All right welcome back to PhysioFitness and we've got to clinic one for you today on ankles. Now this is for people with stiff ankles that have lost range into dorsiflexion. Now that's pretty common after ankle sprains and ankle injuries and a lot of the time we see people have just missing 10 or 20% of the ankle range and that's what's affecting them when they run or play sport because the stiffness gives them pain again. So what we do on a clinic when someone's got a stiff ankle might be a chronic ankle that's really stiff and they've lost this range here or they're stiff in their range they get to that point and they're stiff through the ankle maybe they've lost some range through the back as well because when you when you don't do enough dorsiflexion you also get a bit tight through the back of the capsule there we mobilize that ankle to try and improve the dorsiflexion range so when they run or when they go and play sport they don't have that stiffness component and then they stop getting pain. So I'm going to show you what we do and then I'm going to show you what exercises stretchers you need to do at home and how you're going to replicate what I do at home. So for this exercise here or treatment if you like what we do is we're going to move the whole foot in an anterior posterior direction. Now this is really classic physio one-on-one it's the sort of thing we learned in our sort of first year of uni but there are tricks with this when you basically do an AP you've got a really good grip on the tibia because the tibia is such a moving now if you know your anatomy the fibula is here the tibia is here right the fibula sits a little bit lower than the tibia okay the maleolyso when you put the block underneath now I just roll a towel up for that when you put the block under little trick is just angle it on the same angle as where that tibia and fib is so you're not having it sort of sitting here and blocking the fibula because if you look at where that tibia is if you block down here you're going to lose some movement there so I would just roll it up nice and tight just put on a little bit of an angle now it's all on the grip with this one use a towel it's much nicer on the patient sometimes you have to double that towel up if they're very sensitive so if they're at acute phase where this is a little bit smaller a little bit sensitive from the injury you might have to double that up because the grip or here might be too sore a bit of that chronic you can probably get away with that I would put that imagine you're going to put that over the tibia and that web part is where your hand is going now you don't go and squeeze the bejesus out of it this is just a grip so you don't slip and your thigh here controls how much dorsiflexion you're doing so what I tend to do is rest one hand here if you can see this and then get my hand as close to that joint as I possibly can and then get into a position where my arm is the line of pull of push directly through the joint if I push back from here I'm going to shunt it into up into the sort of tutter curl joint which is I don't want to do I want to go on the line of that joint now as you move into more dorsiflexion that line sort of changes so you're going to have to have your shoulder right over your hand and that also gives you the same sort of rules as you lock the hand lock the wrist here lock the elbow lock the shoulder and drop the body so I'm not pushing down through my arm I'm actually locking the arm and then dropping the body okay which is a much nicer for the client because you can really feel the depth with that and you're going through in a straight AP direction until you feel that tension or until you see that person start winsing a little bit that they feel either a little bit of pain starting all the stretches just too much so you want to stay on that range where you're just dropping in a bit of a stretch at the end and then back away you're okay with that yeah and this movement gives them the glide if you imagine that's your tip and fib and this is your tail is sitting underneath with a foot it gives them this movement okay because as they move into dorsiflexion that joint doesn't just sort of hinge like that it slides and rolls back all right so I'm doing the rollback with a glide movement to stretch the tissues that are connected in here stretch all the tissues that surround that that have tightened up does that make sense so when I AP them like this I'm giving that joint movement that it's lost if you like so the componentry of the AP movement of the joint that tail is as it slides underneath the tip and fib that's the movement I want to stretch out and then they'll find when they stand up they've got more dorsiflexion because as they move through there's less resistance in the soft tissues and that helps it move better so when they handle load and land and when they're running if that stiffness is gone they won't get as much pain happy days so that's the AP now when you want to get to end range you just kind of have to go into way more dorsiflexion now you can do it two ways one is you basically come right over the climb like that and now I'm going to have to push down that way so I'm going to have to push backwards because the joint angles change so I basically AP them but pushing them that way you know that and that feels probably a bit stronger because I'm right up the joint in range again I don't want to be pinching in the front so you don't be right to the top end but from that position and just drive down and back pretty forceful stuff but again that's for people who can handle it and that will give that last in range that last little bit of dorsiflexion stretch which they need but you can also do them standing so if you have a jump up clear this is listen it's a little bit harder but it's also quite good because when they're doing weight bearing you're getting a way more sort of a factor of what they're doing when they're running so for like their weight bearing and they're having problems this is really going for them to do just face me a little bit if you can see this so what I'm going to try and do is actually block that tailors so I'll effectively I'm gliding it back because what she's going to do is then glide forward so she's going to try and push that knee forward and I'm blocking through here and I'm pushing backwards as she goes forwards and then she backs away so it's almost like she's doing as much movement much effort as I am if you like because if she moves forward and that's not blocked that tailors is tight it's just going to come forward it's not going to get that movement there I wouldn't go and put your fingers on like that that's just too tender you've really got to use your palm so you've got to sitting right back and lock again this as much as you can and just drive that forward as she comes forward into here you feel okay with that and you just got to be careful he's not cheating if she's trying to get more dose of the dose he's probably going to push your knee inwards or into medial you don't want that so just make sure she's sort of staying knee over foot and you just he just drives it forward she has to keep her heel down so don't let her heel come up and you push that back and I just do repetitions like that same amount of repetitions that you would do APN as you're now doing sort of in reverse okay now this is quite a nice one to do especially sort of that insta-angle rehab where they're just trying to search that well a few degrees of dorsiflexion depends on the sport of course but this is also the same sort of thing we're going to do for home mix so let's show you how you're going to do that at home all right so to do that one at home what you need is a solid power band and an anchor point and a box of the raise or you know a sofa or something that's high now when you at this point here this has got to be anchored here and it can't move up and down so that anchor point needs to be lower than the box or the height the sofa what are you going to use to put your foot up on so clear put their around your foot so if you imagine this is the same sort of principle as what I was showing before holding that tattis so now the band is holding the tailors okay so the band is driving that AP glide that way of the tattis and she's then for then going to push your knee forward which brings her into dorsiflexion with AP glides imagine that is my hand and that is the movement that she needs to work on again try not to only get the pinch here very crucial in a shout out to calisterat from the ready state for this because this one I completely stole from him you've got to keep that band sitting below the mouth of the opposite as he stated a lot of people the band slips up and that's not going to do any AP glide of the tattis that's actually going to do the reverse which is a completely opposite thing of what we want happening so you've got to make sure that band is sitting right down underneath the tibana fib that's why that anchor point has to be lower and if anything the spot needs to be probably a little bit higher so very crucial that you do that otherwise you're just going to do the completely the wrong thing so have that sitting below the two bony points have really tucked under there and nice and heavy band on there so it just doesn't move can you imagine if this was down even further you'd get a way better effect down here okay so that was really anchored down there that's a really helpful position to bend because when she bends in knee forward that's just really giving a nice glide you feel okay with that yeah and again watch the pinching the front don't go to the point where it pinches but that sort of repetition range against the same sort of thing aiming for about 30 or so pushing forwards maybe two or three sets of that to help with that dorsiflexion range okay hope that helps