After reading the book "On Writing Well" by William Zinsser, I realized that writing and program design have a lot of similarities. An example of this is clutter. Clutter is an easy way to decrease the effectiveness of one's writing and one's program.
Early on in my career, I have had a handful of patients that regardless of what I did, their squat technique was always off. I would work for months and months and I could only make so much change. Banging my head against the wall, it took me way too long to start to look at the ankles during my assessment process.
The ankle joint is one of the most overlooked joints in the body when movement dysfunction or pain exists. Poor ankle mobility can cause poor movement patterns, knee pain, inability to squat to full depth and a slew of other problems.
HOW TO ASSESS ANKLE MOBILITY
Before you start randomly throwing ankle mobility exercises into your programs, first start with this simple assessment from the FMS/SFMA.
By assessing the ankles you now have an objective measure that will A) tell you if you have a deficit and B) is an objective way to retest your mobility to see if you are actually making improvements.
ANKLE MOBILITY FIXES
There are a ton of very good ankle mobility correctives out there. The following are just a few of my favorites placed into one location for your convenience.
Since the calves are always in use with walking, standing, jumping, running etc... they have the potential to develop trigger points and tightness. In order to address this there are 3 things we need to focus on.
1) Self Myofascial Release: To Your Calf and Plantar Fascia.
Using a foam roller or a lacrosse ball (any ball will do really) roll the entire length of the muscle for 30 seconds to 1 minute. If you find any tender points along the way, stop and keep pressure on this area for 5 deep breaths.
Note: The plantar fascia is part of the superficial back line. It had a direct fascial connection with the gastroc, therefore rolling both out can offer greater benefit than one alone.
2) Stretching - There is a lot of chatter going on in the field of health and fitness that stretching is overrated, and we do too much of it. As there is much merit to this, focused stretching to areas that NEED to be addressed is beneficial. Bottom line here: Don't stretch a muscle just because it feels tight. Use objective measures that assure you that what you are stretching (like our DF assessment) is actually improving your mobility and movement.
There are many ways to stretch this area of your body. Just make sure that when you stretch, you hold the stretch for 2 minutes without coming out of it. Research done from Dr. Andrea Spina and the FRC courses suggests that tissues need at least 2 minutes of constant communication to effectively make positive improvements.
3) Ankle Mobility - These are best served as movement prep for your workouts, and to help improve ankle joint mobility. Here a couple of my favorites below:
Ankle Mobs to Wall
Mulligan Mobs with Movement
Calf Rock Backs
Whether or not you feel your technique is good or not, take 2 minutes to assess your ankle mobility. It can potentially help you find limitations that can help improve your technique and performance.
Hope this was helpful, please leave your comments and feed back below.
Just to be clear, Physical Therapists do not fix people.
You read that correctly, physical therapists (myself included) do not fix injuries. I know you are thinking 'well why do I spend all my time and money on co-payments and deductibles if no one can fix me?'
In an outpatient setting, a PT is able to determine the root cause of your pain through the evaluation process. By understanding your mechanism of injury, current symptomology, and examination of movement a PT can give you a movement diagnosis that allows them to address any pain, tissue extensibility, mobility or motor control issue that might be present.
You are probably thinking now, 'hey you just said PTs can't fix me, but they can put me on the road to recovery?'
Exactly! Physical therapists put you on the ROAD TO RECOVERY. This does not mean we fix you; the hones truth is the only person who can fix you is... YOU. The bottom line being that a PT alone cannot ¨fix¨ your ailments all by him/herself, the other person in the equation of recovery is YOU.
Every time I see a patient, any benefit they get from seeing me I call “the window of opportunity.” All tissues in the body have a threshold level that once met, pain settles in. The benefit you get from PT is increasing your threshold, which improves your pain tolerance.
So if you see a PT for 20 minutes to an hour twice a week and have your window of opportunity opened, what you do with the remaining 23 hours will have an even greater impact on your window as well.
What I often see is a person feels much better after leaving PT. These effects lasts roughly a day or two and by the time they return for their next visit their pain has returned.
SO WHAT IS THE BEST WAY TO GET THE MOST OUT OF YOUR REHAB!?
The number one tool a patient has for recovery is their home exercise program (HEP). Your PT should be giving you, the patient, 2-4 corrective exercises that will maximize your window of opportunity between visits. But more often than not my patients have all the excuses in the world why they can do their home exercises, which on average takes under 10 minutes to complete.
This boggles my mind because if I told you in 10 minutes a day you can be pain free, would you say yes, I will do whatever it is? You may be nodding your head yes, but my experience begs to differ.
If you do your exercises as prescribed, you keep the window of opportunity open a little longer, so the next time your PT sees you they can continue to make it larger until your threshold of pain returns to normal.
Even after being pain free, you must remain pain free for six months before you decide to cut back on frequency of HEP. Would you rather spend 10 minutes a day now however it fits your schedule for the next 6-8 months or continue to have pain and see PTs for the same problems over and over again.
HERE ARE A FEW TIPS
Do your exercises at a set time every day. This will help you to develop habits.
For example after you brush your teeth in the morning you do 5 minutes of exercises.
Break up your exercises throughout the day.
If your PT gives you 10 minutes of exercises but between life, kids, relationships, work etc some days you just can find 10 minutes. No problem.
Break up the exercises into smaller time slots. Do 2 minutes of exercises sprinkled throughout the day on 5 separate occasions. No one ever said you HAVE to do them all at the same time.
Hope this helps! Take advantage of this tool and feel better faster!
The Turkish Get Up (TGU) is a highly technical exercise that requires attention to detail for proper execution. Last week I wrote about how to properly perform the TGU, you can read that here. This week I will take this a step further and discuss 4 common technique flaws and how you can fix them.
1) Set Up -
During the set up, we want to have enough space to work with. I often see people set up with their legs too close together. This decreases your base of support, making you less stable and increases the difficulty of the first step (see number 2 below).
2) Leg Kicks Up -
This happens when we do not produce enough tension during the initial step or if you are using too much weight.
3) Misplacing the Moving Leg -
During each stage of the get up, there are optimal places to put your extremities so all your joints are properly aligned. Often times people put their legs in places that decrease their base of support which makes this exercise harder.
4) Not Hinging From the Hips -
When people are reversing their get up, people often have difficulty with the transition from 1/2 kneeling position to placing the hand on the floor. People like to bend from their spine and flop to the floor. You must maintain your core stiffness and push your hips out to the side. This keeps the spine in a strong position and trains hip mobility in the frontal plane.
Try some of these quick fixes and let me know in the comments section below if they were helpful.