Category: All Things Rehab

Common Ankle Problems

Let’s navigate through compensations seen not just the ankle, but up the chain! Do you have ankle problems? Done a bunch of wall ankle stretches to no avail? Perhaps you have to look elsewhere. Namely, how ankle restrictions link up through the rest of the body. How are ankle limitations commonly seen manifested through common compensatory strategies? That’s what we dive into in today’s post. Check out Movement Debrief Episode 155 below to learn more.

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When Can I Run Again After an Ankle Sprain?

Ankle sprains are such a bugger and take some time to heal. But once you’ve let swelling and such run it’s course, when is it safe to run? We answer that in the video below. Here, you’ll learn my criteria and progression that I look for when having someone safely return to running. Watch and learn! Ankle sprain red flags The first thing you have to do after an ankle sprain is make sure you don’t have a fracture. There are these rules to follow called Ottawa Ankle Rules, which are a cluster of findings that would indicate getting some imaging done. These findings include: Inability to weight bear Pain within the viscinity of either malleolus If you have these findings, you most definitely need to get some imaging. Do not pass go, do not collect $200. But if you do not have these findings, move along to the next part 🙂 Returning back to running after an ankle sprain Running is merely a series of bounds (jumping from one leg to the other) for an extended period of time, so after an acute ankle sprain, we have to make sure components leading up to this go okay without any issues. To determine the course of action for this return, we can start from the most fundamental actions of the bound, then build our way up. The steps below are the progression that I use. You want to make sure that you have minimal increases in pain/swelling before moving onto

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When You Only Feel Quad During the 90-90 Hip Lift

The Lewitt postion (or 90-90 hip lift) is supposed to target hamstrings and distal glute to drive hip internal rotation all…day…every…day. But what if you feel quads only? Is that okay? Uhhh….no fam. Find out in the video/post below what is going on here and most importantly, what the heck to do about it! Why are quads contracting during the 90-90 hip lift? The quadriceps extend the knee, but there is no “pure sagittal” movement. There is a rotational action through the knee joint as you drive extension. That rotation is tibal external rotation and femoral internal rotatio. Since the lewitt position aims to increase femoral internal rotation, the quads can compensatorily contract to drive internal rotation, but attempting to do so at the distal femur. This cheat could be because you are asking the individual to posteriorly tilt the pelvis against gravity. But fam, we want internal rotation at the proximal femur, so this action is likely not going to get you a whole lotta femoral internal rotation and subsequent sacral nutation. In fact, quad activity is often paired with lumbar extension in this case. So what is one to do? I’m glad you asked!!!! Other interventions to use when you feel quads during the 90-90 hip lift Your first line of defense will be to coach the snot out of this move. Make sure they can create a pelvic tilt without engaging abs as well as keeping the lower back flat on the floor. That can help your

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How to Move with Less Tension

In order to move more, you have to be able to both create and reduce tension. But what if you have someone who is tense AF? When they move, they tighten EVERYTHING? Check this video to learn what to do. Ways to get people to move without tension Folks who are SUPER TENSE when they move often benefit from manual therapy, foam rollers, and things of that nature. Think of using these strategies as an “assisted” way to get them to move. Movement-wise, you want to get these peeps to move with as little tension as possible. These folks benefit from very slow segmental rolling strategies. In order to complete these rolls, you have to move with as little tension as possible. The lower body roll is a great starting point: But if you are feeling frisky, try the upper body roll. It…is…brutal: Even doing things where they are moving individual joints as slow and with low tension as possible. Breathing-wise, focusing on nasal breathing that is silent, easy, and effortless can be a great way to reduce tension in these individuals.

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When to Combine Pronation and External Rotation

Although external rotation and supination are paired, so too with internal rotation and pronation, sometimes you must drive pronation and external rotation. This need is especially common if you see a twist through the knee joint. In today’s post, we dive into when you have to do that. Steps for combining pronation with external rotation With these types of folks who present with hip external rotation loss and inability to pronate the foot, you have to untwist these folks. The first line of defense if you have manual skills is to perform manual therapy of the foot. I would look at restoring the following movements: Ankle dorsiflexion Calcaneal eversion First ray manipulations Cuboid manipulations If you don’t have manual skills, wedging the calcaneus laterally to drive eversion can work. You can also perform offset exercises, such as an offset wall squat, to drive rotation and further external rotation: Be mindful as you drive these motions, often people can cheat calcaneal eversion by plantarflexing the first ray even further!

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Fixing Radial Nerve Pain in Weight Bearing

Ever get pain going down the outside of your arm when you are weight-bearing? Numbness, tingling, the whole shebang? If you notice issues that resemble this, you are likely dealing with radial nerve sensitivity. In order to make the radial nerve less sensitive, you need to increase movement, space, and bloodflow to the nerve. How do you do that? Watch this video below! Reducing strain on the radial nerve Nerves need three pieces to be healthy: Movement Space Bloodflow In order to maximize radial nerve excursion, we have to look at the maximally lengthened position of the nerve, which is as follows: Wrist flexion and ulnar deviation Forearm pronation Elbow extension Humeral internal rotation Humeral abduction Scapular depression Contralateral cervical sidebending You can check the test for this below in this video: When you take a look at these motions, do you notice a common theme of where you need to drive motion? If I want to create space around the nerve (or day I say….EXPANSION), you need to drive what? Internal Rotation And if you need internal rotation, you gotta put air where? Anterior Chest Wall So the first line of defense to maximize nerve excursion, you have to maximize anterior thorax expansion and internal rotation. If you do that, you’ll maximize space around the nerve, which can reduce sensitivity. But fam, that may not be enough! You may also have to restore the mobility of the nerve. The neurodynamics. Basically, you can start with moving the nerve along

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The Evolution of My Treatment Process

What has changed in my treatment model? If you aren’t getting better, you are getting worse, so how has your thought process and model changed? I was asked this question recently, and I think over the last several years many things have changed. There has been a bigger focus towards: The basics Sleep Building power And more! What changes have been made? Check out Movement Debrief Episode 147 below to learn more!

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