlin 2015 Revised © Alastair McLoughlin 2019 and 2022
The right of Alastair McLoughlin to be identified as the original Designer, Developer and Author of the Work has been asserted by him in accordance with the Copyright, Design and Patents Act 1998.
All rights reserved. No part of this text may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover, or reprinted in any physical or electronic manner without the written consent of the author.
The ideas and concepts explored within this text are those of the author. For educational purposes only.
No diagnosis is being offered nor any cure promised by the application of this information.
Alastair McLoughlin cannot be held responsible for any injury arising from the application of this work by the practitioner to any third party however caused.
This work is not a substitute for medical attention. Please seek your physician’s advice if in doubt.
INDICATIONS FOR USE
The feet are the foundation upon which the human body stands and contacts the earth.
Smooth and full articulation of the ankle joint is essential for good mobility and ease when walking or engaging in sports activities for example.
Treat both ankles if they are found to be restricted in any way.
- Tension and restriction of ankle joint articulation
- Reduced or restricted circumduction of the foot
- Ankle problems
- Knee pain
- Foot pain
- Balance problems
- Uneven gait
- Extremely good for athletes and sportspeople
CAUTIONS OR CONTRAINDICATIONS
Please exclude the possibility of any bony fracture due to a recent undiagnosed foot or an ankle injury that persists and is not responding to treatment.
Refer for medical diagnosis if you are unsure about any undiagnosed medical condition.
Be aware that the bio-mechanics of the body can change signiﬁcantly with this work including the knees, lumbar spine, pelvis and upper body.
If surgical pins, screws or plates have been implanted, this AoB release work can still improve articulation of the ankle.
Please do not force any movements that are restricted - especially circumduction, dorsiﬂexion or plantar ﬂexion of the foot and ankle.
Do not perform the assessment if there is a risk of fracture!
Position of the patient:
Patient is laying prone on the treatment table.
Use of the face hole of the treatment table is optional.
With the patient prone, flex the knee to 90 degrees.
Carefully rotate/circumduct the foot and ankle in both directions.
Make a note of any ‘flat spots’ where circumduction is not smooth and circular.
With ankle restrictions you may observe the foot moving in a ‘triangular’, ‘square’ or irregular fashion.
If there is any restriction, crepitus, clicks, grinding, pain or discomfort - make a note of where, along the arc of movement, any of these problems or anomalies are located.
Remember what you observe - so you can re-check your work afterwards.
Application of the AoB procedure:
Move 1: The moves (i) will be applied to the front (dorsum) of the foot as indicated.
Hold the foot in slight dorsiflexion and make (approximately) three AoB movements, from the dorsum of the foot towards the tibia as shown in the instructional video presentation.
Use the first finger and thumb together to perform this work.
The AoB movements commence and finish on the midline of the foot and ankle.
Move 2: These movements (ii) will be applied from the medial aspect of the ankle around to the lateral aspect of the ankle, as the anatomical model shows.
Whilst still holding the foot in slight dorsiflexion, commence movements the medial aspect of the ankle.
Perform a series of AoB movements around the ankle. Two fingers are used at the same time in this part of the treatment.
Moves are both proximal and also distal of the medial and lateral malleoli. i.e. - one finger above and one finger below the medial malleolus.
See the instructional video presentation for clarification and exact finger placement.
When you have worked around the ankle (from medial to lateral), you will come to a point when it becomes awkward to continue due to the position of your hand and fingers.
This point is about two-thrirds of the distance around the ankle.
NOW CHANGE YOUR HAND POSITION! (iii)
Repositioning your hands:
Example – When using your RIGHT hand to make the moves on a client‘s RIGHT foot:
Upon completion of the moves (ii) and your hand position is no longer comfortable, change hands to (iii) in the following way:
Your right hand replaces your left hand position on the sole of the foot, which should be holding the foot in slight dorsiflexion.
Your left THUMB then completes the AoB movements around the lateral aspect of the ankle - above and below the lateral malleolus as shown.
The treatment is concluded by movements on the Achilles tendon as shown as moves (iv).
(Use these moves if plantar and dorsiflexion seem restricted or stiff.)
After a few moments, reassess ankle articulation by gently rotating the foot.
Note any improvements, and also any parts of the arc of movement that still feel restricted.
Repeat if necessary during the same session.
Repeat at next session if assessment still finds restrictions or tightness.
Three, four or more treatments at weekly intervals may be necessary to release extremely tight or restricted ankles from old injuries where calcification has taken place or where oedema makes ankle movement difficult.
Additional AoB ankle release moves:
If, during your post-treatment assessment, whilst circumducting the foot, you notice small areas in the ankle joint that still feel restricted apply AoB moves as shown as (v).
In order to determine this, articulate the ankle slowly and methodically - stopping at any point that feels restricted or ,blocked‘.
Closing your eyes may help you ‚see’ or feel where the restriction is located.
These extra AoB moves are extremely small and accurate.
Re-assess by circumducting or rotating the ankle.
Continue applying these micro-moves until you are happy that you have achieved the maximum benefit for this session.
Help the client to a seated position:
Pause and check your patient experiences no dizziness or light-headedness.
If they are dizzy or light headed, then wait for a minute or two to allow that feeling to clear itself.
Only then may the client get off the treatment table (a), by placing BOTH feet on the floor at the same time to allow even weight-bearing into both knees and hips to occur.
If the client continues to be dizzy (b) after waiting two minutes, then lay them in a fetal position, cover them with a blanket and wait for the dizziness to pass.
Invite your patient to the seated position again and check that any dizziness has now subsided.
If your patient feels well, then you may get them to stand by placing BOTH feet on the floor at the same time to allow even weight-bearing into both knees and hips to occur.
How it works:
We are working the retinacular ﬁbres, tendons and ligamentous tissues of the ankle.
Adhesions or binding of the retinaculum to the underlaying surfaces will inhibit movement of the joint.
AoB work eﬀectively and quickly (in many cases) creates a freedom of the ankle that is greatly appreciated by clients and gives looseness and relaxation to the foot.
Walking and running become so much easier when the work is eﬀectively applied.
Weekly session of this work may be needed for a month or two - depending on the severity and history of the complaint.
Targeting very tiny areas where tissue is binding in the ankle helps resolve many restrictions and articular deviations.
This is wonderful addition for any regular, maintenance treatments you offer – especially for sportspeople and athletes.