Hey Terry,

The medial malleolus is the end of the Tibia. This is the large long bone in the lower leg and the main ‘weight bearing’ bone. The tibia doesn’t extend as far down the ankle as the fibula (lateral malleolus), but rather it ‘sits’ more on top of the ankle. This is why the lateral malleolus has to glide out of the way as the ankle moves, especially during dorsi-flexion, to allow the talus to slide/glide under the tibia.

This means that the medial malleolus doesn’t move anywhere near as much to allow this gliding of the talus. It’s the fibula that moves to create the room for the dorsi flexion. This is why the mulligan/banded distraction works so well, as it essentially pulls the tibia over the talus and forces that movement (which is a classic physical therapy manipulation done passively as they drive the talus down and back under the tibia)

Interestingly enough, manipulation of the fibula head can also help the range at the ankle. If you’re an MWod Pro user then you’ll see a manipulation in this video:

http://www.mobilitywod.com/daily/friday-october-11th-2013/

I have around 8 degrees more dorsi-flexion in my left ankle than my right. This is because I have more of a ‘bony block’ in my right caused by stiffness in my tarsals and lateral malleolus. Again, this is a mob that is done by many physical therapists to help improve ankle function.

Hope that’s all made sense.

Are there any videos that show the mulligan/banded distraction you mentioned?

I’m familiar with the process for the knee and rotating the tibia internally and then firing the quads, but I haven’t seen anything involving a similar method for the ankle.

Sorry I think this may be one of them out there. Funny, I’ve seen tons of videos and never ran across this one. However this is a lot different than I expected. I was expecting some kind of rotation to be implemented while using the band distraction. In this video it looks like it’s just the band distraction while pushing through the ROM.

Please share if you know of any others that would be useful.

http://www.youtube.com/watch?v=lOSvwy5jN-M

I like this one too… but yes you’re right. It’s generally called the ankle distraction. I tend to ‘scour around’ as he says and do lots of ankle rotation/movement whilst doing this. I find having the ankle up on a bench gives a very different effect.

Try it in combination with flexing the toes first, ensuring the arch doesn’t collapse then rocking forward into dorsi-flexion, this gives a nice similarity to walking and other activities that activate the flexors of the toes (and maybe arch too) whilst simultaneously needing ankle dorsi-flexion.

http://www.mobilitywod.com/2011/09/episode-313-improving-ankle-range-super-friend-addition/

I actually feel the restriction in my medial malleous or I feel blockage in my medial malleous.  Are there any red flags with this?