♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
(upbeat music)
- Hi, folks,
I'm Bob Schrupp, physical therapist.
- And I'm Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course.
- I was just looking over
to see if you agree with me, Brad.
- Well, of course I wouldn't. (both laughs)
You wouldn't. - Let's carry on Bob.
All right, today,
we're gonna talk about 10 stroke exercises for foot drop.
This is really actually good
for someone that has really,
a weak ankle and foot. - Right.
- Really, very little movement,
'cause we're gonna show you
from the start what to try,
and then, you know,
move on to more advanced stuff, as hopefully,
as things improve. - Right.
And if you're a foot drop is not from a stroke,
it's still, these are still. - Right.
These are all still. - Effective.
Applicable. - Mm-hmm.
So, all right, Brad,
why don't we first start off with just,
you wanna make sure the calf muscle's
gonna be stretched out,
because if it's tight. - Mm-hmm.
- It's gonna make you,
you're gonna be fighting against that, so.
- Right, right.
- Do you want to show a stretch?
- Sure.
- Well, we got a big mess here, don't we?
- Yeah, well, we're gonna use all this.
- Yeah.
- All these handy items here.
Okay. - Should I, well,
you're gonna stretch me
or you're gonna? - Yeah, yeah.
- I'll take this off first.
- If it's to the point where the person,
the whole side is involved,
they're not able to do a self stretch
and you need to do it,
have someone else stretch.
Why don't yous scooch down
this way a little bit, Bob?
And you're gonna help stretch the other person.
Take your hand like this.
This part right here,
you're gonna put right there at the ankle,
top part of the ankle.
Grab around the heel, the calcaneus,
and your forearm goes against the outside,
right below the pinky toe, if you will,
the fifth digit,
and stretch like this.
'Cause if they've had a lot of tone in here,
this will not go easy. - Right.
- And this gives you a lot of.
- Leverage. - Leverage,
and you don't have to hurt your back,
so I'm stretched with my body
and not doing this.
Oops, get that tie outta the way.
This works, but it's a lot easier to do this,
and you can sustain a stretch
and Bob will let you know
that I'm getting a fair amount of pressure.
- Yeah, yeah.
- Okay. - Now,
you can do it yourself, too,
with a belt. - Sure.
- And I'm gonna assume you
maybe don't have much arm strength.
You know, you can just loop it
around the foot like this
and put it around the forefoot.
- Yep, that's the thing,
to get it in the right location.
- Yeah. - So you get leverage.
- And then you'd pull it like this.
- Yeah.
- You can give yourself a stretch.
- You could do it with a sheet too.
- Right, yep. - And you just pull yourself,
self. - Oops.
- I also. - The cane.
- What's that?
Oh, the cane would work out really good.
- Yes. - Yeah, sure.
Just pull like that. - Yep.
I like to use that
with a lot of patients. - Oh, nice.
And it's not so floppy as the belt.
Now, I'd also like to see,
maybe even do like a hip abductor stretch like this.
- Sure.
- Because these muscles tend to be tight
on someone who's had a stroke.
- Right.
- And they, the more you have tone in your leg,
the more it's gonna affect the foot,
believe it or not.
- Right. - So.
- And if you're not familiar with that word tone,
it just means the muscle's tight.
- They're working on their own accord, really,
you know, without your.
- Right. - Your input.
- The muscle's are working all by themselves
and you cannot control it
because of the injury to the brain.
- You could even stretch this way.
- Sure. - To the end.
- Yep. - I mean, itself.
All right, let's go back.
Now let's go to the,
really, the first crux of the.
- Oh, yeah,
Bob's got a nice little device here.
- So I just put a,
I had a sock
and I taped a straw on there
and I put a little bell on the end.
- Sure.
- Because initially, again,
you may have no movement whatsoever.
And so what you can do with this,
I'll go up here, Brad.
- Sure.
- And 'cause you visually wanna be able to see it
and maybe prop yourself up,
or maybe you do it,
just put it on the floor,
but you can, you're just gonna see
if you can get some movement at all.
And with the straw,
you can see it.
And if you get to the point,
you can actually hear it too, the bell.
- And remember, you know,
if you had a stroke,
a lot of times your vision
and all your sensory areas are compromised.
Any little thing to show progress is gonna be helpful.
- Yep, and I'd like
to see you doing this,
I mean, you could do hundreds
and even, it's a couple hundreds of these.
If you get it to move, yep.
- Get those muscles to wake up.
- I mean, you've gotta,
and if it doesn't work with the leg straight,
if you could maybe even bend the leg a little bit,
put a pillow under there. - Sure.
- And go like this. - Yep.
You know, even a little bolster.
- Sure. - Like this.
- Yep. - It's a rest.
- That again, breaks up the tone,
which makes it sometimes easier
to move at the foot.
- Right. - So.
- And I imagine they could go like.
- Yep, they can try doing this too, absolutely.
Any movement you can get is gonna be a plus.
- Right. - To start off with.
- Sure.
- All right, the next thing is gonna be the wobble board.
Brad, do you wanna do that one?
- Yep. - And Lonnie can pan on down.
- So a wobble board is something they have
in a lot of therapy departments.
But it's a wobble board
because there's a ball on the bottom
and a board here,
and it wobbles.
And if you're gonna go on a hard surface,
it's nice to put some shelf liner
or some dicem on the floor.
Otherwise, it slips all over.
You wanna have a good grip on there.
You can start with two feet
and the good leg is gonna help the weak one.
And you're just gonna wobble it.
Oops.
Forward and backwards.
So the backwards is the important thing,
'cause the foot drop means the toe's gonna drop down.
So if we help it go up with the other leg,
you can get that motion started.
After you do this,
you might do it for two to three minutes,
few times a day.
After a few days, with luck,
you can start doing.
- [Bob] But you could also do your.
- [Brad] Just the whole program.
- [Bob] Brad, you're side to side in your circle.
- [Brad] Oh, sure, right.
I was just focused
on dorsiflexion for now. - Sure.
- But Bob was saying,
you work this way
and you can work circles,
just to get that ankle moving. - Yeah.
- [Brad] In all the planes,
which is a good idea.
Good point, Bob.
- [Bob] But you're right.
As soon as possible, Brad,
you want to go down to the one foot.
- Right. - I mean, that's,
'cause the studies have shown
that while the other foot helps,
it does not, I mean,
it doesn't hurt things,
it doesn't really help. - Sure.
- [Brad] It doesn't help recover the.
- [Bob] Yeah, you want to get that foot independent
as soon as you can.
- Yeah, you wanna be able to see it, so.
Another one, this is another Brad invention with the cane.
Go ahead and take your cane
if you have one, or,
and you're gonna hook the foot like this
and pull it up,
and then I want you to try
to hold the foot right there
and then slowly lower it down.
- Yeah, why don't you do that on a profile
so they get a better sense of that motion, Bob?
- Probably should have done this
with a white sock.
Let me go ahead
and just pull my sock off. - Ooh, Bob,
did you get?
Is everything cleaned? (laughs)
- [Bob] I don't know.
There. - Let's go ahead.
Okay, go ahead.
- [Bob] So I'm pulling it this way,
and then I'm gonna slowly let go
and let it see if I can hold it
and stop it from falling down.
- Right.
- [Bob] I mean, if you have no strength at all,
what's gonna happen is you're gonna go like this
and it's gonna just flop drop.
- Yep, just flop.
- [Bob] So you gonna start by pulling
and then see if you can slowly let go.
And it's eccentric strengthening is what we're trying
to do here. - Yep.
- So, the other one you can do,
actually, again, Lonnie,
if you go down to the floor,
you could actually draw,
put a cardboard down, Brad,
and make a little clock here.
- [Brad] Oh, sure.
- [Bob] And you're trying to move the foot
to from 12 o'clock
to two o'clock. - Right.
- [Bob] You know, again,
a visual thing that you can do.
- [Brad] Right, you know, exactly.
Maybe we should just draw on the floor. (laughs)
No. (both laugh)
- [Bob] And you can go the other direction too.
- [Brad] Oh, yeah.
- You can go. - Yep.
- 12 o'clock to 11 o'clock. - Right.
You know, if you're lucky,
you may have a floor
that has a pattern on it,
where you can just visually. - Use.
- [Brad] Put marks on the floor.
So some tile floors are like that.
All right, as we advance on, Brad,
here, hopefully you can get to the point
where you can get to a countertop
and hold onto the back of a countertop.
And you're gonna start
bringing the foot out like this
and you're gonna try to,
as you bring it out,
try to lift it up
and bend it out to the eversion.
- Now this is something that's hard to see,
'cause there isn't a lot of range
in the ankle in this direction, but go out.
Bob is actually,
can you relax your foot, Bob? - Sure.
- He's going out this way
with his foot this direction.
So he's getting some motion
and that's called eversion. - Yeah.
I'm turning the ankle out.
- And that little bit,
you get those muscles fired up
and it's gonna help the dorsiflexion,
the foot drop as well.
- Right, exactly.
All right, again, moving on,
now we're assuming that you're starting
to get a little more strength.
Now what you may do is maybe,
why don't I hold onto the back of this chair, Brad?
- Sure.
- And you can do this with a shoe on
or a shoe off,
but you're gonna start just trying
to balance on that one leg now.
- Get some weight through it.
- Yeah, get some weight through it
and see if you can make it work a little bit.
So you can even let go here.
- Right, you may want to start with a cane.
- There we go.
Even the cane and the countertop on another side.
- Yep.
- And, you know,
you can try this on your good foot first.
- Right. - And you can see,
it takes a little bit of work,
but that'll start working the eversion
and inversion. - Right.
- And work in all different directions.
- If you happen to have quad weakness,
you gotta be careful,
'cause if your knee bends
and your quad gives out,
it could cause a fall.
So just, you may wanna have someone holding onto
if that's a problem.
- Now, that, yeah.
Very good point, Brad.
Now, if you're starting
to get to the point
where you wanna walk
and maybe you had an AFO ankle foot orthosis.
- Mm-hmm.
- The step down from that is just
to get an air cast.
And what this does is it supports the ankle
and stops it from going,
turning in or out. - Right.
- So you won't sprain your ankle.
- Right.
- But you still can work on going up
and down like this. - Right.
- It won't hold it up for you.
- Right.
- So if I slip this on.
- That is a big concern with people
I have drop foot,
or after a stroke,
when you don't have good ankle strength,
is that they'll just sprain their ankle.
- Right. - Because it'll invert in,
roll in. - So when,
if I tighten this up real tight, Brad.
it'll stop me from turning this way
or this way. - Right.
- But I still can go up
and down like this. - Right.
- So this, you can start walking with this
and work on trying to bring
that toe up while you're walking.
- Yeah, so. - Go down, Lonnie?
- You got his foot? - Okay.
- So go ahead, stop right there.
When you're in this phase of the gate,
you're really focusing mentally
on pulling the toes up
and getting this gap in here.
- [Bob] Yeah.
So yeah, and what Brad just said,
when you're walking, yeah.
I want, this is where we are gonna allow you
to look down even. - Yep.
- [Bob] And see if you can pull
that toe up every time you come through.
- Yep.
- [Bob] And you don't have to worry then,
about spraining your ankle. - Right.
- So, and if you can't,
if you can't bring the toe up at all,
you just, you're gonna do this thing
where you lift up the hip higher
than you should. - Right,
and compensate that way.
Mm-hmm.
- All right.
Again, moving on.
Let's say, now you're to the point
where you can actually do some strengthening.
You can take some, well,
we have exercise tubing or theraband,
and you just wrap it around the ankle like this,
and you can work on turning it in like this.
- Sure.
- And you can work on turning it out.
- This is one where it's nice
to have a partner.
I'll hold on to it, Bob,
because it's just easier
to get a better angle. - Yep.
And then you can even do this.
Oops, sorry, Brad, geez.
- This really works better with a shoe on
'cause it kind of grips to the.
- Oh, I was just gonna show how you can do,
yeah, you could even do ankle dorsiflexion by.
- Oh, yeah.
- If you went around both. - Mm-hmm.
- If I stood on this
and I went like this,
now I can go work going up.
If you've got athletic
or tennis shoes, or whatever,
they work a lot better than the theraband.
- Yeah. - 'Cause the theraband grips
to the sole a lot better.
So that wasn't a,
that wasn't a very good demonstration. (laughs)
- Right, yeah. (laughs)
- The last thing, Brad,
is what we start having people work
on is doing what we call side steps.
'cause the ankles having
to work while you're doing this,
it's. - Sure.
- Having it turn in and out,
and walking backwards.
- Yeah.
And then you're walking,
ankle strength balance. - Yeah.
- And then you're putting it all together.
- And while you do that,
you may wanna have somebody with a belt on
holding onto your belt
to give you some safety. - Right, yeah.
Especially going backwards,
the risk for fall's high.
So got someone bigger than you, hopefully,
is gonna hold you,
if in case you need a little help.
- All right, thanks, folks.
Thanks for watching.