Severe ankle restriction - any ideas??

[GKWADDELL]

Hi Bill:

WOW!!! I can't believe a forum where you and other experts answer questions.

Here is my problem: Severe right ankle restriction due to multiple ankle sprains playing soccer; barley 5 degrees dorsi flexion. about 4 lateral sprains over 3 years (about 10 years ago) and roll the ankle all the time

You can imagine how this affects my mobility, especially in squats - which I have temporarily given up.

I have done regular PT - the therapists couldn't understand why I needed to squat & deadlift (I tried to enlighten them but...) They did the standard "shake & bake" on my ankle with some manual resistance for the fibularis muscles - no better!!!

Years ago Mike Boyle taught me the ankle self-mobility drills & I have watched his & your vids on you tube. The self-mobs don't do anything but cause residual pain in my ankle. I also tried Gray Cooks squat correction - didn't do anything.

I had another PT quickly look at my ankle, he said the ATF was shot & I have extreme weakness in the fibularis resulting in lateral hypermobilty (I roll this ankle with the drop of a hat).

I do all my workouts barefoot & try to work on the ankle but nothing helps. Is there a technique to mobilize the ankle? Would Graston help?

Is the joint damaged beyond repair ?? I would appreciate any help you or the other experts here could provide!

Thanks!

P.S. had x-rays after the 2nd MAJOR sprain - no fractures etc., M.D. said just to tape before I played.

[Bill Hartman]

A couple of things that may be helpful (understanding at this point that it's a crap shoot if you lack normal ligamentous stability and I haven't examined you directly)...

Ankle joint traction. There tends to be an alteration of the position of the talus and fibula that may cause compression and limit dorsiflexion. Buy a couple mini-bands from jumpstretch.com and get the video about ankle sprains to learn how to do it. they also have info about resisted walking for rehab which is actually fun and also helpful.

Taping the fibula. If a therapist manually repositions the distal fibula and your dorsiflexion improves, you may be able to tape the fibula into a more effective position to allow exercise and even see an immediate increase in strength. See a video called Mulligan's mobilization with movement for ideas. There's some clips on youtube but I'm not sure if the ankle thing is on there.

It does sound like you need some mobilization of the joint and the above would be a start without formal therapy.

ART or IASTM may be helpful in regard to the fibularis weakness if there's extensive scarring. You may have also had really crappy therapy...this I can't be sure of, but it does happen.

You'll also have proprioceptive deficits that you need to address on a regular basis if it's recurrent.

Bill

[GKWADDELL]

Thanks Bill!

I have the JS bands and the video already, never thought about tractioning the ankle this many years later since they do it immediately on the court after the sprain,

I have wanted to get the Mulligan videos for a while, so now I have a reason - more of my money to OPTP.

I think the ATF is gone, I trust the PT (Dr. Michael Jones) as much as I would trust you, but Dr. Jones only had a few minutes to spend with me at a workshop and only did a superficial eval.

The first P/T for the ankle was awful -saw different therapist every visit, no soft tissue work, just heat, isolated supine mobilization, stim and then use a pro-stretch for the gastroc & soleus, and ocassionally some proprioceptive work on the wobble board. No integrated movement patterns what so ever.

Can you recommend a good source of info or exercises for the weak fibularis muscles; the only the other exercise PT's gave me was using a flat thera band for resisted inversion and eversion.

Thanks again for the quick reply!

Gordon

P.S I spent today watching your presentation from the 2006 JP Fitness summit - it was really great! I hope you do another!! I will be ordering your Golf DVD soon; I work with some golfers who could use all of this and MORE!

I also have a severely restricted right shoulder and limited / non-existent thoracic extension: Fail shoulder flexion, shoulder rotation bi-lateral (but right is worse than left and external rotation is FAR WORSE than internal).

I have had ART for the shoulder and it is better but the PT had no idea (not kidding) as to why it is impossible for me to pass Apley's test (this was the second not so great PT I have had; and it was at a different location) I am going to use the thoracic & shoulder techniques you went over. The PT's never did any of that with me; hopefully that will help free up my shoulder.