0:05 This is Brent and in this video we're going over ankle mobilization. I'm very 0:09 excited about this video as well as the next several videos in this series, 0:12 because as you guys have probably started to realize, movement impairment, postural 0:17 dysfunction, improving the quality of human movement takes more than just 0:21 looking at muscles. There's joints involved, there are arthro- 0:25 kinematic motion as well as arthrokinematic dysfunction to think about. Now 0:30 self-administered joint mobilizations have always been a gap in our exercise 0:34 selection. It's been very hard to find techniques that were effective as well 0:39 as easy to teach and safe. Now luckily we've had some very creative individuals, 0:45 we've had some very innovative techniques all of a sudden come in. We 0:49 have guys like Kelly Starrett who's using these monster bands to create all 0:53 sorts of changes in arthrokinematic motion. Now his techniques are a little 0:58 extreme for my taste it might just be the populations that we work with, but 1:02 then after talking to my friends Pete Schultz and Aaron Swanson over at dynamic 1:06 sports physical therapy, I realized there was some ways to regress this stuff. I 1:10 got a chance to work with it a little bit myself and add my little twists 1:14 based on my thinking of dysfunction, and all of a sudden we have a set of very 1:20 easy, very safe, very practical techniques that my personal trainers can use with 1:26 their clients, as well as my ATC's PT's and DC's can now add to home exercise 1:33 program so all of that mobility you've been working for in joints, is kept from 1:37 session to session. I'm going to have my friend Melissa come out, she's going to 1:40 help me demonstrate. Now before we even start thinking about what we should do 1:45 to the ankle we have to think about what is happening at the ankle in dysfunction, 1:48 which is we have the the calcaneus, the heel bone, the tail is stacked on top of 1:54 it and then the tibia on top of that. Now in lower leg dysfunction dysfunction in 2:00 this area, the talus has a tendency to switch anteriorly, try to get stuck 2:06 anteriorly which then blocks the tibia and the calcaneus from being able to tip 2:11 into dorsiflexion. It's like a mechanical block. Some of you guys have probably 2:16 felt that when you go and do a calf stretch and you actually feel it more of 2:20 like a pinching or pressure in the front of your ankle. The other thing that 2:24 happens to talus is it starts shifting medially, 2:27 which creates that foot flat thing we see in so many individuals. So we have to 2:32 do for our mobilization let's find a way to work on dorsiflexion which is that 2:37 range of motion that's commonly lost, while trying to shift the talus that 2:44 way. Right it's stuck this way we want an anterior to posterior pull. Now my 2:50 problem with some of the mobilizations I've seen in the past is in order to get 2:54 room for the talus to shift, you kind of need to create some distraction in 3:00 the ankle. Now we might not be able to do that all that well with 3:04 self-administered techniques, but previously I've seen a lot of people try 3:09 to stand on this leg, they put pressure through the tibia through the talus, 3:13 through the calcaneus, and compress the talus and then they try to do the 3:17 mobilization, and it just doesn't work because there's no room. Like I said this 3:20 is where I went to dynamic sports physical therapy and Aaron Swanson was 3:24 all of a sudden doing this technique raised up on a step, and I kind of 3:29 realized the genius that was happening here. Now Melissa has to put the weight 3:34 on her back leg, this is unweighted. So at the very least I have no more 3:39 compression and when she drives into dorsiflexion, I'm hoping that this big 3:44 monster band will give me enough force to keep the talus in place just like 3:51 if I had put my hand here over the neck of the talus. So getting back into 3:55 setup now, she's put this nice thick band just below her lateral and medial 4:02 malleolus. Alright so just below those so the band kind of ends up on the angle 4:09 right here of the ankle which is on the neck of the talus, she's going to 4:13 shift her foot forward and get some good some good pull. I'm going to go ahead and 4:20 give her a dowel or a foam roll or something, so that she can maintain her 4:25 balance. She's going to try to keep her back leg underneath her body. Remember I 4:30 want this leg taking on all the weight, if that leg gets way back behind her 4:35 she's going to have to switch weight on this leg and then we have 4:37 the compression problem again. Now we can get really fancy here not only use this 4:43 dowel for balance, but put it between the second and third toe, put it a few inches 4:49 maybe four or five inches in front of her knee, and now not only does she have 4:54 something nice to balance with, but if I tell her to drive forward with her left 5:00 glute, so I'm working on a right ankle, her left glutes going to actually be 5:04 doing the work, I can have her work on dorsiflexion trying to get to that stick 5:10 which is not so easy. Alright let's try 15 to 20 reps of that, it's usually the 5:15 rep range I've been working on lately. 15 to 20 reps making sure she keeps her 5:21 heel down, if she doesn't keep her heel down we're not working on dorsiflexion 5:25 anymore. I keep that heel down and she's got this huge posterior pull. 5:32 Now you can start applying I know my PT's out there, my ATC's out there, my DC's 5:38 out there, we're all taught our mobilizations our grade ones, grade 2's, 5:41 grade 3's, grade 4's, it would be a little too much for me to say that we could 5:45 replicate that here. But you guys could go from these larger amplitude movements 5:52 to like let's say she has no pain she's just really stiff, maybe I can get her 5:57 into end range and then just have her oscillate, right like we were taught to 6:02 and our mobilizations in school just one to two oscillations per second for 6:09 30 seconds, and maybe that's how I'm going to do this technique. So now you 6:14 guys got two options; we can go through a full range of motion and she can use the 6:19 stick as the goal, or we can take her to her end range and just try to oscillate 6:24 a little bit. If she was somebody who was having pain I do want to warn you guys 6:29 with this, let's say she has ankle impingement, we only want to touch that 6:34 pain. We don't want to go into that painful range. Just touch it, because the 6:38 last thing I want to do is take a nice inflamed ankle and make the inflammation 6:45 and the pain worse. We definitely don't want to do that because it's going to 6:47 change your gait, it's not going to help her move better, 6:49 I would still use this technique, I would just say let's say she starts feeling a 6:55 pinch right here, well good, I would have her set that stick back, I just want you 6:59 to touch the pain, don't go into it, don't make it worse, 7:03 and then she's going to back off it. Alright so we're still getting work on 7:07 that anterior to posterior mobilization, but through a range of motion that's 7:12 pain free. Alright guys so I want you to work with that, let me have you go ahead 7:16 and switch sides so they can see that you're putting all of the weight on the 7:19 other leg. Just want to see you guys see both sides of this set up, and then we'll 7:27 show you the medial to lateral pull on the talus because it's the same thing. 7:35 What I want you guys to notice is she set up nice and tall, good kinetic chain 7:39 checkpoints, her shoulders are over her hips, her foots beneath her, and 7:43 then I'm going to have her squeeze this glute and really think about squeezing 7:47 this glute so that she does not start loading this leg, which is going to add 7:53 the compression and make that mobilization a little harder. Once again 7:58 we can do those larger amplitude movements, we can do the smaller 8:03 oscillations at end range. Or if she had a little pain in her ankle we could go 8:06 just up to the painful area and back, trying to help with ankle mobility 8:11 without exacerbating that pain. Alright the next technique I'm also really 8:16 excited about which is a medial to lateral mobilization. So we got to switch 8:22 around here make sure they don't trip over the band, 8:28 thank you. No other way, so you can, there we go, 8:39 good. Now I know what you guys are thinking 8:45 that we probably go mediolateral and start rocking back and forth this way, but that 8:48 actually does not work out very well. You guys are going to get a medial to 8:52 lateral force just like you see. I'm going to have her step out just a little 8:55 bit that way, put the stick in this hand between our second and third toe. I 9:01 actually kind of like a little bit of abduction here so that the tibia is 9:07 slightly internally rotated, and then they're working on keeping their first 9:12 MTP, that ball just behind their big toe down on the floor. Alright this seems 9:18 to keep inversion. What I don't want to see is them all of a sudden flop into 9:23 eversion because just like compression won't let the talus move this way, if 9:27 all of the sudden i evert, all of the sudden now the talus can't move back into 9:32 position laterally. So I needed to stay inverted but with first MTP on the 9:39 ground, and then she's going to do the same thing, she's just going to do a 9:43 little dorsiflexion and work on talar mechanics but now in the frontal plane. 9:51 How does that feel, all the same stuff applies. Most of the weight is on this 9:56 leg, she can do larger amplitude movements, she can do the smaller 10:00 amplitude movements at the end of a range. Like I said if she had some pain 10:04 we would go just up to the point of pain working on good ankle mobility, without 10:09 exacerbating that dysfunction. Melissa thank you very much. I hope you guys 10:13 enjoy these techniques. Go out and grab some of these monster bands they're 10:17 really not that expensive. I know you guys can find steps in your club, a dowel, 10:22 few pieces of cheap equipment, and all of a sudden we fill a huge gap in our 10:26 postural dysfunction and self-administered technique model. I'll 10:30 talk with you soon. 10:40
