♪ Bob and Brad, the two most famous ♪
♪ Physical therapists on the internet. ♪
- Hi there, folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our own opinion, of course, Bob.
- Today we're going to discuss the best three exercises
for foot drop, return to normal walking.
- Right.
- Big problem after, a lot of times after a stroke.
Or a lot of times people get, maybe neuropathy.
- Right, some kind of nerve - Nerve damage
- Or it could be from an accident.
You know, if a lesion that way.
But this is a system, so it's not three separate exercises.
But they all work together.
- That's right.
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- Yeah, we're only about that tall
in that one. - That's right.
We're tiny.
All right, Bob, so we did do a video
a few years ago on this exact same topic.
But we're addressing it,
the approach is a little bit different.
A little bit better, I think, here.
- So this is an updated video. - Systematic approach.
- So if you have foot drop, in other words,
you'll know you have it because it'll be typically one foot,
and you'll hear that slapping.
- That slapping, right. That foot slap.
- Sloppy, slapping foot on the floor.
And you just have a hard time
pulling your toes up like this,
or you may not be able to at all.
- And you're gonna catch your toe a lot, too.
- Exactly.
- The one thing that you really want
to distinguish between, though, Brad.
'Cause quite often I'll see people have,
they think they have foot drop,
and they actually have weakness in their hip.
- Sure.
- And they can't lift the hip up high enough.
- Okay.
- So you want to make sure it is the foot,
and not the hip that's weak. - Sure.
And one way you could test is just simply
in a seated position, put your feet out in front of you
and dorsiflexor.
In other words, here, let me do it from the profile.
Can you pull your ankles up like this all the way?
- Exactly. That's a great test.
- One side compared to the other.
And it might be this is my normal foot
and the other one only goes up half as far.
That would be an obvious sign.
- And it could be a little weak, too,
if you bring them both up
and if you have a friend push on it.
- Yep.
- And they push on this one and it kind of gives way.
- There you go.
- But the fact if you're still able
to pull it all the way, the full range,
that means it should be able to clear the floor
when you walk. - Right.
So there's a couple of things that could be the problem.
It may be a weak anterior tib muscle.
Or it could be that that muscle's not that weak,
but tightness on the other muscles,
on the calf muscles, somewhere in those tissues.
One way or another you need to have that range of motion,
so you want to do some stretching.
So this is the first step. - Right.
- And there's a lot of ways to stretch your ankle
into dorsiflexion, but the best way, Bob and I feel,
is you either use an incline board,
or use one of the ProStretch devices here.
'Cause they really get after it aggressively.
They do a nice job. - Yeah.
So this is kind of, I think their first phase
of the ProStretch, and it was quite simple.
You just go in there and lean on it,
and you can obviously really stretch the calf here easily.
You can do it in a seated position, even.
- Sure.
- You can even go like this and work on it.
But I actually use this one,
because I use it prior to running
and I like it for plantar fasciitis.
So it actually stretches the greater toe.
I know I'm going off on a different subject here,
but I get my foot in here just like this.
Did this this morning, I just give it a good old stretcher.
And it's stretching the bottom of the foot too.
- [Brad] Stretching that whole area.
- [Bob] That whole posterior chain there.
- So you can also use an incline board like this,
and you can make these.
We actually have a video on how to make one of these
if you have someone handy in the family.
Or you can purchase them as well.
But this works really well just using body weight.
And right now I'm gonna stretch here.
I'm gonna get my gastroc.
And then you also want to bend the knee.
And make sure you get the stretch with the knee bent.
- You want it stretched both ways, in other words.
- Right, and you can hold that stretch
up to 30 seconds while you relax.
I'm holding onto the Booyah Stik
just for something to balance,
but you can go up to a cupboard, a wall,
banister, whatever there may be,
so you can relax while you're stretching.
- Now none of these are gonna help the strength.
These are laying the groundwork
so that if the strength comes back you've got the motion.
'Cause if you don't have the motion
and the strength comes back,
you're still gonna have a foot drop.
- Right, so this is phase one.
- And one thing, we mentioned this a little earlier, Brad,
but you can have nerve damage,
and how long does it take nerves sometimes to recover?
- Months, months. - It can take 12 to 18 months
or longer, and they may not recover.
So there's that possibility too.
In a stroke, you're relying on other parts of the brain
hopefully to take over and help out.
And swelling to go down. - Right.
- So all these things take time.
So you want to make sure you have the motion
while it's there. - Right.
Yeah, if you don't have the motion
doesn't matter what returns, it's not gonna work.
So this is a very--
- Important step.
- Yeah, very basic part.
So make sure you're stretching,
getting the ankle to dorsiflexor
so the toes can come up all the way.
Number two is you need to strengthen,
make sure you have the muscle strength
to pull that ankle up, because that's the whole thing
of foot drop, is you're not able to dorsiflex
and then your toe drags, and that's the drop.
Or if you come down and it falls forward and slaps.
But that toe drag is so critical
'cause that's gonna make you fall.
- Right.
- That's gonna make you trip up
on the slightest little thing on the floor.
- What I'll see even, on people,
they might have enough strength to do it for ten steps,
and all of a sudden they start to fatigue.
- Sure.
- And then they become susceptible to catching their toes.
- Sure. - So it's more sporadic,
you don't know when it's gonna happen.
- That's a good point, Bob.
Now I'm gonna show just a real basic way
to strengthen that anterior tib,
the muscles that is responsible for that
pulling the toe up so it doesn't drag.
And all you do is simply ankle pumps.
Now you can see I've got normal strength
and both feet are doing the same.
But if you have foot drop, like we mentioned before,
one of them is probably not gonna go as high.
Or it may be so weak you don't have any motion.
If that's the case, I like to use a cane like this
for assistance, and then you're gonna pull it
all the way up - You've got a cane
with kind of a flat handle.
- Yep. - That works the best.
- I call it the pistol grip, okay.
- Pistol grip, yep.
This works really well, Brad,
I thought this was a great idea.
- Yeah, we're gonna use eccentric strengthening
to get it started, which is a very proven method
to strengthen a muscle. Yep. - To regain strength. Yeah.
- So I'm gonna pull it all the way up
and then I'm gonna try to hold it there
and take the cane away, and let it down slowly.
Now if you've got really weak muscles there,
that can be very challenging, particularly at first.
But if you can even hold it for half a second
and then let it down,
and they'll often times kind of shake like that,
if you can see that. - Yeah.
- Very typical symptom there.
- The other thing that might work would be a dog leash.
Brad. - Oh!
- If you put a dog leash around there and held it
and then let it go. - Right, yeah.
You know anything that you can use to assist that motion.
- Right, that cane just seemed, it's really almost
like it was made for it. - Right, yeah. It's--
- And a lot of you are gonna have a cane,
so it works out well for that.
- So you're gonna do that.
Three sets of 10 is a good thing to work up to.
Remember, when you start, 10 of them might be enough
and you might be so fatigued you hardly do it.
Now the nice thing about this is,
after you do this it might get those muscles
just kind of triggered enough where all of a sudden
if you didn't have any motion,
you have a little motion.
And if you even-- that much progress is big.
- Right. - That's really critical.
That's a big green light, you're gonna improve.
So you really want to continue to work on this.
Probably not seven days a week,
but I'm gonna say five days a week is nice to give it--
- I think you can do it a lot, in my mind.
In my opinion. - Right.
I'm a big believer in taking at least one day off.
Forget about it.
- All right, day of rest. - (laughs)
But, you know, you're gonna know.
People, you probably get to know your body.
- Well I think it's one of those,
because it's such an endurance muscle,
I think you could do it a couple times a day.
When you're in your chair, just--
and especially if you've got the cane available,
that's my opinion.
- Yeah, and you're gonna get different opinions
from therapist to therapist. - Yeah.
All right, what's next? - Now the next one is,
this is a big one, gait training.
Actually focus on how you walk.
Now you can use a cane.
I like to use a little bit taller,
and I'm gonna use a Booyah Stik because it's taller.
And I just have more control.
- Brad's got the gait belt on because this is,
you really want to be safety first here, right?
You do not want to fall and put yourself back here.
- If you're to the point where you can walk but it drags,
but you feel pretty confident with your balancing,
you don't think you need a person, that's fine.
But you probably might want a stick or a cane.
- The person would be right along with you
in case you lost your balance, if you didn't feel safe.
- Yeah, make sure you're safe, have the person with you.
The next thing is, get a full-sized mirror
for some bio-feedback, we call that.
So you can have it on the wall.
We've got one here that rolls around,
that's pretty convenient.
Most people don't have the roll-around one at home.
But then you can look at the mirror,
and you can actually see, you might look in the mirror
and say, "jeez, I never realized my foot dragged,
or you might circumduct,
you might have some of these unusual movements
that you may not be aware of until you see it in the mirror.
And then when you see it, it helps your mind correct.
- Yeah, that's exactly right.
The mind is gonna help try to correct it.
- So if this is my weak foot, you're gonna focus
on lifting it up and swinging it through.
And when the foot comes down, the heel is gonna hit first.
I always tell my patients, just think
about your heel hitting first.
Because you must dorsiflex to get that to happen.
So whatever it takes so your foot is in this position,
you might be looking in the mirror,
might be thinking about the heel hitting first,
or it might be thinking about your toes coming up
towards your nose.
Everyone has a little different way of thinking about it.
- Sure.
- The next thing is, you can use hurdles.
And by hurdles you can do simply is get some two-by-fours.
And (laughs) these I actually went out in my garage
this morning and I cut them up.
They're nothing fancy at all.
You should have at least four,
but it's nice to have more than four.
For this video, four is enough.
You're gonna get them a certain distance apart,
so that when you walk over them--
Now, this is, if you're unstable,
you really need someone holding onto you.
Because that could make you trip and you'd have a fall.
I'll get this out of here.
So I'm gonna go here, and this--
If you touch the wood, obviously,
you didn't lift your foot up high enough.
So the goal is to walk smoothly and picking up the foot,
heel striking first, all the way through.
It is nice to have probably
up to 10 of these, you could have.
And as you feel more comfortable with it,
you could tip the two-by-fours up on end.
- More of a challenge.
- Yep, then you've got 3 1/2 inches to go.
And you're gonna go up and down,
and thinking about right there the heel goes down first,
forcing that anterior tib muscle to roll.
- So obviously it's not a natural walking pattern
anymore then. - No.
- But you're trying to exaggerate it
so that when you do walk, you'll have enough dorsiflexion
to get by. - You get some carryover,
- Some carryover, right. - Yeah, exactly.
- By over-emphasizing. - Right.
So you're gonna work on this for maybe five minutes or so.
Don't get so-- if it's hard for you,
don't get frustrated with it.
Take a break, and come back to it.
- Because eventually you're gonna want to work on endurance.
You want to make sure the foot's gonna stay
held up appropriately, like if you go on a walk for a block.
- Exactly.
- 'Cause if you start tripping towards the end,
that's just as dangerous
as if you've been tripping all along.
- Exactly.
So obviously it's one of those things,
take your time, be consistent,
and get that muscle back to work.
- All right.
- So that ankle dorsiflexes.
- All right.
Thanks, everybody, for watching.
(quick music)