The Brantingham protocol
Radiographic examination may be used and, if
necessary, laboratory tests, to rule out metabolic
diseases, such as gout, severe degenerative joint
disease and rheumatoid arthritis. Such diseases
are contra-indications for manipulative procedures.
A light traction (axial elongation grade 3 mobilization
5—10 times) of the hallux can then be initiated
at the joint, followed by the application of ice
surrounding the joint. Mild soreness during and
after this procedure is considered acceptable. This
can then be repeated for two to three visits.
However, if severe pain is felt by the patient, stop
mobilization of the HAVB joint and treat only the
other joint dysfunction in the foot and ankle.
The following step, should no adverse response
develop, involves axial traction, and mild adduction
(toward the middle of the body) mobilization
of the hallux is performed using grades 3—4, again
followed by ice.
This procedure is repeated at the following consultations
using strong, grade 4 mobilization and,
lastly, a high velocity, low amplitude grade 5
manipulative thrust is applied to the joint. The
hallux is thrust into adduction and the first ray
(first metatarsal) into abduction. Ice is applied to
the joint at the end of each of these procedures.
The authors highlight the importance of constant
patient assessment. The speed at which the
patient progresses from mild mobilization to
grade 5 adjustment of this joint is dependent
on patient response in terms of pain and function.
https://sci-hub.cc/10.1016/j.clch.2005.06.001
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