ES: R Posterior and Lateral Ankle Pain (10-2-23) Initial Program

Previously had symptoms in the right ankle with therapy going from 9/2019 to 3/2020
Current complaints:
- Walking now more then running but that is still painful
- Pain is posterior and lateral
- Swollen
- Ice, rest, elevate helps but no lasting relief
Initial Movements
- These should be completed daily ans possibly a couple times per day
- Some important concepts:
  - REASSESS your pain after each movement
    - This means after you do an exercise or movement, stand up and walk around
    - Does it feel better, worse, or the same
    - If the answer is better or the same then you should continue to utilize that movement.
    - If you get up and it feels worse, then we need to either adjust that movement(don’t go so far, do do as many) or ditch that one and we can come up with something else
  - Try to avoid pushing hard into a stretch, the stretch is the ankles weakest position and if you push into it with too much force it will usually make the pain worse
  - These initial movements should be gentle
  - Go just to the beginning of pain or stretch
  - Complete each movement 2-3x/ day as you are able or as specified down below
- Movement #1: Myofascial release for the calf
  - This is a gentle way to mobilize the calf without having to stretch it too hard
  - I like to place the ball as described in the video link and 2-3 spots on the calf and pump the foot/ankle up and down 10x
    - 26.1) Self MFR Calf VIDEO
- Movement #2: Gently move the ankle through a full range of motion stopping short of pain
  - 10 reps slow try to get to the edge of pain and then move the other way
  - 28.1) Seated Ankle Dorsiflexion and Plantarflexion VIDEO
- Movement #3: Wake up the muscles that help the calf: Like the hamstring: Hamstring Isometric with Opposite stretch
  - Push down into one heel as you raise the other
  - Hold each 5 sec then switch legs: try for 5-10 on each leg
  - 116) Hamstring Isometric with Contralateral Leg Raise VIDEO
- Movement #4: Bridge with deep knee bend
  - Stretches your quad and engages some downward pressure on the ankle but you are lying down so it is a little safer then jumping into standing stuff
  - Make sure you feel your quads stretch and not your lower back
  - hold each 3-5sec and repeat 8-10x
  - 105.1) Pelvic Clock Progression into Bridge VIDEO
I would do the above sequence for a week and see how that is feeling. If everything is feeling ok, then I would add some strength circuits like the one below every other day. You can do the daily movements one day and the strength the next. If doing both strength circuits on the same day feels like too much, then break them up: Day 1 daily movements, Day 2 daily movements +strength #1, Day 3: Daily movements, Day 4: Daily movements +strength #2
EACH STRENGTH CIRCUIT CAN BE COMPLETE 1 OR 2 SETS DEPENDING ON HOW YOU FEEL
Strength #1:
- 28.7) Seated Heel Raise Update VIDEO
  - 8-15 reps slow especially on the lower aspect
  - Also try to stay in a range that is not really painful
- 119.3) Tib Anterior Raise Wall/Seated Video
  - The opposite of a heelraise and engages the front of the shin (Tibialis anterior)
  - Can be standing back to wall or seated if needs
  - 3- 10 reps but hold each for a solid 5-10sec
- 174.1) Updated Sidelying leg Raise Pelvic Position VIDEO
  - Your lateral hip stability has a big impact on assisting ankle stability
  - You are laying down for this one so pretty low risk for the ankle while the other 2 movements above stressed it more directly
  - 5-15x hold each in the air 5 sec
Strength #2:
- 172.1) Band Loop Side Step 4 Way VIDEO
  - With this one start with band on feet alternating a side step while standing in place
  - Keep the band around your feet so it challenge
  - s the hip and the ankles
  - Can progress as I discuss to stepping in multiple planes as tolerable
  - 5-15 slow steps each direction
- 120.1) Tibialis Posterior Band VIDEO
  - Helps to stabilize the arch of the foot
  - 8-20 slow reps
- 137) High Lunge at Table VIDEO
  - Balance in a lunge
  - Be careful with this one
  - The further back you step the more stress on the ankle, shorten your step if it hurts
  - Keep a narrow base of support and try to hold balance 10-15sec, then switch legs
  - Try for 3-8 each leg
Might be a good idea to ice after strength days or if sore in general after any of these movements if you feel any increase in pain