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Self-administered Ankle Mobilization

Self-administered Ankle Mobilization is a method of stretching, relaxing and strengthening the muscles surrounding the ankle joint. This technique can be used to restore natural ankle range of motion, reduce swelling and improve balance. It is completed through a variety of guided stretching and strengthening exercises, which can be done at home or in a physical therapy session. Additionally, mobility can be improved through the use of foam rollers or massage balls. This type of mobilization can help reduce pain, speed recovery from

Transcript

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