Ankle Strengthening with Resistance Bands.

This is an email from one of my blog patients who is trying to strengthen his feet due to severe pain. 

  Hello Rich, how are you?  I have been slowly getting better.  I have been using the ankle-foot maximizer (https://www.medco-athletics.com/afx-ankle-foot-maximizer#sin=34175) for foot strengthening every other day and have a question about strengthening.  There are 4 different color bands with this, yellow being easiest, then red, green and blue.  I am so glad I saw your video on not using the anterior tendon when strengthening the post tib!(https://youtu.be/QP3Ud4d39dc) This is what I've been doing in the evening 3x/week:

WARMUP:

BFST heat for 20 minutes

foot circles 20 each direction

foot dorsiflex and plantar flex 20 reps each

Then start with afx bands: (Yellow for a couple weeks then Red)

Plantar flex         Slight knee bend    

Eversion             Slight knee bend

Inversion            Slight knee bend

Eversion             Knee almost 90 degree

Inversion            Knee almost 90 degree

Dorsiflex            Both slight and bent

Plantarflexion Ankle with Knee Slightly bent

When I do the 90-degree ones, after watching your video I decided to keep my foot slightly plantarflexed by putting a 1" lift under my heel as to not use anterior tendon.  I have been starting with 2x10 on all 6 of these movements.  Next time do 1x10,1x15.   Next session do 2x15 until I reach 2x20 on everything and then move to the red band, which I did just the other day.

Does this sound good?  Any recommendations or changes?

Thanks allot Rich, I hope all is well!

Dr Blake's comment: Almost my friend. The Plantarflexion of the ankle should be done first with the knee slightly bent, and then the knee at 90 degrees or so. The first part gets the gastrocnemius and the second part gets the soleus. The Eversion should be done with the knee slightly bent in both and the ankle first pointed (like in Ballet) and then the ankle at a right angle. The first gets the peroneus brevis and the second the peroneus longus. This the same for the inversion: pointed for the posterior tibial and ankle right ankle for the anterior tibial. You can actually add the third inversion exercise with the ankle pointed and the knee at a right angle to fire the soleus more. The dorsiflexion movement is only with the knee slightly bent. I hope this helps. 

Ankle Strengthening Video: YouTube Viewer's Comment

YouTube Viewer's comment:

Why did you ask her to stop when she started to substitute?

Dr Blake's response:

When isolating a muscle/tendon while strengthening, it is important to strengthen that one muscle and not allow for substitution. Substitution means that the patient will use another group of stronger muscles to do the activity, and not use the weaker muscle (it will go along for the ride). By isolating a muscle/tendon, you can increase its strength rather quickly and correct muscle imbalances produced by strong vs weak muscles. Dr Rich Blake

Foot and Ankle Strengthening: Email Advice

This is a fun email. You just have to love this gentleman's attitude. It is great!!!



Hi Dr. Blake,

     First, I'm so thrilled to have discovered your blog! It's hands-down the most extensive source of information that I have found on the interwebs.

     I recently started doing crossfit training and I love it, but it's hard on the feet and ankles and that's always been a weak point for me. I've been reading your blog today and I wanted to ask some follow up questions.

     Roughly 15 years ago I had reconstructive ankle surgery on both ankles. The correction in the right ankle was much better than in the left, but I have significantly less pain in both post-surgery. I suffered a hairline fracture in my ankle as well, maybe 12 years ago now.
     After the surgery, I did physical therapy and the therapist focused on strength and range of motion of my ankle. She had one piece of equipment which I didn't think to get the name of but I thought it was really effective and would like to try to buy. This tool consisted of a flat circular plane and a semi-sphere ball that attached to the bottom of the plane. The semi-sphere ball attached with a screw and there were progressively larger balls that could be attached as the ankle grew stronger and more flexible. Does this sound familiar to you, and if so, can you share the name so I can buy one?

Dr Blake's Comment: This is a BAPS board which stands for Biomechanical Ankle Platform System. Our physical therapy staff uses it on all ankle and foot rehabilitation programs.

http://www.activeforever.com/p-1663-baps-board-biomechanical-ankle-platform-system.aspx

    Next question: I can't do metatarsal doming at all, so what can I do to work my way up to that?
Dr Blake's comment: Try do the metatarsal doming with Yoga Toes on. Focus on working on part one of the met doming which is straightening your toes as rigid as possible. 



  I was watching your videos about the four best exercises to do to strengthen the foot muscles and I could not do the metatarsal doming exercise without curling my toes. I suspect this relates to the inflexibility of my foot, hence why I'm trying to find that flexibility tool the therapist had. Thanks so much again for the blog, I feel empowered!

Strengthening Ankle and Foot: Isolating A Weaker Muscle

Here is a question from my video on YouTube on Ankle/Foot Strengthening (see the video below).

Why did you ask her to stop when she started to substitute?

When isolating a muscle/tendon while strengthening, it is important to strengthen that one weak muscle and not allow for substitution of the surrounding stronger muscles. Substitution means that the patient will use another group of stronger muscles to do the activity, and not use the weaker muscle (it will go along for the ride). By isolating a muscle/tendon, you can increase its strength rather quickly and correct muscle imbalances produced by strong vs weak muscles. Dr Rich Blake 

A typical example is the marathon runner who comes in knee pain. You test his muscle strength and all muscles in his lower extremities are strong except for some weak quads. You isolate the quads in your strengthening program, gradually build up the strength, and they return to running with no knee pain.

Foot and Ankle General Strengthening Program

Strengthening exercises for the foot and ankle are numerous with some helpful and some possibly harmful. I hope that these exercises will give anyone looking to strengthen their feet and ankles a good start. After 30 years of being a podiatrist, the word is finally out. People need to strengthen their feet and ankles. The video shows the basic program taught by our physical therapy staff at Saint Francis Memorial Hospital in San Francisco. Patients can monthly increase the number of sets and reps done, and change the exercises to make them more challenging. This is a great 3 to 4 time a week program when you know you should be building up the strength in these poorly often neglected feet of ours.

Ankle Strengthening: Video on Eversion with Exercise Bands

Thera-Band is to exercise bands what Xerox is to copiers. I grew up as a podiatrist on Thera-bands, although never honestly knew there was a hyphen. And there are so many other good sources of traditional exercise bands and sports cords that will all do basically the same. The video demonstrates the most important exercise for ankle sprains, balance, supinators, and general foot and ankle strength. The peroneal tendons are vital for big toe joint stability, arch stability, and lateral (outside) ankle stability. The peroneus longus should be strengthened separately from the peroneus brevis as demonstrated well in the video. Home strengthening exercises should done daily in the beginning stages to make sure the habit develops, but gradually over the 2nd and 3rd months done every other day. I love my patients do 2 sets of 10 repetitions (reps) at a resistance that they can do daily, gradually increasing the tension on the band. With these exercise bands, as the exercise gets easy, the level of resistance is increased. Our current office system of exercise bands has 6 levels, and the patients are normally started on the easiest level. You can go very gradual with initially 2 sets of 10, then 2 sets of 15, 2 sets of 20, and then 2 sets of 25, before moving to the next color. Doing the exercise slow as Liz demonstrated well is important. Doing the exercise more in the evening or late afternoon is preferable, since you are tiring the ankle. If you do the exercise before vigorous activity, you could risk strain from fatigue. I love with patients and unstable ankles to eventually get them doing 2 sets of 25 reps with a bike inter tube (off the charts in resistance!!).

Foot and Ankle Exercises: Video on Flatfooted Balancing Exercises: The Best Functional Exercise with Variations

Search Amazon.com for balancing disks


   
   The Single Leg Flatfooted Balancing Exercise is one of the most useful exercises invented. I personally use it for my patients over 50 on balancing programs, and it is used in core rehab, knee rehab, ankle rehab, and foot rehab. It is one of the best methods of foot and ankle strengthening. Gradually the patient works up to 2 minutes with the eyes open, then up to 2 minutes with the eyes closed, then eyes open with the soft pillow, then up to 2 minutes soft pillow with the eyes closed. Some patients will purchase the thin rubber disks for greater difficulty and do other variations as seen with the basketball. I must emphasize that the supporting knee (weight bearing) is slightly bent to protect itself from hyperextending and this position adds to the difficulty balancing. The exercise can be initiated at any time of the day, but should be done normally in the last 2 hours of the evening before bed. This is due to the fatigue of the leg produced, as you increase the time, and you need sleep time to recover. You really do not want to do this exercise before other strenuous weight bearing exercises. Gradually, like any good strengthening exercise, you limit the exercise to 3 times per week. There should also be no pain anywhere with this exercise. If pain develops, stop, and if it repeats itself each time you try the exercise, seek advice on what is wrong, or how to modify.