STS REHABILITATION

18 SportEX

Suggested interventions for the management of hypo- and hypermobility of parts of the trunk and lower limb

Figure 1: Cuboid

manipulation MOBILITY

Figure 2: Sub-talar

manipulation

Hypo- mobility Regional 1) Hip extension/ rotation ● mobilise ● stretch

2) Knee extension ● mobilise

Figure 3: Transverse tarsal joint manipulation

Inter-articular 3) Tibia/fibula joints 4) Talocrural joint 5) Transverse tarsal joint 6) Cuboid ● mobilise (see Figs.1,2,3,4)

Figure 4: Soleus is stret- ched while actively maintain- ing the foot arch. This is done by a combination of hip external rota- tion, activation of the tibialis poste- rior and the foot intrinsics

Intra-articular 7) ST joint (Fig.2)

Hyper- mobility Regional 1) Core stability 2) Hip extension/ rotation control ● muscle balancing 3) Hip/knee/foot alignment ● muscle balancing ● alignment retraining (+/- orthoses) (see Fig.6,11,12)

Inter-articular 4) Talocrural joint 5) Cuboid

6) Inferior tibia/fibula ● as Intra-articular below

Intra-articular ● eccentric retraining of peroneus longus, tib- ialis posterior and tri- ceps surae ● bracing ● taping ● orthoses (see Figs.5,7-12)

Figure 5: Late stage multi- directional rehabilitia- tion which can be done taped

Figure 9: Low dye taping

Figure 6: General wobble board proprio- ceptive retraining with a sports specific element.

Figure 10: Rotaroll eccentric eversion control

Figure 7: Heel lock reinforcement for closed basket weave (not shown)

Figure 11: Slow controlled rocker board touches with core stability

Figure 8:

Jogging with eccentric and isometric evertor control of position with low dye tap- ing

Figure 12: Hip/ knee/foot alignment is maintained by hip external rotation and local arch control. Strengthening therefore takes place in an optimised position