Hey, in this video today I'm going to cover with you four exercises that you need to be
doing. If you've had an ankle sprain in the past, and you're beginning to have chronic
ankle pain if you had an ankle problem for months now, and the pain just doesn't go away,
that's not normal. There's probably some weakness and mobility problems
happening inside your ankle that you can begin to clear up using these four exercises today.
My name is Dr. David Middaugh. I'm a specialist physical therapist at El Paso Manual Physical
Therapy. And this channel is dedicated to helping people stay healthy, active and mobile,
while avoiding unnecessary surgeries, injections and pain medications. Please consider subscribing
to our channel so that you don't miss out on any of the health videos we upload every single week.
The first exercise you need to do is toe curls and toe extensions. So many people
don't realize that toe muscles, the ones that curl your toes especially,
are critically important for the mobility and the stability of your ankle bones. Now the way that
you do this exercise is just make sure you're seated you can be barefoot or with socks on it
doesn't matter, you're going to put your feet out with your heels down just like so. And once
you're in that position there, which you're going to do with both toes and be careful not
to do this too hard because you can get cramps. Do this in both feet with the toes on both feet,
curl your toes down as much as you can comfortably going without cramping,
and hold it there for 10 seconds. Make sure that when you're bending your toes down,
you're trying to bend every single knuckle and all your toes. Even right here it’s kind of in
the meat of your foot, you want to try to bend those as much as you can without pain or cramping.
After about 10 seconds, then you're going to come upwards and try to bend your toes apart,
you have muscles that bring your toes together and apart. And they help with bringing the toes
up and down as well. So, you got to use them all. So up for 10 seconds toes apart. Great,
that's about 10 seconds, then you can go down for 10 seconds toes together, and you do 10 rounds of
this. So down one and up one is one round and do those 10 times. Yep. So then go up,
hold for 10 seconds right there. And after 10, you can come down. And as she's doing this.
I'm just going to explain why this is important using my skeleton.
Now in the ankle here, if you've had an ankle sprain typically happens on the outside of the
foot, the joint itself doesn't move normally. That's why people have problems. In fact,
the bottom part of the ankle bones called a tail is right here, this bone can shift
positions forward and backwards and even sideways a bit it can tilt left and right or in and out.
We call that pronation and supination. But there's some muscles that
start back here in the calf area behind the lower leg. And they send tendons that run right over the
inside of the ankle right here. And they cross that ankle joint, and they run into the toes,
flexor hallucis longus and flexor digitorum longus are the ones I'm talking about. And there's
another muscle called the posterior tibialis. That will work as well that attaches to
the arc of the foot, these three muscles together when you curl your toes like that,
they start to fire and give your ankle joint better mobility and stability.
What I mean by those two words is it moves better that's mobility. And then the joint is positioned
better. That's the stability part. So, you can begin to feel better in your ankle. So,
after you've done these 10 rounds, so 10 times going down, and then 10 times going up.
Next, you've got to learn how to use these same muscles with your feet flat on the ground.
Now this one's a bit tricky, and it's real subtle. So, I'm going to get the camera
and move just a bit closer so you can get a better look. Alright, so for this exercise,
you're going to have your feet flat, just like so. And then if you look at the arch of your own foot,
if you look at the arts of our models foot here, you should see it just suddenly go up,
we can do this, you're going to be grabbing the ground with your toes, all five toes, mainly your
outer toes, and holding it for 10 seconds. And you're doing your best here. It's not
always easy to do but you're trying to keep the base of your big toe. Specifically,
right here you're trying to keep that down in elevate this, something else that should happen
is your ankle should tilt outwards just a bit when you grab your toes, like this down here. So, when
these grab, arch comes up ankle tips out slightly. Now we're doing this and seated right now,
so that it's easy to keep your balance but here in a second, we'll finish off the reps and standing.
This exercise is a little tricky. A lot of people skip this one because it's just
frustrating to get it's so subtle of emotion. It doesn't need to be perfect though. You can
grip your toes down without curling them too much try to flatten these out a bit more.
Yeah, that's better. And just you see how she's blanching in her toe tips like that.
That's what we want is just a little bit of a white or lighter skin color at the tips
because you're putting pressure to them. Then you're successful doesn't need to be perfect.
You want to try to keep that base of the big toe down though,
that that can become a problem if you're picking it up too much. So, try to keep that flat.
So now go ahead and stand up. Let me just zoom out a bit, go ahead and grab again.
There you go, let's set she's grabbing right through the ankles suddenly move out. Perfect.
And this is practicing using those same toe flexors to get stability
in the ankle joints. Excellent work. So do 10 second holds 10 times like this, really,
this is an exercise that you could stand to do all the time, whenever you're standing around,
say, you know, at the grocery store, if you're in line somewhere, if you're just standing at
home or at work, this is something you would do inside your shoes, obviously, you can do barefoot,
it is a great thing to activate these muscles on a consistent basis. And you're going to get
tired doing this. That's okay. Of course, stop when you get tired.
But you don't have to do this nonstop. Okay, let's move on to the next exercise, go and have a seat.
For the next exercise you can do plus signs, X's and O's, all I'm talking about is making
the shape of a plus sign an x and an O with your ankle. So, take your ankle that hurts,
and just going to go up and down and throw your toes into it. So, when you come up
to extend an open. And when you come down towards you to come together and go up and down a few
times literally two or three times, you're going to go left to right to make the plus sign. Yep,
there you go and throw your toes into it. You're trying to get your ankle joint
right here to move as much as possible, avoid moving your whole leg, inwards and upwards.
It's okay to move some but you just don't want to miss moving the ankle joint. After
you've done about five to 10 plus signs. Now do x's. So, you're going to go from out and up
to down in. And then you can go from in and up to down and out. And it doesn't matter that you
alternate, you can go all out in up and down in and do that a few times. And you can go in and
up and down and out and do that a few times you can crisscross and do both, it doesn't matter.
You're just trying to get good ankle mobility and use your toes; I can't emphasize it enough.
You've got to use those toes for what I mentioned earlier using these toe flexor muscles to get
your ankle joint to move properly with the use of those toe flexor muscles. And then the last
motion you want to do about five to 10 reps of as well is O's. So, we're going to go in circles
using the toe. So, when you come up to the top of the circle talking to fan out, and extend
or come up, and then when you go inwards, your toes should be going inwards. When you go down,
toes should curl in and go down out to the side Tosha go outwards like that. And you just try
to go all the way clockwise and then all the way counterclockwise, go both directions a few times.
Excellent job. Now, I recommend you do this a few times a day, she got chronic ankle pain literally
like three times a day, sometimes in the morning sometime in the day, and then sometime before you
go to bed. But you literally can't get enough of this exercise. If you're hurting more doing any of
these exercises, including the next one that I'm going to tell you, there's probably something else
going on, it could be like a cartilage problem, you might be developing a bit of arthritis.
Especially if you're 50 or older, when you might need to go see a doctor, potentially
a foot specialist or a manual therapist like myself would probably be the best person since we
understand the mechanics and can offload cartilage and guide you in more specific exercises for your
specific problem. But if these exercises help you to feel better,
walk better and have better mobility in your ankle. That might be all that you need to
get rid of that final bit of ankle pain that you've had since you've had your ankle injury.
The last exercise of the four that we're doing today, our heel raises, we're going to do a
seated version and a standing version. But I need you to use your toes again, just like I said,
remember toe flexors helped to position that ankle bone properly. I do this because I'm simulating
the talus is like my fist right here. And then the tibia, this long inner bone, the bigger one
and the fibula at the bottom. They make this shape. They call it the mortise.
So, it sits in like that. So, the joint moves up and down like this, but it has the ability to
shift forward and back and when you fire those toe muscles, then you position it properly,
so you get full mobility. So, for the heel, raise grip of those toes a little bit, not super hard.
And then bring both heels upside your feet just under you just a bit more. Yeah, there you go.
And it actually will add a bit of resistance. If you lean your elbows on your knees like this.
If that's too much, you can definitely get off of it. But typically, in seated, this feels kind of
good to just put a little bit of resistance through your legs. So, keep the toes down,
bring the heels up I'm popping, I have a joint popping every time that stopped a scared away,
toes going to be grabbing the whole time. Yep, just like that, and go up and down
nice and easy. And then once you feel like you're ready, we're going to do some holds.
So go ahead and come up and hold it for 10 seconds. As high as you can, gripping the
toes gently, you don't have to grip as hard as possible, but you are trying to lift your heels
as high as possible. And you should begin to feel the calf muscles work and burn a little
bit. After about 10 seconds, come on down. Let's do another five reps like that. So, at home,
I would recommend 10 second holds 10 times. And there's a scientific reason for that we're
trying to get the muscles to fire properly. And if you hold it for about 10 seconds,
then you get more of the muscle fibers to work better for you so that you can
get a more efficient muscle contraction, increase your strength as fast as possible.
For the sake of today's video, we'll have you pause. So, you can go through all 10 reps, but
we're going to go on to standing next. So, let's say you have an injury on the right ankle and this
one, when you stand up, lean on to your left a bit more. And you can definitely use something
for balance if you need to, you might lean up against a wall a piece of furniture,
I've got a stepstool here with a handle on it for our lovely model 93 balance stand on this side.
So, you want to put the balance point away from where you're heard. And so, if you have
the problem on this side, you'd be holding on with your left side over there. So now this allows you
to not bear 100% of the way through both legs or 50/50, you can put more like 40/60 or 30/70
adjusted to the percentage that you can do and use your muscles but not have any increased pain.
So, let's just say we're going to start conservative at 9010. So put 90% of your
body weight on your left foot, and just 10 go ahead and grab the toes. And then lift
your heels up as much as you can. But with 90% of your body weight on the left and 10% of the right,
hold for 10 seconds. Toes are grabbing just a bit. After about 10 seconds, gently come down,
don't drop yourself down real fast. And if you felt comfortable doing that, then let's try 80/20.
So, 80% of that side 20% On this side, grab with your toes, go ahead and come on up. Excellent job,
hold for 10 seconds, staying at 20 This might be the first time that
you're putting this much weight to the to the leg. So, you just have to go through it
in this method so that you don't overload it and potentially aggravate it.
If you felt good there, unless go 60/40 or 70/30, you can make the jumps as you feel appropriate.
Let's go 60/40 here, there you go. So, we're almost at 50/50. And we're going to go beyond
50/50. Good. So, let's say that's about 10 seconds, let's say you're doing great, and you can
do 50/50 And you want to challenge your ankle, it's hurting less, it just kind of aches from
time to time. But it feels good to put weight through it, you feel like this is helping you.
Now let's go 60 On this side. 40 on that side. So go ahead and grab your toes, they're
leaning more on this side. And if you feel like you need to shift your
balance hand to the other side, that's fine, you could be feel like need to switch.
It's a little more stable when it's with the more weight. Okay, so this feels good, or you want to
put on the other side. Sure, thing switch. So that way you hear that the 60 here, the 40 here,
great, there's more stability that way. Fantastic. So just make sure you're still using
your toes here, throughout the exercise. So now let's go 70/30 And we're going to
go all the way to as close to 100 as we can just so you can see where you can take this exercise.
So, 70% of the right 30 On the left, still grabbing with the toes, when you grab with
your toes appropriately here, you'll feel the meat of the calf muscle like the thickest part of the
calf muscle working, of course, but also a little bit lower below the bowls of the calf muscle,
that's where those toe flexor muscles are. And they'll get tired in that region. And then
also, of course, in the soul of the foot in the meat of the foot. You got muscles in there that
are getting a workout here too. Alright, so let's say you're doing fantastic you've been progressing
with this exercise, it's been a few weeks are getting stronger, and you're ready to go 90/10
Or maybe even 99 One, I would say 99 One is where I would max us out. So, 99 190 9% of
your body weight on this side, and 1% looks this way, you're still going to hold on for balance.
So, it's not a true 99 one, but we're just for simplicity's sake and we're not worrying about
a bunch of percentages here. Let's just to touch on this side. So, you can be like this. Just like
that. Yeah, just to touch on the left foot, you're still balancing with your right hand.
Perfect, you're not really pushing off with this one you're just touching, then
go ahead and grab with the right foot. Uh huh. And come all the way up, hold it for 10 seconds,
balancing with this leg mainly. And now it's a heck of a workout for you here. You're really
challenging that ankle. The neat thing about this, though, is it's not a dynamic movement,
you're not changing direction, its real control, you're holding on for balance.
So, it's a safe way to strengthen your ankle to get that missing strength so you can get
the full stability for your chronic ankle pain. So, if this goes away completely, chances are you
don't need to be in a brace if you've if you've been getting better since your initial injury.
If you feel like you don't have any popping or clicking, it's just been like a dull ache or
adult pain, it just won't go away that final 1020 Maybe 30% of pain that you initially had
just doesn't go away. It's likely strength and mobility that you're missing in this we'll get
to that through that last remaining part. So, you can be 100% pain free and get back
to being more active. So, once you've done those four exercises, now you got to start
being more active. You got to get out to walk or jog or do the activities that you were doing
before so that you can get back to normal and eradicate your chronic ankle pain. Hey guys,
if you liked this video, give us a thumbs up and don't forget to subscribe so that you don't miss
out on any of the helpful videos we post every single week. We'll catch in the next video. Bye