The most memorable experience with working with someone that had an ankle sprain was training Brian.
It all started about three years back and I was off to the local recreation centre to do my regular Thursday afternoon shift. When I got in, I checked to see what was scheduled for the day and I saw I had an appointment with Brian.
Brian was a 12 year old boy that was smaller then the average 12 year old but what he lacked in size he made up for in energy and drive.
Brian’s mom brought him into the gym. About two weeks before our first appointment he was playing soccer and sprained his ankle (inversion sprain). He got it checked out by his doctor and the doctor ruled out anything serious. It was a Grade I sprain. He asked his doctor what he could do to maintain his conditioning for hockey but also rehabilitate his sprained ankle. The doctor recommended to come see me.
At our first appointment, I sat down with Brain, got a background on his injury, what his fitness level was, what made his ankle worse, what made it better and what his goal was. Plus, I got him to do some movements with his ankle, knee and hip.
I had the information that I needed, now the injury workout would begin.
We began with improving the movement, strength, stability and balance in the ankle using the equipment we had in the gym. After we focused on the ankle it was onto working on lower body movements and then working on upper body. We finished off his session with cardiovascular work.
I always find it very motivating to see someone injured in the gym. It always rings the words in my head, “What is your excuse for not being in they gym?”
Brian had no excuses and a drive to overcome his injury and get back to hockey.
It was very cool to see how hard Brian worked on the upright bike while wearing his ankle brace.
Before he left, I gave him some homework when it came to his ankle and I would see him again next week.
Every week I would see Brian.
Every week he got better.
He did his ankle sprain exercises at his session and between sessions.
Between our sessions, I would hit the research to see if I was doing things right when it came to his injury and if I had all the exercises and components covered for an ankle injury. What I was missing, I would add.
After about 4 weeks, he was ready to get back on skates and go play ice hockey.
I never saw Brian again but I am sure he is having fun playing hockey and putting in the energy and dedication that he did to his ankle sprain program.
I still have Brain’s program in my office and I promised myself that one day I would do a full program on Brain’s program for others to use.
Well, I finally did.
If you want to check out the program that I used with Brian to help him overcome his ankle sprain and get him back to playing hockey, check out Ankle Sprain Solved:
As a freshman track athlete in high school, I had aspirations of making my varsity letter.
How cool would that be as a freshman to receive your varsity letter?
I was a skinny sprinter/jumper and my best shot at making varsity was going to be the long jump. I was the fourth jumper at the time, but quickly moved to the third jumper. Hang in there with me, I’m getting to my point.
We were at a relay meet, where there were long jump teams comprised of three jumpers. I was the third jumper for this meet. I was doing build ups with our number two jumper. This kid was built the opposite of me: short, muscular, and had these quads that made him look like quadzilla.
He was doing his build-up in front of me when he lets out a scream like he’d been shot, grasps his hamstring, and he goes down. He is done for the rest of the season because of a pulled hamstring, I move up to #2 jumper, and I made my varsity letter. Yeah me.
A Good Ratio to Prevent Hamstring Pulls
Fast forward some 20+ years and I’m a speed coach training athletes such as my old teammate to be fast. When it comes to strengthening an athlete for speed, the consensus from a lot of speed experts I’ve learned from is that the hamstrings are the weak link.
The majority of your leg exercises and movements strengthen the quadriceps a heck of a lot more than the hamstrings. I myself, thought that just doing squats and lunges one winter, I would really strengthen my legs for intramural softball. I didn’t do any specific hamstring work. My first hit sprinting down first base, I tweaked my hamstring.
Lesson learned. You have to include hamstring specific exercises or activity to strengthen them.
Most athletes I see come in with their hamstrings about 50% as strong as their quadriceps, maybe even worse. To maximize speed development, experts would love to see it at a 1:1 ratio, but believe if you get to 75% – 80% then that still helps improve your speed AND is good for injury prevention.
Yes, I said injury prevention.
Females and ACL Tears
So, as we start working with more athletes on speed, we start seeing a fair share of athletes (mostly female) that have torn their ACL’s. We don’t do the rehab, but as soon as they are cleared from rehab, they come to us to get them back to being the athletes that they were.
I’m sure you have had your fair share of ACL athletes as well.
One of my good buddies was an ATC and he decided to do some research on the subject about what we could do to try and prevent those ACL tears from happening. He basically created a report that to this day I am still selling copies of, discussing the reasons why these incidences keep happening, especially in females.
A few of the highlights of Why Females Get More ACL Tears:
A lot of females have blown their ACL’s during their menstruation cycle: their period. This, as a professional, I can’t give help for.
Female’s ACL’s may be smaller in diameter than males, thus not be able to provide as much support to the joint.
Female athletes tend to have much weaker hamstring strength than male athletes. Thus, they can’t activate them as quickly to provide assistance during rapid movement.
Whoa, wait a minute. Did I just mention hamstring strength again?
Working Your Hamstrings to Prevent ACL Injuries
Yes, I did. A good percentage of ACL injuries are non-contact. They were acquired by landing from a jump, cutting, or pivoting. Because of the weak hamstrings, when they do those movements there is a ton of added strain to the ACL for support. The athlete wants to move rapidly, but the ACL says “nope, not today.”
Now get this. The experts say ideally they would love to have a 1:1 ratio between the hamstring strength and the quads, but because there are only 3 hamstring muscles compared to 4 quadriceps muscles, if they can get the hamstring strength to 75% – 80% of the quads that would be the goal.
Yep, you read that correctly, 75% – 80%, which is the same percentage that you are shooting for when you are trying to develop speed. Consequently, if you are working on speed, then you are also reducing the chances of you tearing your ACL.
When you get that strength up, you will be more balanced and your muscles will be firing correctly. Thus, you can reduce the chances of getting other muscle strains. I haven’t had a muscle pull or strain in my legs since that softball incident and that has been over 14 years. And I still run pretty fast.
Once that strength is up, we can then start really developing your speed and quickness. Your landing on your plyometric jumps will be better because all the muscles will be firing to stabilize and support. When we do agility drills where you are cutting from one direction to the next, the muscles in your legs will be firing better, giving you more stability. Thus, when you start to utilize them in your games, you will be faster, better prepared, and your body hopefully will have less chance of getting injured.
To help improve your hamstring strength, I have provided two videos of exercises I like. One is the glute ham raise and the other is manual hamstring curl (or manual glute ham raise). This is in case you don’t have access to a glute ham raise.
The Best Machine to Improve Speed
If You Don’t Have the Machine Above, A Great Alternative
Obviously, there is more to the process of both speed training and injury prevention. But I think if you start with improving the hamstring strength, then the other facets of those processes will become easier to attain.
Adam Kessler is a Certified Strength and Conditioning Specialist (CSCS) and a USAW Sport Performance coach that helps athletes learn how to run faster and improve athletic performance.
Athletes of all levels – professional, collegiate, high school, and younger – have used his Run Faster Method to improve their speed and accomplish the sport goals that they desired. He has a speed blog for speed and sport tips at http://howtorunfasternow.com.
On the other hand, they can also be a blessing in disguise. This is something that I have realized first hand.
The Rush of Training
I absolutely love training, especially powerlifting. I love the thrill and rush of stepping on the platform to compete. I love pushing my body past limits and growing stronger both physically and mentally when I push past barriers with my training. I love being in great shape and moving weights that most people can only wish to move. I’ve loved training (notice I said training and not “working out”) for over 12 years without a break (which really isn’t that much and I still have a long way to go).
When I’m not training, I’m helping others train, reading about training or dreaming about training. The deadlift happens to be my ace and pretty much my favorite thing to do in the world. In my opinion, there is absolutely no better feeling than locking out a heavy deadlift as you feel every muscle in your body tighten up to make it happen.
The hip drive, grip strain, the glutes coming through, the back locking out, the traps stabilizing, the intrinsic foot muscles gripping the floor, the blood rushing through the veins and the rush that flows through the body and mind; just an amazing feeling that only certain people will understand. Not being able to do this for a period of time was devastating.
Great little video from Nick on Gluteus Medius Exercises:
Flash back to November of 2008. I had just done my fifth meet in about seven months, which was probably a little too frequently. I was on pace to pull my first 600lb deadlift at a bodyweight around 178-180. Training had gone well as I had pulled 610 with band tension, tripled 540 and had made good progress on most of my assistance work. Well, I ended up missing 570ish at the meet when I had nearly locked out 585 a few months earlier. Part of the problem was just training stupidity. I had gone too intense for too many weeks before the meet and had competed too many times. But I knew that couldn’t be the only issue at hand because when I made that attempt, the weight was coming up smoothly; I thought for sure that I had it locked. Then as I approached lockout, I just couldn’t finish it. I was upset to say the least.
The Injury was in the Details
So at this time, I was in my last semester in the exercise science and strength & conditioning program at UW-La Crosse. Luckily, I was surrounded by some very knowledgeable people who knew their stuff. I spoke with one of my mentors, an amazing strength coach who knows a thing or two about the iron game. I showed him a video from my missed deadlift. He immediately pointed something out that I hadn’t noticed or really even thought of. My left leg began to shake as I approached lockout. He looked at another video of a 560 pull I had made easily a few months earlier. I had some rotation occurring through my hips and trunk as I pulled the deadlift. It was subtle, but you could sure see it.
So what the heck was going on?
He evaluated me and found out that:
my left glute was not firing as well as my right with hip extension
my right shoulder had some issues as well
my subscapularis was very fibrotic and was stopping my scapula from moving as efficiently as it could
If you have ever read any of Thomas Myers’ stuff on fascia and exercise, this should make you think of the spiral line: opposite hip and shoulder.
I’m assuming that many who read this page know about the book, Anatomy Trains, so I won’t get into tons of detail, but the spiral line is a line of fascia that wraps around the body and at a certain portion of its path, connects opposite hip and shoulder together; basically meaning that an issue with one can affect the other with various movements.
This had implications with the rotation that was occurring with my movement. So he did some ART on my hip and shoulder (left TFL and right subscap among other things) and gave me a few corrective exercises to fix this imbalance that I had. This was probably my first real personal experience/encounter with the world of muscle imbalances and corrective exercise.
I had been decently well versed in every strength and conditioning modality imaginable but had apparently slacked on this whole other department. I was determined to fix my imbalance and get better. I decided to take some time off of competing and hammer these things out for a little while. The January following this encounter, I would embark on my full time internship in order to finish up my degree, which would turn out to be one of the best experiences of my entire life.
They discovered some of the same that my mentor at La Crosse had plus more:
left glute medius was weak
left glute max had gotten a little better but still wasn’t great
external obliques weren’t where they needed to be, which meant that I didn’t have optimal control over my pelvis and trunk and was leaving pounds on my lifts
lower traps were weak, especially the left side, which meant that my scapulae were not as stable as they could have been (implications for all of the big lifts)
I had a slight shift and rotation with squats and pulls, which was definitely part of the issues listed above.
Those were some of the main problems for me. So I hammered out lots of special exercises to help balance things out and get my lifts up. I did however, make one mistake. I still trained too intensely, too often. I picked a meet that I wanted to do that May and trained for it.
Now, these issues that I had were things that were probably going on for a long time. In my early days of training back in high school, I really had no true idea what I was doing (though I sure thought I did) as I pretty much just taught myself and learned from random gym rats and magazines back then.
The shifts and rotation that I had with my squat and pull were subtle enough that an average eye would never notice them, so who knows how long that had been going on. While I had gotten along fine and had built up to a respectable strength level and build, fixing some of these things earlier could have saved me lots of trouble and probably helped me to hit bigger weights easier. I mean, locking out a max deadlift with one glute firing versus two glutes firing is kind of a big deal. So anyhow, I was training hard and lifts were going up, etc. until…..
That is the end of part 1. I got part 2 coming up very soon. Big thanks to Nick. We all have an in jury story.
About the Author
Nick Rosencutter, CSCS, NSCA-CPT, LMT – Nick is a Certified Strength and Conditioning Specialist and Certified Personal Trainer through the National Strength and Conditioning Association and is also a Nationally Certified and Licensed Massage Therapist. He received his Bachelor’s degree in Exercise and Sports Science with a Fitness emphasis and Strength and Conditioning Concentration from the University of Wisconsin La Crosse, and received his diploma in Massage Therapy from Lakeside School of Massage Therapy in Milwaukee. He has worked with all varieties of clients ranging from fat loss to various levels of athletes and is also a competitive powerlifter. He currently trains clients at Southridge Athletic Club in Milwaukee and offers corrective exercise and movement training at Miller Sports and Wellness Chiropractic in West Allis. You can learn more at his website www.rosencutterultrafitness.com
Great interview for you on ankle sprain exercises.
It is with Matt Ferguson.
Matt is part of a group that has developed a device that is more effective at strengthening the ankle and foot.
In the interview he talks about the importance of ankle strengthening. Plus highlights how the AFX is more effective than traditional methods of strengthening the ankle and foot.
(To listen to the interview, scroll down to the bottom of this page and click the play button. If you do not have time to listen to it right now, just click the “download” button and download it to your computer. Then you can listen to it on your computer when you like or subscribe to the itunes podcast. Enjoy!)
This is was what Matt goes through:
Importance of ankle strengthening
Matt and the rest of his team’s background
Where the idea of the importance of ankle strengthening came from
How the feet are the foundation of human movement
Why traditional ways of foot strengthening are not effective
Problems with using tubing for ankle strengthening
What is more effective at strengthening the ankle and foot
The number one activity-related injury is ankle sprains
Sample ankle sprain exercises
How it works and the benefit of AFX (Ankle Foot Maximizer) device
Highlighting research that demonstrates the importance of ankle strengthening exercises
Foot Injury Exercises: How to effectively address issues in the foot, through SMR, mobility, and stability
The foot is a very complex structure for both fitness and health professionals to assess effectively. Bearing weight for the majority of the day it is responsible for absorbing and transmitting forces between a contact point (usually the ground) and the rest of the body.
By far the most commonly diagnosed condition in the foot is plantar fasciitis. While this may be common, many conditions may develop in the foot. Without a proper diagnosis, methods of rehabilitation become blind and often ineffective.
Below are some of the most common foot conditions to keep in mind during your assessment:
Plantar fasciitis: Pain is present in the heel or underside of the arch. Pain usually decreases with rest, and is worst during the first few steps after long rest periods (ie: the morning). Heels spurs, or bony growths, may also show up on x-ray to help confirm this diagnosis. (For plantar fasciitis exercises, check out Rick’s Plantar Fasciitis Relief in 7 Days Program)
Severs Disease: Heel pain that presents in children between the ages of 8-14. Pain is similar to plantar fasciitis however, spur development is uncommon. This condition is caused by inflammation of the growth plate in the calcaneus (heel). Pain gets better with rest and is recreated by squeezing the heel.
Fractures: Fractures can present with minimal or no swelling. Stress fractures are quite common in toes 2-5. Pain does not decrease with rest, the bone may be tender to the touch and night pain may also be experienced.
Neuromas: A neuroma is a benign tumour originating from nerve cells due to regional irritation. Pain is quite localized and is most common between the 2nd and 3rd toe. There may be a palpable nodule that is very tender to the touch.
Tendinopathies: Any of the tendons that assist in stabilizing the arch can become irritated due to repetitive strain. Pain may be present at the start of activity, disappear during and resume post activity. Pain presents as a dull ache and may extend up into the calf. (For Achilles Tendinitis exercises, check out Rick’s Achilles Tendinitis Exercise Solution)
Sprains: Impact sprains may happen especially in flat feet. Pain is sharp, tender to touch, and may be accompanied by localized swelling.
Peripheral Neuropathies: Nerve entrapments higher up in the leg and back can cause pain in the foot, especially on the medial side (mimicking plantar fasciitis). Night pain may be present and symptoms are paired with problems elsewhere in the body (ie: “calf or hamstring tightness causes my heel to flare up”).
Degenerative Changes: The most common arthritic development in the foot happens at the big toe. Pain is localized to the big toe, and may be present at night. There may also be the presence of a bony growth. Bunion formation can present similarly at this joint, however bone growth happens on the inside of the big toe.
#1 – Simple Assessment Foot Injury Assessment
Assess the foot in non-weight bearing first. If a person has an arch while non-weight bearing, you should recognize there is potential for that person to create an arch. Without forces of gravity and load the foot is structurally sound. With optimal function this arch presentation should remain stable upon the foot hitting the ground.
If the arch collapses in assumption of standing, the therapist/coach should start thinking of ways to improve arch stability.In individuals with arch collapse while non-weight bearing, chances of true structural issues are higher. Functional rehabilitation should still be carried out, but without expected progress an orthotic may be needed for full resolution of symptoms. In my experience orthotic prescription is required less if a correct rehabilitation protocol is followed under sound patient compliance.
#2 – Is Self Myofascial Release Good For The Foot?
Pes Planus: The majority of conditions happen because of the foot’s inability to be stable in a gait cycle. This loss of function leads to pronation of the foot or dropping of the arch (also known as pes planus). Pronation of the foot leads to lengthening of the tissues in the bottom of the foot. The result is pain, and irritation due to loss of mechanics.
Self myofascial release (SMR) in these instances creates less tissue stiffness, and greater instability. In cases of forefoot and rearfoot pronation a coach/therapist may be better coaching SMR of the hips and pelvic girdle. Addressing tight fibrotic musculature that maximizes function of the pelvis will certainly create better opportunity for function in the foot.
I got an email from a reader who was looking for some ankle sprain exercises.
I am wondering if you have any ideas for a calf exercise for a person with an ankle injury. They are non- weight bearing and have very little ROM in the ankle (a few degrees of flex/ext). The Dr. would like him to continue strengthening the leg, in particular the gastrocs, however pain levels are quite high.
Thanks! I have really enjoyed your updates and the muscle imbalances revealed.
I have one exercise for Nat.
It focuses on range of motion in the ankle and working the gastroc at a low level.
Justin answers the most common question he is asked during his courses and at the conferences he presents:
What Causes Over-Pronation?
In the video, Justin shares with you: – What over-pronation is
– What causes over-pronation
– How the shoes you are wearing can be making your pronation worse
– The influence of gluteus maximus on pronation
– How the illiotibial band and tibia affect pronation
Justin Price will be coming to Vancouver to present his course for the first and only time in March of 2011.
In this course, Justin will focus on Day One on the assessment side of things, and on Day Two he will focus on what exercises to give based on the assessment.
I selected Justin as one of the international experts to bring to Vancouver because I have learned a lot from him when it comes to lower body assessment, and his assessments of the foot have been very helpful. Plus, I find his corrective exercises very unique and quite different from others I have seen.
That’s it for today.
On Wednesday, I will have a very exciting announcement for you – I can’t wait to tell you about it!
All the material within ExercisesForInjuries.com and related sites are provided for information purposes only and is not meant as personal medical advice. Readers should consult the appropriate health professional on any matter related to your health, injury, pain, fitness, well-being, etc. No action should be taken solely based on the information in ExercisesForInjuries.com . The publisher is not a licensed medical care provider and is not engaging in the practice of medicine or any other healthcare profession and is not entering into any kind of practitioner/patient or practitioner/client relationship with its readers. The publisher is not responsible for errors or omissions.