Corrective Exercise Specialist Case Study- Ankle Impairment

Hope you had a great weekend! I enjoyed my Sunday with my family at home and had a blast teaching a Corrective Exercise Specialist workshop for the National Academy of Sports Medicine in Boston this Friday 5/15 and Saturday 5/16. I enjoyed working with this group. Attendees traveled from more than 5 states to attend the workshop. In addition to some of the best health and fitness professionals in the New England area; 2 Chiropractors, 5 ATCs and 1 RN participated.

In this post I want to share a case study with you. KM volunteered! Thank you KM! Each video is very short, about a minute or less. I add some light commentary to go with what you are viewing.

Anterior and posterior view of overhead squat. Anterior view, pay attention to right foot and knee. Posterior view pay attention to the alignment of her pelvis and left femur. I filmed this video after she has just performed myofascial release for 50 minutes and static stretching for 60 minutes. Her compensations were much more noticeable before this!

Here is a modified version of the overhead squat. We elevate the heels to decrease the demand on the ankle joint for sagital plane movement (dorsiflexion). We are using a 3+12 inch lift since here compensations are so pronounced. We typically use 1 1/2 inches. Sorry about the last 30 seconds of this one:) it picks up in the next video…notice the improvement in quality of movement, depth and symmetry from the anterior view…

Posterior view, heels elevated/overhead squat…watch the abduction of the left femur. You can see that the left ankle just stops moving and she abducts at hip (femur).

Her left ankle is her primary impairment, LPHC secondary.

After I worked with KM for about 10 minutes, this is the result we got, still some instability in the LPHC and restriction in the left hip capsule, but much smoother.

I worked on here squat technique with just a few cues and had her put her sneakers on and this was the final result about 15 minutes total time…your clients patients and athletes have 15 minutes a day, don’t they?

Not a bad improvement for a short intervention. Her original overhead squat assessment provided and even more pronounced set of compensations, but there is still a difference in the quality of her movement for sure.

Imagine if she was going to run or lift weights moving like she was without performing a corrective exercise program? How long would her cartilage in her right knee or the integrity of her lumbar discs last?

For homework I recommended that she continue to follow up with her Chiropractor, execute the corrective program we designed for her and perform the self ankle mobilization technique that I showed her daily. In addition we discussed footwear as well, limiting heels whenever possible.

In addition to the Overhead Squat, I performend a range of motion assessment on her ankles and determined that her dorsiflexion on the right side was 8 degrees (15-20 is deal) and 3.5 degrees on the left side (15-20 is ideal).

Her left tibialis anterior, and glute medius bilaterally (right weaker than left) tested weak with manual muscle testing.

I believe that she has a restriction in her left right capsule, pelvic obliquity and a restriction in her sacroilliac joint as well. I believe that this stems from teh restriction in her left subtalor joint.

After the movement assessment (before the goniometry and MMT) I aksed KM if she had ever sprained her left ankle and she shared that she had a significant injury to her left ankle when she was a teenager.

Key Overactive Muscles
Lateral gastroc (L>R)
Vastus Lateralis (R)
Biceps Femoris (short head R>L)

Key Under Active Muscles
Tibialis Anterior (L)
Glue Medius (R>L)
Intrinsic Core Stabilizers

Thanks for reading!

Eric Beard
Athletic Performance Enhancement Specialist
Corrective Exercise Specialist

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One Comment

  1. Anonymous
    Posted May 19, 2009 at 9:14 am | Permalink

    EB – this is neato to watch. I can relate to her due to a serious ankle injury I incurred 7 years ago. You should see me go down steps – slowwwww. My right ankle has a deficiency in range of motion. It was great to see the slight improvement in her. I’m interested to know what work you did with her ankle so that I can do it for myself. Looks like it would help.

    ~ Stacy (Madden)

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