The Amazing Mulligan

As we reach the latter weeks of the high school basketball season I am once again fascinated by the Mulligan Concept and its profound utility in treating lateral ankle sprains. To date as a DAT student and athletic trainer I have had 8 patients suffer 12 lateral ankle sprains (Grade 1-2) with sparse few days of time loss injury. In one case of time loss, 1 quarter, the patient suffered the initial injury at an away competition without my being present to treat the patient at the time of injury. The other case was referred as a suspected and confirmed avulsion fracture causing the patient to miss 7 days. In this case the use of modified MC Lateral Ankle Sprain Technique (LAS) and fibular reposition taping also likely reduced the duration of time loss. In each case, excluding the avulsion fracture, the initial treatment is sufficient to return the patient to participation directly. I do not only utilize MC LAS techniques when treating cases of LAS. This would represent poor clinical reasoning. In most cases, a combination of A-P Talar joint mobilizations to restore lost dorsiflexion, MC LAS, and FRT are the primary treatments used. In some cases, if the individual is struggling to regain full motor control in all ranges of motion, TMR is utilized along with eccentric heel raises after treatment prior to returning to practice. These combinations of treatments have returned 6 patients with 10 cases of lateral ankle sprain to participation without time loss. In most cases FRT, and perhaps a traditional ankle tape application, or an ankle wrap type application of power flex, if swelling is persistent, is continued with TMR/eccentric heel drops prior to participation if weakness or motor control deficits persist. Often times, treatment choices are driven by the severity of the patients symptoms and if the injury was suffered in competition or in practice. General return to function and significant reduction in pain will suffice to return a patient to competition with further treatment picking up after if needed. Who knew the most common athletic injury across populations would be this fun.