Dananberg manipulations

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Hi

ive just been watching some interesting videos on the vasyli medical website, showing Howard Dananberg manipluating lower limb joints. In particular the 1st mtpj and the ankle manipulations were very intriguing. Im wondering whether anyone has experience of utilising these manipulations coupled with a regular stretching programme, for effective treatment for common foot disorders such as: hallux limitus and soft tissue ankle equinius?

 

http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=353581#post353581

link to videos attached

 

I use these interventions on a daily basis with excellent results. Have written up a couple of case reports on them in use for HAV, Morton's neuroma and non-specific foot pain. Sometimes I use them in conjunction with stretching, sometimes with orthoses or as a stand alone therapy. I have been using them for 17 years and I now tend to use them as my first line of intervention in a number of conditions.

Hope this helps

Regards

Dave

 

Whilst I don't usually use Howard's techniques I think the role of mobs (both joint and soft tissue) within the podiatric context has a place. They often form a significant part of any rehab of the injured patient but whilst stretching has a place it is not uncommon (for me at least) that functional exercise to strength an area is more commonly needed.

 

Thanks for the compliment by referring to these by my name. However, I certainly did not invent the process of manipulative medicine. The earliest written record was in Egyptian literature dating back to 1500 BC. So, some type of manual medicine has been practiced over the last 3500 years. Anything with this type of staying power clearly has merit.

While I was in practice, I used them daily. Long term issues often resolved spontaneously when properly utilized. Manipulation, like any clinical skill takes time to develop.

Probably the best utilization for manipulations are for a variety of heel pain. If there is limited ankle mobility, then the plantar fascia can be stressed. Sometimes, the lateral column restriction related to the cuboid can cause spasm in the abductor hallucis and mimic plantar fasciitis. Cuboid manip can provide spontaneous relief.

Good luck and I hope you find adequate reward from this type of care.

Howard

 

Howard Retired! lucky you.

I have been performing mobilisations and manipulations to the foot and and knee since 1991. Still use it today on everyone who comes into the clinic no matter what the reason.
works a treat on foot pain, back pain headaches, shoulder abduction firing patterns hamstring length etc. etc. etc.

sunny here finally only 26C today. bushfire about 12Km away this morning. Probably kids lit it. They will wish they had not when they are found.

Regards
paul Conneely
www.musmed.com.au

 

I consider that the foot and ankle mobs that I do are essential for excellent outcomes. The techniques I use are adapted from Dr Dananberg and Dr Stanley Beekman's instructions and teaching (Via WWW.). I think it is essential for all podiatrists who are interested in the tissue stress model to understand and use myofascial / muscle train releases and joint mobilisation as it affects the foot and ankle and gait progression. I do think that consideration of Saggital Plane Progression and reduction of Perturbations is important and mobs and releases will facillitate reduced SPPP.
I think it would be useful to get along to one of the courses run by Ian Linane or Paul Coneely but tthey always eem to fall at the wrong / inconvenient time for me.

Regards Dave Smith

 

Dear Dave

let me know when you are free and I will organise to run one in Sydney for you.
regards
wet today, can't pick it
Paul Conneely
www.musmed.com.au

 

I think mobilisation and stretching are hugely under used by many of us. They certainly should have a place in our consideration of treatment plans.
I recently applied these to a client that has had a Charcot Induced ulcer to the MLA for 10+yrs.
The change in ankle joint ROM in particular, and other joints in the feet and resulted in a significant change in weight bearing and gait, making it possible to redistribute pressures away from the MLA. The change has been so significant we have had to change type of footwear and recast for different orthoses. Ulcer has reduced from a diameter of 5 cm, down to 8mm. I honestly don't feel this would have been achievable without the implementation of stretches and mobilisation to both feet. Most pods probably wouldn't risk exerting any from of stress of a foot with a history of Charcot's. My thought was that their was still a level of ROM available, but because the patient had changed the way they walked in the outset of the ulcer some 10yrs ago to compensate. however, this gait change had never been addressed after the Charcot's had resolved.
I also see this with post op patient's from surgery on their feet. In the initial weeks they walk so tentatively, and change their normal relaxed gait pattern. I spend time on getting them practice walking and swinging through normally, and along with stretches/manipulation/massage, and have found much better outcomes in returning to normal function.
Just a thought.

 

I think mobilisation and stretching are hugely under used by many of us. They certainly should have a place in our consideration of treatment plans.
I recently applied these to a client that has had a Charcot Induced ulcer to the MLA for 10+yrs.
The change in ankle joint ROM in particular, and other joints in the feet and resulted in a significant change in weight bearing and gait, making it possible to redistribute pressures away from the MLA. The change has been so significant we have had to change type of footwear and recast for different orthoses. Ulcer has reduced from a diameter of 5 cm, down to 8mm. I honestly don't feel this would have been achievable without the implementation of stretches and mobilisation to both feet. Most pods probably wouldn't risk exerting any from of stress of a foot with a history of Charcot's. My thought was that their was still a level of ROM available, but because the patient had changed the way they walked in the outset of the ulcer some 10yrs ago to compensate, this had continued on. However, this gait change had never been addressed after the Charcot's had resolved.
I also see this with post op patient's from surgery on their feet. In the initial weeks they walk so tentatively, and change their normal relaxed gait pattern. I spend time on getting them to practice walking and swinging through normally, along with stretches/manipulation/massage, and have found much better outcomes in returning to normal function.
Just a thought.

 

Dear Ninja
I could not agree more. The art of mobilisation can be learnt rather easily but to master it one has to practice it on a daily basis.

I have some photos sent to me by two podiatrists who decided to have a 'go' with this patient who had walked with this weird gate all his life.
They had only just finished the workshop a week before and the results published are after one visit despite a life long dysfunction.
any questions, only happy to answer
regards
paul Conneely
www.musmed.com.au

 

Thanks Paul a whole course just for me wow you're so considerate. Austrailia's a bit of a long trip though, maybe I'll wait till your coming here again

Regards Dave

 

Dear Dave
I have not told anyone yet, but there is gold in my backyard!
overcast, doubt it will rain. tomorrow 39C
Regards
Paul Conneely
www.musmed.com.au

 

Really interested to learn more about this and feel it would be a valuable addition to my clinical skills. Are there any dates/plans for a workshop in Melbourne next year?
Rory

 

Dear House and anyone else
could you please send me an email on paul@musmed.com.au

I would like to think i will be running workshops next year in Sydney and Melbourne and tasmania (somewhere)

Beautiful day, slight breeze only 26
they now have upted friday's temp to 39C
Ouch
Regards
Paul Conneely
www.musmed.com.au