Hi everyone!
Firstly I'd like to introduce myself, since this is my first post here on physiobob.
I'm a physio student from Italy, thus I ask you to apologize me in case of any language mistake I can make.

Well, this post is about manual therapy techniques used to restore joint mobility, working on arthrokinematic range of motion.
Since I have to prepare a dissertation for my graduation which is due in the next autumn, and I have always been fascinated by manual therapy, I lately begun to search on databases like Cinahl, Medline to find an interesting topic on which focus.
It is well known that ROM gaining can be obtained with joint mobilization following Kaltenborn's convex-concave rules, most likely because of an elongation that occurs in capsular/ligament connective tissues.
Well, now I come to the point. I have always been told (and in my clinical placements I had the practical confirmation) that in order to obtain elongation (plastic deformation) of connective tissues, the force must be applied for a long time (eg one minute). Conversely, I have found studies which utilise high-frequency anterior to posterior oscillation of the talus to increase ankle dorsiflexion. If this can be understand in acute ankle inversion sprains thinking about a dorsiflexion improvement following pain decrease (since I'm new I can't post links, so here it is Pubmed's reference number: 11276181), it becomes a bit more difficult to justify in healthy patients (Pubmed: 18486749 - 17996551). All these studies demonstrated improvement in dorsiflexion ROM, and the latter two with just a 30 seconds mobilization, made of 10 oscillations (that means, a oscillation every 3 seconds).
In view of this, I was wondering why there is such a difference between clinical trials and the connective tissue's classical model of its viscoelastic properties. Thus, I thought it could be a good idea for my dissertation, to plan a study in which compare the two ways of doing anterior to posterior talus mobilization on healthy subjects, both using grade 4 Maitland's technique, one with high frequency oscillations such those used in the studies I cited before, and one with low frequency, maintaining the stretch at the end of the arthrokinematic ROM for a longer time (eg 20 seconds). The main outcome would be dorsiflexion ROM, by which I'll compare which treatment is more effective.

What do you think of this idea?
I tried to look up for any kind of article which explains or analyzes the time and rate to respect in applying an arthrokinematic mobilization, but I found no studies. Does anyone of you know anything about?

Any comment is very much welcome. Thank you.


P.s.: I posted the topic in this section because I thought it could be of general interest in musculoskeletal practice. If any admin or moderator is of different opinion, please move it where it fits best.

Cheers.

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