3 Modifications to an Already Great Manual Therapy Technique

Chris Johnson is a great PT that everyone should be following on social media if they aren’t already. He posts a ton of great exercises and knowledgeable posts on the daily. One technique, that I’m not sure if he came up with, or if he just popularized, is the one seen below. The video mentions it as an assessment technique, which it is, but it is also handy because it can be transitioned right into a treatment technique with the exact same motion! Check it out below:

Below I have 3 modifications to the technique that can add some nice improvements to an already great technique.

  1. Add some tibial internal rotation. Take the same hand contact as you would, but place the patient’s tibia in some internal rotation to help improve a lack of tibial internal rotation that is often found in a painful or “dysfunctional” (I know Chris, probably wouldn’t like that word, sorry Chris!) lower extremity pattern. As the patient goes into their hip abduction and external rotation there will be a relative tibial IR moment at the knee that can be enhanced by the tibial placement into IR.

2. Sit on foot, do manual technique (tibial IR) to proximal tibia-femoral joint. By doing this technique you still get some benefit by holding down the foot as a whole by sitting on it and can focus the manual technique to the tibio-femoral joint to help improve tibial IR again.

3. Patient in half kneeling with rockbacks. Have the patient in half kneeling and have the same hand placement as the original technique. This technique can be done 2 ways, one with the patient’s hands on ground as shown above, or they can be more upright in a taller half kneeling position. With the hands on the ground the focus may switch a bit more to some mobility through the posterior chain and in taller half kneeling it will still be focussed to mobility through the foot/ankle/shin. The patient should make sure to keep their knee in a relatively abducted/externally rotated position and not let a valgus position take place during this motion.

The main point of all 4 of these techniques in my mind is to restore good foot positioning while the patient works on the ability to move and load into the hip, while subsequently also helping with tibial IR.

Hope you guys enjoyed the above videos and techniques. Would love to hear any feedback on thoughts or maybe after you give them a shot clinically. Looking forward to hearing from everyone!

Dave Leyland

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