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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.