♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi folks. I'm Mike Kenitz, physical therapist assistant.
- Brad Heineck, physical therapist.
- And together, the most famous physical therapists
on the internet.
- Well, not quite true, but Bob was taking the day off.
Mike is filling in. We're happy to have him here today.
He's going to do an excellent job
and I'll see if I can keep up with him.
Today's title, best ankle rehabilitation exercises
for fast recovery and prevent future ankle injury
based on science, Mike.
So before we go any further.
- This week's giveaway is the SleepOvation mattress
as well as a pillow.
Brad and I both have these mattresses.
I think it's awesome.
- Right?
- I was honestly skeptical at first,
but I could sleep on my back again with them.
They're great.
- And you couldn't be before?
- No, it would kind of bothered me.
- Top quality.
- So to check out our give away,
go to BobAndBrad.com/giveaways.
You can also go to Facebook
and it's pinned to the top.
For 60 second versions of us,
You can find us on Twitter, Instagram,
and TikTok is not on the board.
- Oh, Bob would be jealous.
You just flew through that.
Excellent work.
- I have practiced.
- There you go.
All right.
We need to work at that.
- I guess.
- All right. So I did a little research, Mike.
Journal of Athletic Training,
all of this information is probably no surprise
to anybody in the field,
but 70 to 85% of ankle injuries are from inversion.
In other words, the ankle rolls this direction.
The injury is on the, yeah.
Well, you're just really inverse.
Well, the injury, can you see that with the black shoes?
The injury is on the outside of the ankle
on the lateral aspect, we call that.
There's the most common ligament.
Should we do that?
That ATF.
- [Mike] Anterior talofibular ligament.
It's just basically what bony landmarks it connects to.
Also the CFL, the call calcaneal fibular ligament.
- You don't need to remember that,
but it is on the outside.
80%. This is interesting.
I didn't know it was quite this high.
80% of all ankle sprains reoccur,
or you injure that ankle again in the future.
It's kinda like back pain.
Once you get back pain,
the statistics are very high on having back pain
in the future.
So this video listen up,
we're going to show exercises that have been proven
to minimize future ankle sprains.
And the key to that is proprioceptive exercises,
which you may not be aware of what they are,
but we're going to show you that later in the video,
some real nice exercises you can do at home
with some help on a lot of it by yourself as well.
So we want to strengthen also, the muscle in the hip.
Hip abductor, the muscle up here,
and this has been going on in these studies
have been proven time and time,
but I'm lost.
Help me out.
The hip abductor muscle here is always weak.
If the right ankle is injured,
and if it's the left ankle,
the same side of the ipsilateral,
we call that, hip abductor's weak.
We got some nice, simple exercises for that as well.
So now Mike has experienced a severe ankle sprains.
- I have had a grade three ankle sprain on both ankles,
back to back years.
One was ultimate Frisbee,
and one was just playing like flag football.
I was in my twenties.
- Oh really?
- Never injured my ankles in real football in high school
or soccer growing up as a kid.
But when I was older, yeah, rolled them both.
Exactly what you're talking about.
- Wait until you're in your fifties.
- Can't wait.
- So we're gonna start this rehab.
We're gonna assume that you've already
recovered the swelling.
The pain is under control,
and you could start to walk on it a little bit.
We want to make sure that your range of motion
regains in all the planes.
So we've got a nice little exercise.
I called the ABCs,
both Mike and I have worked with patients on this.
- What about the one, two threes?
- The one, two, threes? No, no.
We're going to ABCs. So what I tell my patients,
imagine your big toe has a piece of chalk on it,
and you've got a blackboard in front of you,
and you're gonna make capital letter A
with that piece of chalk up over
and then cross and then go to B.
- What about cursive?
- No, no, no cursive.
If we want to stick with just the regular old
capital letters and then go to C,
and go ahead and Mike, continue to do it.
What we're doing here,
it gives you something to think about,
and you're actually forcing your ankle
into all planes of motion.
We've got plantar flexion, dorsiflexion,
inversion, eversion, and everything in between.
And when you get tired, you stop.
You may only get to F or so.
E or F on the first time you do it,
but after a week or so or less,
you may get to the full alphabet.
If you can get to the full alphabet, you're doing well,
you probably can stop that exercise.
- [Mike] I'm on M.
- [Brad] Are you getting tired?
- [Mike] A little bit.
- Yeah. Yeah.
He's got a healthy ankle.
So it is a nice exercise.
Now, when you can start walking,
your ABCs are going well, your walking is pain free,
but you know, it's got a ways to go.
This is going to be the exercise you want to start.
You can start at this one.
Mike, you want to lay down on your side.
You can do this on the floor.
You can actually,
a bed will not work for this exercise.
Can you straighten out your body a little bit more?
There you go. Now bend the bottom knee.
The bottom one. That's the top.
There you go.
Straighten this leg out and do hip abduction.
I've mentioned if this is the sprained ankle,
this muscle here is going to be weak.
It just, it always is.
So you can do these to start out with
and do 10 to 15 of them.
If it gets too difficult,
you can put an ankle weight around your ankle,
or you can just simply roll over.
- On the other side?
- Yep.
And lift this leg up slightly. Bend this knee.
Okay. Go up on your right elbow.
And you're going to get in this position.
Now his right hip abductor is going to do a lot of work
right now if you lift your hip up in the air,
quite a bit harder, right, Mike?
- [Mike] Mhm.
- [Brad] Yep. So, and if you want to work this one together,
you can go down with this and up there you go.
And you get both hips at the same time.
The bottom hip is far more aggressive.
Mike is saying oh, that hurt.
- [Mike] Awkward.
I haven't strengthened my hip abductors much.
Probably why I sprained my ankles. Huh?
- Actually, there are some studies on that as well,
if weak hip abductor muscles lead to a sprained ankles.
We're not going to get into that. Excellent.
So that's a really nice combination
of hip abductor strength, critical exercise.
Where did my loop go?
I do want to mention also, this is even better.
A step in the next direction of the rehab
is put some resistance around your knees
with a loop strap,
and then we have weight bearing and you can start
to do this.
I am going to hold my billiard stick for balance.
And this is a great way to strengthen it
'cause then you want to do both legs, too, regardless.
- Yup. Start with the easy band, too.
Yellow's easy.
Read your set. Every set has different colors.
- Yeah.
When you can do 10 to 20 of those without any problem,
then you're going to get in that athletic,
particularly if you're returning to a sport
and you simply do this, big steps.
So you're strengthening the hip abductors.
You're strengthening the ankles
without being real aggressive.
It's a great way to do it.
And go back.
I usually have my patients go about 15 feet to the left,
15 to the right and go back and forth up to five times.
You'll feel it.
- Yeah.
We usually use these more on the younger athletic people
that want to get back to performing sports.
- Right. If I have someone that's, you know,
in their forties and very want to get back to walking
in normal ADL, you know, things of daily life,
we don't worry about it so much.
- Yeah.
- Anything else Mike,
that you want to bring up
before we get into the key of this proprioception?
Any other exercises that worked well for you?
- I did a lot of just calf raises.
You can do them seated, just ankle pumps.
This is non weight bearing for early on if you're painful.
You can progress, you know, to standing,
holding onto something like a chair,
just going up or eventually,
if it doesn't hurt, you can try one leg.
I mean, now I'm to the point where I'm normal.
So I can hold on to a dumbbell in his hand,
if your gym has a calf raising machine, you can use that.
But I still constantly strengthened my calves all the time.
Just prevent any other injuries from happening.
- And if you're not an athlete,
you're not real aggressive or young,
you probably don't even need a weight or anything.
Just doing one leg is adequate.
- If you don't own a weight, honestly,
you can just do more repetitions.
Like I've known basketball players
that just do like a hundred reps a day.
But, yeah, that's all I do.
- Alright. Next the proprioception.
This is a simple one. I really like this one.
- Did you make this up?
- Oh no. I've been using...
- I've never see this one.
- Yeah. This one is a nice one, actually,
Bob and I discovered this one
about 10 years ago and we've been,
we've got other videos with it.
I call it the Ziggy Ziggy.
If you put your feet, you have to have shoes on,
not barefoot, not stocking foot for sure.
Because your shoes offer resistance
and you'll see what I mean.
You can do it carpeting or a smooth floor
and you go like this
and what's going on is you got weight bearing
through your ankles, which is good,
'cause that's the way you're going to be active
in the future.
And you're strengthening a lot of muscles,
including the peroneals,
which support that lateral aspect of the ankle,
which needs the strength.
And it's a good beginner way to go.
And as you get better at it and you're feeling,
oh, it doesn't hurt anymore.
My ankle's not getting tired like it used to,
go to one foot.
- [Mike] Know what you look like?
Like MC hammer doing the Can't Touch This dance.
Can't Touch This from the 80s?
- I can touch something.
Can we get back to this?
This is like working with Bob. It's just another...
- That's what it reminds me of.
- So that's the Ziggy Ziggy.
You want to demonstrate the four point, yep.
- So this is a four direction toe touch.
So you stand on your leg.
Which one are they going to stand on?
Their bad ankle or the good one?
- They're going to stand, you can do it actually either way.
But the most important is this is your sprained ankle.
This is the bad one.
- So first you're going to do is tap forward.
Try to keep your balance that you can go out to the side.
You can cross over typically in front.
I guess you could get behind if you want.
- [Brad] You can do it either way.
- And then backwards.
So just try to keep your balance.
Honestly, if I'm trying to do 10 reps of these,
like you can already see me moving around a bit.
- And when you first start.
- You might have to hold on to something.
- Yep. Give it a stick, cane, whatever it takes.
Now when you get pretty good at this,
for higher level people, the higher level athlete,
close your eyes and do it.
- Gosh.
- It's a whole nother,
'cause your vision is really important.
Again, proprioceptive,
this is making the muscles fire very quickly
so that you can maintain balance,
which is going to be real advantageous.
- My ankle is actually like fatiguing.
Like it was burning just from standing.
- And you've got a healthy ankle.
- So, you know, these are good.
Depending on your level,
you may just do that with a stick,
eyes open five times and get used to that.
The next thing, again, here,
we're going to go on to,
this is definitely for the athlete.
Mike is the injured person. He's an athlete.
He wants to get back to playing ball
so he can stand on one leg without any problem.
It's not painful,
but it's not ready for this activity, the sport.
So this is higher level.
You don't have to get me in view.
People don't like looking at me anyways,
and you simply play catch.
Now I'm going to throw it up high.
You know, down low, up over to one side.
Mike, can you turn 90 degrees to your right?
When I do this with a patient,
I put a timer on.
Every 30 seconds I have the patient turn.
Obviously I don't have them turn
so they're facing away from me.
Turn 180 degrees.
There you go.
I'll go make sure they know their degrees.
- [Mike] Get the long way around there.
- And now what I do also when it gets too easy
is I have the person get a bigger ball,
one of those great big physio balls,
the exercise balls, which makes it harder.
Or Mike, can you grab a cushion?
- We got a Pete's Choice foam pad here.
You can stand on this.
Also, I noticed too, if you're standing here,
it's a little easier where if your other leg's up here,
it's more challenging.
- [Brad] Another easy way to challenge it
and get the benefits.
And if you'll notice Mike,
and I'll also, as things get better,
you can throw a little faster.
If you look at his ankle, it is really working.
- [Mike] And I have shoes on.
We were trying this barefoot earlier.
That was harder. Yeah.
- Okay. So you get the idea.
That proprioceptive exercise is really good
for that high level athlete, but you never know.
I just saw on the news this morning,
a man set a record for scuba diving.
- Of what?
- Scuba diving, what was the record?
- He's 101 years old.
- Oh, oldest guy, oh gotcha.
- Yeah, it's his third record.
Every year, for the last few years,
he's been setting the records like man, that's wonderful.
It gives me some hope.
- Will that fix a broken heart?
- No. Well, once again,
what is he eluding to is
we could fix it by just about anything.
- Except for a broken heart.
- Excellent job. Thank you very much.
- Bye.
(rhythmic beating)