♪ Bob and Brad, ♪
♪ the two most famous ♪
♪ physical therapists on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapists.
- And we're the most famous physical therapist
on the internet.
- In our opinion, of course, Bob.
- Today we're gonna talk about three, not three--
critical exercises with injured foot
or ankle with no weight bearing allowed.
You're unable to walk on it for some reason,
- Right. - And during that time,
what do you do to keep your body and your legs
and your lower extremities fit?
- Right, what can you do and what shouldn't you do?
And that's what we're gonna clear up.
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- Absolutely, Bob.
Bob, I wanna talk about this video a little bit.
We have one other video that's similar to this,
but it didn't combine the exercises with the ankle
non-weightbearing and proximal in the hips,
so that I wanted to combine it
and make it complete.
- Make it complete.
- And this started from a friend of mine.
He's actually a retired physician and his wife
and they live in Indonesia.
And I don't know--
- Crazy.
- Well, they're very, they're fun people.
And this woman is very active.
As a matter of fact, she was climbing up in a tree,
fell 20 feet.
- Oh my gosh.
- It's a long story why she was up in that tree,
but it was for a good reason.
I'm sure.
And she broke one ankle and spraying the other one,
the broken one is no weight bearing per the doctor's orders,
sprained ankle, painful.
You know, she's in a tough position.
- Well, she could be, as we know, I mean,
thankfully you're still alive and no head injury
and we've gotta be thankful for the things that we do get.
- Right, exactly.
So, and the question is,
is what kind of exercises can I do
with no weight-bearing?
Either because the doctor says you can't do it,
or it's a sprained ankle.
You can't because it hurts so much.
Well, you wanna get things moving.
Well, let's go back before that, before that,
if it's swelling and it's painful,
I address that you have to control the pain
and the swelling.
You can control the pain, using a cold pack,
a gel cold pack.
One that is flexible that you can wrap around the ankle,
we're gonna elevate it.
So if you're laying on the couch,
get some pillows underneath it or in the bed,
elevate above the level of your heart.
- We've also done videos on how to make an ice pack.
And you can look that up.
They're rather easy to make.
You just need either some salt or alcohol--
- Rubbing alcohol mixed with water.
Yeah, just Google Bob and Brad,
how to make your own cold pack.
- And some freezers bags.
- Yeah, freezer bags.
Not the--
- But they're nice and malleable and foldable.
- Yeah, and very inexpensive.
So you're gonna do that.
And also compressive.
In other words,
Ice wrap is what a lot of people may already have.
Actually, technically, and this is for you, Allen.
'Cause I know you're, you know, being a doctor,
you said you wanna use Comprilan, which is,
it looks like a strap, but it's better.
That would be the--
- It doesn't stretch as much,
which the stretching can get you into trouble.
- Right, you can get too tight with it.
- It can get too tight with it.
- A Comprilan works much better than that.
- C-O-M-P-R-I-L-A-N, right?
- So if you need to order some online
and you wanna get the best stuff,
that is the product then to get.
So let's say the pain is reasonable.
You're taking maybe some across the counter meds
or pain meds per your doctors recommendation,
the swelling's good.
It's time to get it moving.
- Now we're assuming that you're allowed to move it.
- Right, this is the tricky part.
If you have a sprained ankle, chances are,
you're gonna be able to move it whenever it's tolerated.
If it's a fracture and the doctor says no weight bearing,
you have to make sure that you can start moving it
without irritating the fractured site and making it worse.
- You don't wanna impede the healing.
- Right, keep that thing--
- And sometimes they might allow one direction
and not another.
So you've got to get it clarified.
- Right, from your orthopedic doctor.
Get that cleared.
If that's the case, they say, well,
you can't put weight on it.
But you can move it if it doesn't hurt.
Then this is what we're gonna do.
- The next phase.
- I call them the ABCs.
So this is will make sense if you just bear with me,
Bob and I will both show 'em.
I swear I tell my patients.
I say, imagine you have a piece of chalk on your big toe
and do you have a chalkboard right in front of you
and you're gonna make the letter A,
with that chalk on your big toe.
So you're gonna go up, capital too.
- Capital letters, yeah.
- So you go up and you use your imagination
down and then across A.
And then do a B, straight down, make the two loops.
And what's going on is it gives you something to think about
where you effectively do full range of motion--
- You're incorporating all the movement.
- All the planes of motion, exactly.
And you know how far you get,
let's say you get to letter D the first time,
you get to D as in dog and your ankle is tired
or starting to hurt.
Giving you sharp pains that's the time to stop.
And you do this two to three times per day throughout today.
Let's say in three days from now,
instead of getting to the letter D,
you're already up to the letter M,
you know how much progress you've made.
- Exactly. - Right.
- It's a fantastic way to keep track.
- It really is.
So go ahead and do that ABC's.
- Take it all the way through the alphabet, if you can.
- Right, absolutely.
You can do that with both legs.
- It's gonna help the swelling too.
Movement helps the swelling.
You want the swelling to go up into the body.
- As a matter of fact,
while you're laying down with it elevated.
- That's the best time to do it.
- That's a good time to do it
because you've got the muscles pumping
that fluid back to where it belongs,
and you're getting some exercise.
So the ABCs.
Now, the next step,
can you do strengthening exercises with it?
Because once you get your ABCs down
and you've got full range of motions pain free
on a sprained ankle,
you go ahead and start strengthening it.
Oftentimes with a TheraBand,
the two-banding.
- Yeah, some type of resistance.
- Right, exactly.
- And the TheraBand is more of a flat, band.
- Right, and you can order that online.
- This one actually comes in a loop.
- Right, it's like this,
the loop can work well for your ankles too.
We'll show this as well.
You wanna show the loop, Bob?
- I can show the loop as far as just like dorsiflexion
and Plantar flexion on that.
- So this actually works a little better
if you have shoes on, if you're able to put them on,
depending on the fracture or the problem with your ankle.
- Yeah, yeah, this isn't working with for me very well,
because I don't have no shoes perhaps.
- Yeah, you'd have to hold it,
but you can see my shoe was a little rigid.
I'm working on Plantar flexion,
and then I can work on dorsiflexion at the same time.
- Okay, now I'm gonna show how to do it if you have a band.
These are very popular.
You can buy these online very easily
and I'm gonna push down.
And this is the primary motion.
Typically, I have people exercising,
as long as it's tolerated.
All of these exercises should only be done if it's pain free
and, or just slight pain, but nothing, no sharp pain.
If you get sharp pain, you're just tearing tissue apart.
You're taking a step backwards.
So use good judgment.
And I'm saying that particularly 'cause I have a feeling,
this woman is a little more aggressive
she's very active.
If you're up in a tree, 20 feet (chuckles)
you've got some personality.
- You've got confidence.
- Now doing dorsiflexion, pulling the ankle up,
it's kind of hard to do without someone helping.
Unless you can take a band,
you wanna go over there
and hold this Bob? - Sure.
So Bob's just gonna hold it.
You can, if you're creative,
you can put it around like that.
There we go.
And I'm going to pull up and go down, pull up.
And there we get some resistance.
And the farther Bob goes away from my foot,
the more resistance it is offered, and I'm gonna do 10.
You can--
I'm gonna snap you, Bob. (laughs)
It's gonna let go.
Do 10 to 15 reps.
By the time you get to 10,
you should feel tired
or feels like it had enough then you're good.
If it's too easy at 10, then you offer more resistance.
I can show,
this is a really critical motion it's eversion, going out.
'Cause most ankle sprains--
- [Bob] Especially with ankle sprain.
- Yes, yeah, and with a fracture, it may not be,
but it's still an important motion.
And this you can usually do by yourself
as long as your other foot is capable of holding it
the way we have it here.
And then we're gonna work that way.
It works those peroneal muscles
and all the lateral strengthening stabilizers there.
And we're gonna do again 10 to 15 reps
and do these two to three times per day.
- [Bob] Now, that could have been done with a loop too.
- Yeah, that is where the loop shines.
- [Bob] That's probably the best one for the loop.
- And you can, you know,
you could do both ankles at the same time.
Again, following the rules.
As long as pain is not a part of the problem
or being created.
Now doing the other direction where you ankle goes in.
It's a tough one.
- I mean you could have a loop and I could hold on.
You could loop it under a chair leg or a table leg
or something that way. - Yep, anchor it that way
and then we're gonna go this direction.
- [Bob] I mean, you could keep a loop underneath the couch
and just leave it there.
- Yay, yep, get it set up and just leave it.
And that's your exercise area for that exercise.
Okay.
Now the next thing you know, this is really critical.
The muscles in your knee and your hip,
you can do exercises without irritating the ankle.
So the no weight bearing--
- This can almost started right away.
- Right, exactly.
Good point.
So, Bob, do you wanna demonstrate?
- What are we doing?
- The reason I want you to do it,
'cause one bothers my back and you're good at it.
- Sure, which one are we doing?
- Let's start out with laying down.
You can do this on your bed.
A carpeted floor, firm floor works a little bit better.
Straight leg raise.
- Straight leg raise, okay.
I usually bring up the one leg as support.
This is the one we're trying to strengthen.
I just bring it straight up to usually about,
what is that, 45 degrees?
- Yep, usually I say to my patients
and align with the other leg is good.
If you wanna go higher.
And I'm sure Kira, or is it Kara, I'm not sure.
- She could go-- - Yeah, she could go.
- But that's really not as much strengthening.
This is more strengthened
when you start getting above that way.
- If she wants to stretch your hamstrings that's okay.
- Sure, and I mean, if she really needs a challenge,
you can start putting some weight around more.
- Sure, yep.
If you can get it on the ankle comfortably up here,
yep, you bet.
Do that with both legs and let's go to the next one, Bob.
This is where I really need you.
Lay on your side. - Sure.
- We're gonna do a hip abduction.
- Can I go with it this way?
- Sure, I don't care.
We'll look at your backside
and we'll see what kind of comments we get.
Can you lift this leg up?
So working that hip abductor muscle,
this is incredibly critical for future walking.
So if that muscle gets weak,
you can walk with a Trendelenburg
or one of these gaits where you walk like this.
- [Bob] Keeping the toe straight forward.
I'm not going like this.
- Yeah, right there.
It's really critical
that you get that abductor muscle properly.
- [Bob] This is (indistinct) right?
- There you go, Bob.
Okay, now shown them other way.
And I think she'll be able to do this one.
- This one?
- Well, no.
- Oh, supine.
- No, on your side,
you're going to have to face the camera, Bob.
- What are we doing now?
- Hip abductor with the bottom leg.
- Oh, okay.
- Yeah.
I got my--
- You do this one by your own.
- Yeah, I do this, where I go like this.
- [Brad] Yeah, much more aggressive, isn't it?
- Yes it is.
- [Brad] And she may be able to do this
'cause she's a pretty active.
- I have no weight on my ankle.
I've got my knee bent back.
So there's no stress on the ankle.
- So now this is a muscle getting
really aggressively strengthened.
But this one is too.
- I'm getting a little bit of that one too.
- Yeah, exactly, you're working both at the same time.
- Yeah, that's one that is aggressive.
No doubt about it.
- Now lay on your stomach.
We're about to finish up
with prone hip extension glute maximus.
- So you can either do them like this,
or you can also throw on a little bit like this
to get more isolated on the glute max.
- Versus hamstring.
- Versus the hamstring and glute.
- And it may, depending on how your foot
or ankle feels as well, but,
and your obviously do with both legs.
- And you can swim.
(laughing)
- All down, it's a lot easier to do one at a time.
It's a lot easier.
- It's easier on your back.
- Right.
All right, so that combines everything into one video.
I'm hoping that everything goes well.
I have a feeling that she is going to just--
- I'm sure she's gonna bounce back fine.
- Bounce back very quickly.
- Very athletic person if she is the case.
- Right, exactly, yeah.
And you know, with a doctor helping her.
Neurologist are wonderful,
so I hope this is of a help and--
- Good luck, stay out of those trees, my God.
(laughing)
- What are we gonna do, Bob?
- Yeah, what are we gonna do?
Thanks for watching.