(upbeat music)
- [Male Singer] ♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists on the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course.
- Hey Brad, you wanna talk about drop foot?
And we have some of the best exercises
for walking normal.
This is really, you guys are gonna like this.
Brad has really come up...
This isn't your idea.
- No, well part of it is, but yeah,
I went to a course
and this is a really helpful and useful idea
for a therapist, as well as people for you at home
who you don't have a lot of money to spend
and you've gotta get a loved one,
or a family member to improve,
this is something you can...
- Yeah, I love this idea. - Yeah.
- This one is really cool.
- And that's actually gonna come up at the end.
We need to go through a little explanation
so you get a good education on what we're going into.
- And by the way, if you're new to our channel,
I see a couple new people that wandered in,
please take a second to subscribe to us.
We provide videos on a stay healthy, fit, pain free,
and we upload every day. - Excellent.
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On Facebook,
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and lots of other cool stuff.
- Sure. - All right.
- Let's go to work.
- All right, you want Napoleon?
- Yeah, let's get Napoleon over.
Foot drop. What is foot drop?
- Napoleon Bonaparte.
- If you have foot drop, you know what it is.
I'm gonna just show you a little...
- Demonstration. - Demonstration, yeah.
- Watch my left foot.
If I come forward and you hear someone walking.
And they plop with that one foot.
And there, it's a functional foot drop
that can actually walk with it,
but it puts them at risk for fall.
And some people, they end up dragging
because they don't have enough ankle strength
to lift the toe up.
So actually, it's not the whole foot dropping,
it's mostly just the toes.
They're not pulling up, we call that dorsiflexion.
And we need to have the anterior tip muscle,
which is right here, pull that ankle up
so that when you swing through,
it doesn't drag, just like I demonstrated, so...
- It's a very dangerous condition
because it can result in falls very easily.
- Exactly.
- Especially after you've had a stroke.
A lot of times, people after they've had back surgery
or if they've had a sciatica problem that got worse,
that's when usually the time is for surgery,
is when it effects the nerve
that is effecting the dorsiflexion.
- Right.
So if we look at Leopold,
I just wanted to go through a little bit here.
- Napoleon. - Napoleon.
- Whatever. Old bone head up here.
Oh, watch, your gumby's falling off.
Bob, can you fix that for me?
I don't want him dropping on the floor in front of everyone.
So this orange tape represents the anterior tibia.
- That's pink tape.
- Pink tape, whatever.
That's a color issue.
And it connects up to the front of the ankle here,
and when the muscle belly, which is here,
just watch how this works.
It pulls up and that's how we get dorsiflexion.
- [Bob] So yeah, the muscles that actually provide,
lift your foot, are coming up from
the calf area here basically.
- [Brad] Right, yep.
- [Bob] The shin and the calf.
- Yep, so we need to come up with something
to assist that muscle, to wake it up,
get it stronger, and that's what we're gonna show you.
- Yeah, the problem might be up in the head,
in that after you've had a stroke.
- You've got a problem in the head, Bob.
- What we're trying to do is,
you know, if that part of the brain has died,
we're trying to engage other parts of the brain
to come in and help out
and help get that foot drop,
you know, to no longer be there.
- This could be from a lower back problem as well,
so it may not be from higher centers of the brain,
but it could be from a nerve problem
in the lower back as well.
- Right, as you already mentioned.
- So Bob, let's...
You wanna show them some ankle dorsiflexion?
- Sure.
- So first of all, we wanna get this muscle to strengthen.
Okay?
So if Bob is gonna strengthen that muscle,
you can just try and do it actively.
If you don't have the strength to do that even,
which is often times the case,
but you have a little movement,
right now I've got a patient,
he can just move it slightly,
about a quarter of an inch, half an inch.
But we need some strength.
You can use the cane.
- [Bob] And you can just hook it right on.
Especially a flat handle cane here works really well.
You can hook it on the bottom here,
and what I like about this Brad,
is you can pull it up like this,
and then one of the first things
I've tried to have people do is can you hold it?
Or just slowly lower it down?
'Cause a lot of times,
people can't maybe go this direction,
or maybe they have a little bit.
You know, they can pull it up
and then they can go ahead, try to hold it,
try to hold it, try to hold it, try to hold it.
- [Brad] And let it down slowly.
- [Bob] Yeah, let it down slowly.
So pull it up, let it down, let it down slowly,
you know, try to hold it up.
- And when you hear Bob doing his little chant here,
that's what therapists do.
They'll say "Hold, hold, hold, hold,
"slow, slow, slow."
All these repeated verbal cues can help the muscle kick in.
- I think the other thing that works out good Brad,
and I don't wanna take too much time on this, Brad,
but even if you're just laying down like this
or sitting down like this,
just see, you know, you're trying to use,
you're trying to connect other parts of the brain,
if it is after a stroke,
and you're just trying to get a little bit of movement.
And sometimes, remember how we took even a straw
and taped it on there Brad?
- Sure, yeah, so you've got a visual.
- Put a colored straw on there
and you're just trying to watch that
and say "Get some movement, get some movement."
- Right.
- So that's a good starting pull.
- That would be bio feedback. - Right.
- Visual bio feedback.
The other thing that works well
is if you have a wobble board.
Therapists in a clinic always have a wobble board.
Typically, people at home don't.
All you need is something to give some mechanical advantage.
You can just take a soup can.
I've got some organic garbanzo beans here.
That'll probably help out a little bit.
But you put your foot...
And it works better with a shoe,
if you've got a firm sole,
and then you can use that to...
- [Bob] Sure, give you a little leverage.
- [Brad] A little leverage.
And this works better on carpeted floor
versus tile like this, 'cause it's a little slippery.
- [Bob] Ah, it's a good exercise Brad, I like that.
I haven't seen this one.
I'll have to engage this one.
- [Brad] Yeah, and I didn't even get this one
from the course.
- [Bob] You came up with this one?
- [Brad] Yeah, yeah.
- [Bob] All right, we'll call this the Heineck Technique.
- [Brad] Yeah, you know, you could use,
if you got a dumb bell, that works pretty well too.
And you can work that.
That actually works a little bit better.
- [Bob] One thing Brad, going back to even maybe
the use of the cane, even a little bit of this,
reminds me is that with foot drop,
the muscles start to tighten up on you.
- [Brad] Sure.
- [Bob] So you wanna make sure that you are
stretching the foot too.
And a cane always works well for that, doesn't it Brad?
You can just pull towards you
and give a good stretch.
You can also do it with a towel.
- If you got someone that wants to help you at home,
this is a good way, a good manual stretch.
This is the right way to do it, as far as I'm concerned.
But Bob's gonna show you with his sheet,
which I don't like the sheet at all, but it works.
- Or a belt. - Or a belt, yep.
- Anything you can pull.
- Because you wanna make sure you're maintaining
that full range, if you're trying to get some strength back.
- Exactly.
- You're gonna be fighting that also.
- Yep. Good point, Bob.
All right.
- Where we at now, Brad?
So the cane method.
- Bob, let's say you were at the point now
where you do have some active range.
You can pull it up but it's not enough
so you can walk normally.
Now what people, a therapist or doctor might say,
"Oh, maybe we're thinking about an AFO,"
which is a plastic device like this.
- Ankle foot orthosis.
- Right, and that's gonna hold your foot up.
Let's put this one on.
- Well here Brad,
why don't you give me the other one actually?
- This one?
- This one (indistinct).
- The ankle foot orthosis holds the foot up.
They work really well to keep your foot from dragging
so you don't have the problem with tripping.
The problem is is if you're making progress...
- It's doing the work for you.
- Right, it's doing the work
and it's not gonna allow you to progress any more.
- Yeah, you're not gonna get strong
by using one of these.
- Particularly if you get a custom AFO.
These are really expensive, a custom.
They're gonna be five, $700.
- Oh, at least.
- And that's a last case resort.
When you cannot function
and you cannot get progress with it,
then you go with this.
- Yeah, we'd rather have you have that and not fall.
But if you're still trying to gain back strength,
you know, you may want to hold off on getting one
and try this instead, what Brad has up coming here.
But yeah, this is one off the shelf,
and you can see, you slip the shoe over the top then,
but it helps hold the foot up.
- Right, it's not gonna fall down,
allowing that toe to drag
and get that fall risk going.
Okay, so Bob, what I wanna do is
my first little tidbit is we're gonna use some fair band.
This is one thing you have to have fair band,
it can't be fair tubing.
The first simple thing is...
- When he says fair band, it's actually a stretch band.
Fair band is one of the brand names.
- Right.
- So...
- But what I'm saying is it has to be a band.
It can't be the tubing.
- Sure.
- Stretch tubing will not work for this
and you'll see why in a little bit.
You tie a knot in one like this,
then you hook that, you gotta have a shoe on,
it's not gonna work bare foot.
A shoe with a sole.
And you're just gonna go around the leg like this.
And that becomes...
- Kind of your AFO, isn't it?
- And to your tibia.
And so when you're walking...
And I've done this with a number of patients,
that helps pull their foot up.
So now we're strengthening other muscles in the leg,
because usually, it's not just that muscle,
there's some other muscles that are involved
with the gait problem.
- Yeah, for a stroke, quite often the hip flexors
are a problem too, so.
- Right, and if you use this
and you're still having problems
and that leg is dragging through and up in here,
then we go to the next step,
and this one is a grand daddy.
This is a beautiful-
- Well, this is one Brad too
that you were just showing there,
a lot of people do this, they also back knee.
- Right. Hyper extend the knee.
- Yep, they're walking like this.
They slide forward and then they go like this.
Sort of like that, so.
- We're going to go to this next.
- We're going to go to this next one
that solves a lot of problems.
- Therapists out there watching,
I think you're gonna love this,
if you haven't used it before, and people at home.
Watch carefully, you might have to repeat it a few times.
Get a nice five inch wide exercise band.
You're gonna double it up
and the height of it should be about chin level
or a little higher, okay?
If you double it up and it's only this tall,
it won't be long enough.
And then you mark where it's half way.
Can you see the black mark on here?
That's the mid point.
Okay?
Now it's important for that, so you get this on right,
otherwise, you're gonna have problems down the line.
You put that black mark down, your foot on the black mark.
Can you help me Bob here?
- Yep.
- I had no problem with this before
when we weren't videoing.
There, I'm gonna put my foot on there.
Get the...
So there's no twist.
- Hold it up there for a second Brad,
just to show how long this is.
- Yeah. There we go.
So without the stretches, you know,
we can stretch...
Maybe you wanna do a few arm stretch exercises in there.
- Hold it all the way up there, just hold it up there.
There we go. - Yeah, okay. There you go.
- Now you're gonna cross not once,
but twice.
It'll work if you only do it once
but it works a little better with twice.
See you down at my foot, I got the criss cross,
now we're gonna cross behind the knee.
And you'll see this once I get it on
why we're doing it behind the knee,
and then we're gonna cross again over the thigh.
And I have tension on this.
Not a lot, but about half tension.
It'll vary from person to person.
- [Bob] And now you're going around the waist.
- [Brad] Around the waist.
Okay?
And then it's like you have a belt.
You're gonna knot this up but not too...
Don't knot it up too much.
- [Bob] Yeah, 'cause you won't get it unloose. Right.
- So there's a cross above the ankle.
A cross behind the knee.
And then it crosses again here at the hip.
And I want this up a little higher
so it gets onto that hip flexor.
So people with a stroke, that CVA,
this is really a key area for them.
They're gonna have...
Let me get my knot on here a little bit.
Usually, you're gonna use a walker or a cane.
And now when they walk,
the bottom loop is gonna help dorsiflex,
so the toe doesn't drag.
That's gonna help pull that up.
The cross here is gonna help prevent
that hyper extension that Bob was talking about.
And the force here from the strap
is gonna help the hip flexor pull forward
so we're getting three benefits.
Not only the drop foot but the hyper extension
and the hip.
And it really is a nice device.
And it helps you and it gives that full feeling.
It's like when you put a brace on, Bob,
things feel better.
This is like a whole leg brace.
- Yeah, I can't wait to try this actually.
I've got a patient right now even that...
- It is really fun.
- This is really a good tip, Brad.
- So again, use this with walking.
Obviously here you're not gonna leave it on all day long,
but you know, for a 30 minute session, it'll work out fine.
- Yeah. - Wow.
- All right Brad, I think, you know,
you just proved the theory that we're not just pretty.
- Yeah, we're pretty ugly. No, we're handy.
- Yeah, we're handy and helpful.
And look at this. - Yeah.
- This is a helpful tip.
- Yeah, if your spouse doesn't find you handsome,
they'll find you handy. - That's right.
- I got that from Red Green.
- Red Green, you stole that one.
- Yeah, I stole it.
- All right, thanks for watching.