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New to Us?

There are TWO options to Begin:

• Consult-Only (45-min Live or Virtual Session)

OR

• Consult+Eval+Treat (90-min Live Session) *RECOMMENDED*

Our Process:

Consult

  • Deep dive into your history, complaints and previous treatments
  • Learn and discuss WHY previous treatments didn’t work
  • Uncover the true SOURCE of your complaint(s) and HOW they developed
  • Learn realistic strategies to self-manage and self-treat
  • *Identify the systems, structures and functions to be Evaluated*

Evaluation

  • Examine, measure and test the systems, structures and functions identified in the Consult
  • Create the clinical Assessment (your situational summary)
  • Develop the Treatment Plan (what order to treat and how)

Treatment

  • A Pre-test is performed to measure a specific, challenging/painful movement or position
  • Hands-on, integrated manual therapy treatment is performed (based on the eval)
  • A Post-test is performed to highlight the changes from the pre-test
  • Results are measurable - every session

Current Clients:

Need to continue your current care?

*Please note*

If you haven't been seen in:

3+ months -> a Re-Evaluation is needed

2+ years -> a New Client Evaluation is needed

Access Your Ankles – Reduce Pain and Enhance Performance

By:

Dr. John De Noyelles, PT, OCS, CSCS

Do you wish you could squat like that?

Proper ankle mobility is important for most of our functional and higher level movements. Specifically, decreased dorsiflexion, or bending of the ankle (the foot getting closer to your shin), will likely add undue stress on joints up the chain including knees, hips, and the spine. If you cannot access your ankles well, you will have to borrow (compensate) extra movement from those other structures. From lesser to greater extents, dorsiflexion is utilized during walking, running, stair negotiation, and squatting. Here is a classic example of a test that illustrates the impact of decreased dorsiflexion on deep squatting. This is a test that you can do yourself. This "deep squat" is limited in depth:

 

 

The addition of a 2x4 under the heels decreases the need for dorsiflexion, allowing for greater depth. Although there may be more to this including hip and spinal mobility and control limitations, the ankles in these pictures are the limiting factor in a functional squat:

Another test you can try yourself requires only a wall and floor. Keeping your foot completely flat, bring it away from the wall as far as you can while still being able to touch the wall slightly with your knee. Measure the distance between your toes and the wall. Roughly speaking, this measure should be approximately 3 to 6 inches depending on your specific needs. Take note of what you feel when you do this test, either a stretch feeling behind the ankle and into the calf, or tightness and possibly pinching in the front of the ankle. The first picture illustrates limited dorsiflexion.

This is better:

How much should you have? That depends on what you need it for. If you squat (whether it's for strength training or tying your shoes) or walk or run up hills or stairs, you will likely need more. Many of my high level and younger clients are lacking this range of motion, which is likely a reflection of how we move or don't move in our society. It is also what prompted me to write this blog post.

If you noticed tightness or a stretch feeling behind your ankle and/or in your calf, then the muscles and tissues of your calf and Achilles are likely the limiting factor. You may try adding a typical runner's wall calf stretch (not shown) to your routine. However, soft tissue mobility may be restricted. We find it helpful to gently loosen these tissues and calm the muscles down with some self mobility using either a rumble roller:

- Or a lacrosse or tennis ball:

There is no need to force anything. Keeping your calf relaxed, slowly roll your muscles over the points of the rumble roller or over the ball until you find a stiff or semi-tender spot. Let that spot "melt" over the point for 30 seconds or so. You can then get those tissues to move by slowly dorsiflexing your ankle back and forth.

If you had felt a pinch, stiffness or block in the front of the ankle during the test, then it's possible the ankle joint (talocrural joint) is the restriction. One optional self-mobility technique I prescribe for this uses a pull-up assistance band. This is a great tool for mobilizing ankles and hips and can be purchased fairly cheap in stores or online. Just make sure you anchor it to something very stable (such as a squat rack):

In this position, keeping your foot and heel flat on the ground and keeping the band where the ankle meets the foot, gently lunge your knee forward thereby dorsiflexing. Perform 10-20 times.

This serves only as a basic guide to self-assessing your ankles and does not discuss other reasons you may have difficulty with your ankle mobility or functional movements such as a squat. The numerous bones and tissues of the ankle and foot, the knees, hips, pelvis, spine and trunk may all be factors. Only a thorough assessment can help identify these factors. Once found, manual and exercise therapy directed at these problem sites can help make your movements looser and more efficient.

 

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New to Us?

There are TWO options to Begin:

Consult-Only (45-min Live or Virtual Session)

Consult+Eval+Treat (90-min Live Session) *RECOMMENDED*

Our Process:

Consult

  • Deep dive into your history, complaints and previous treatments
  • Learn and discuss WHY previous treatments didn’t work
  • Uncover the true SOURCE of your complaint(s) and HOW they developed
  • Learn realistic strategies to self-manage and self-treat
  • *Identify the systems, structures and functions to be Evaluated*

Evaluation

  • Examine, measure and test the systems, structures and functions identified in the Consult
  • Create the clinical Assessment (your situational summary)
  • Develop the Treatment Plan (what order to treat and how)

Treatment

  • A Pre-test is performed to measure a specific, challenging/painful movement or position
  • Hands-on, integrated manual therapy treatment is performed (based on the eval)
  • A Post-test is performed to highlight the changes from the pre-test
  • Results are measurable - every session

Current Clients:

Need to continue your current care?