“Fix the hip extension,” he said nonchalantly.  The ease of his answer frustrated me.  I had struggled to improve a patient’s dorsiflexion for two weeks and his answer was too quick.  I was convinced he hadn’t listened to me and pressed further.

“I don’t think you understand.  I can get the ankle better and restore the range of motion with manual treatment, but it doesn’t stick,”  I repeated.  

“Yes, so fix the hip extension and the dorsiflexion will stay without needing to mobilize it every session,” he stated confidently.  

I knew the SFMA and I understood the concept of regional interdependence, but there were many other things I would try and improve on this patient before I’d think about fixing hip extension. But, he wasn’t changing his answer.  So I left to improve hip extension, prove that wasn’t the problem and then come back to get a different...