(Ambient music)
- Hi, I'm Bob Schrupp, physical therapist
- Brad Heineck, physical therapist.
- And together we are the most famous physical therapists
in the world.
I thought we'd do a musical.
- Yeah. Yeah.
Stick to your day job, Bob.
(Bob laughs)
All right.
In our opinion of course.
- Our opinion.
- What's the topic today, Bob?
- I don't know, it's your thing.
- It's my job, you're right.
Here it is, ankle injury.
If you have an ankle injury and you want to find out
it is getting better and you find out
boy, can I play that game of basketball or soccer?
Whatever it is without re-injury or do I need a brace?
Or should I have the trainer tape it?
So I'm gonna go through a reasonably quick screen
on how you do it, this is how I do it in the clinic.
I feel real confident, as a matter of fact
my daughter just had a... she's a sophomore in high school
aggressive basketball player, sprained her ankle.
And I wanted to figure out, can she go back to play?
So this is-
- This is very important information
because the person's got to feel comfortable going back.
And I think after you pass these tests you feel comfortable
in heading back to the game.
- Right. Exactly.
So ankle injury return, when can you return safely?
First of all, you look at the ankle, does it look good?
Is there swelling?
- Right, exactly. Just visually
- Right. The next thing.
And like with my daughters, no swelling
but if I pushed around the ankle bone
there was one spot that was tender.
So I was a little concerned about that.
So what I did first is
she felt comfortable walking
Of course, she could jog
and she was at the point where she could run around
and move but as far as quick turning in that.
You don't want to just test it that way.
You want to test it in a controlled environment.
So the first thing I had her do was a simple hop test,
which we have here.
And the first of all, double foot two-legged hop test.
Does that hurt?
No pain. Okay, that's first.
- Double legged so that you're not putting the entire stress
on the bad leg, right?
- The good leg is gonna help take part that stress off.
And if you do this and there's pain,
that's the end of the test.
They're not gonna go.
- And the same with, just backing up
if you're walking and it hurts, you're running and it hurts.
It's too early, I'm sorry.
- Even a jog, right?
- Even a jog - Yeah. This is all past that.
this is getting to the higher level.
If they pass that, then you go forward and backwards.
Two legs.
My daughter said no pain.
This is just as a matter of fact one week ago.
Right to left.
She still said no pain.
- Now you're starting to get some of those lateral movements
that you're gonna replicate in a game.
- 90% of all ankle sprains happen to the inside.
If you can see like this.
- Right. so the pain is on the outside of the ankle.
- Right, typically.
And that puts the stress on that
- On that. Right.
- No pain with that, zero pain, go to the next test.
And then we go to the single leg test, okay.
I had her hop like this, no pain.
Forward and backwards just a few times, just testing it.
Still no pain.
And right to left, no pain.
That's not the end of the test.
Now we've got to give it the real test.
This is where it starts.
And this is where I start.
So I keep track of things.
Can I see that, Bob?
- Yeah.
Can you see this? Or is Bob in the way?
Okay. I make a simple chart like this.
If you want to zoom in a little bit, Nancy
I put right and left.
That's right leg, left leg.
And this is a percentage chart over here.
We'll get to that later.
The up down test, right to left
and to and fro or forward and backwards.
So let's say the left one is the one in question.
So on the right leg, the one that's not injured
I'm gonna take my stopwatch, I'm gonna say go.
And she's gonna hop up and down for 15 seconds
and count the number of hops.
Usually, most people that have no injury
somewhere around 30, okay.
Then the left leg, I had her do that, okay.
And she came up with about 28 or 29.
She had no pain so I put zero over 10.
10 meaning extreme pain, zero, no pain.
So she had no pain with that.
Then we went right.
Actually I usually go forward and backwards.
I'd flipped that around. You can do it either way
but I really like to go forward backwards first.
Uninvolved leg, 15 seconds.
And again, it's usually around 30.
It varies from person to person.
- This is all single leg stuff now.
- Yeah. Single leg.
- We're off to double leg stuff and doing single leg.
- That's why I got right and left.
- I understand that. I just want to clarify.
- Just clarify, very good.
And then involved leg again.
Sometimes miss 30
with hers actually she was down a little bit on that.
She was about 29.
She had a little bit of pain with that, not much.
One over 10, okay.
Then went right to left, the big one.
And she went backward, back and forth
and she was fine there again, it was around 30.
And then she did the involved leg, the sprained ankle
and this is with your plain shoe on
no support whatsoever.
And you go back and forth except for the the game shoe.
And I could tell it wasn't as good.
That number was down at about 24.
Her pain was two over 10.
- And in fairness, people do have a dominant leg
just like they have a dominant arm.
- Sure.
- So you're gonna probably have one leg
that is gonna be a little bit better than the others
but they should be close.
30 and 24 are not close.
- Right, plus she had pain with it.
- Plus she had pain with it.
- So she's in that gray zone.
She wants to play, she thinks she can.
The trainer taped it.
So with this, I'm not gonna do the math here
but with her, the actual percentage
you take the smaller number, divide it to the bigger number.
She had 78%.
You come up with .78, move it over.
It's .78%.
These were both above 90.
And if you're above 90,
that's the number that typically they say,
"well, you can play, you might need to wear a brace."
She was at 78.
She had two more days to the game.
I checked her again, the morning of the game.
This number jumped up past 90%.
She had her ankle taped and she played with the tape
since then I bought her ASL ankle brace which I really like.
We have a video if you look on that
capital ASL.
They're nice braces.
- They're great braces.
- Yeah. They're great for the athlete.
The next test, now I didn't do this test with her
but I could have.
It's called the jump test.
This is where you stand with one leg.
You draw a line on the ground.
I can see a line here on the carpet.
You won't be able to see it there, it's not important.
But you stand like this, hands locked behind your back
on one leg and then you take a tape measure like this.
Can you hold that out?
- Yeah.
- Set that right on the floor.
Zero, as on the line, I usually do it in centimeters
you can do it in whatever you want.
And then you simply have the person hop as far as they can.
And it has to be a good quality hop.
They shouldn't fall or they have to do it over
but good leg, you hop three times
and you measure where the back of the heel is
on the tape measure.
So if it's 100 centimeters, 102 and 106
you take three jumps, you write the numbers down
whatever it is.
And then you average it out.
So if it's 102, 195 and 101
it may average out to, let's say it averages to 100.
Then the involved leg, before you test them
you've got make sure they can do this, no pain with that.
Then you can have them do this
and do the hop.
If it's not painful
they can do three hops and hold their balance.
You will normally find the numbers dropped
in whatever it is.
it should be, let's say it was 90 centimeters
after you averaged them out.
Now the math is easy here, I know that's 90%.
That would mean that person is probably okay to go play.
Probably should wear a brace.
If it's below 90%, then you to do some ankle strengthening.
And we do have videos for strengthening the ankle
with a number of other devices
that you can do at home as well.
- Again, take into account you're gonna have a dominant leg.
Because right now I'll bet you
you can jump farther with one leg than you could the other.
- Right. Again, you're gonna look at pain
- Right, pain.
- So the numbers can be helpful.
This really works out good for comparative.
You do it one day, get the numbers.
- Right.
- And then come back.
- If it gets better
then you definitely know you're on the right track.
- So it's a relative thing.
So that's a good point, Bob.
So these are great tests.
I use them in the clinic all the time.
Doctors like numbers for one thing
you could say, they're at 78%.
it's not just, is it good or is a bad?
Or it kind of hurts.
You have a definite value.
- Well, if you pass these tests
you can feel fairly comfortable that you're ready
for just about any sport to get back into it.
- Sure.
- And I think it gives confidence to the patient too.
- Yeah, absolutely.
So. Well that's a ankle and a hand basket, I guess.
- All right.
Oh, good lord.
Thanks a lot.