Posts in stretching
Foam Rolling's Impact on Ankle Flexibility

Foam Rolling is gaining in popularity due to its ability to accelerate recovery, treat sore and painful muscles, and improve flexibility.  Within the leg, ankle stiffness or reduced flexibility is commonly found in the ankle.  This loss of motion prevents the leg bones from properly moving over the foot during walking and running.  These changes in gait increase a patient's risk of developing heel pain, knee pain, or overuse injuries in our tendons.  Manual therapy treatments by a Physical Therapist combined with the use of a foam roller produce immediate changes in flexibility across the ankle improving a patient's ability to squat, walk, or run.   Recent research has identified multiple mechanisms underlying the improvements in flexibility following foam rolling including an increase in an individuals tolerance to stretch.

A recent article in the International Journal of Sports Physical Therapy examined the impact of foam rolling on ankle flexibility (Kelly et al. 2016).  26 subjects foam rolled one of their calves 3 times for 30 seconds each.  Authors then assessed their ankle flexibility in a weight bearing position immediately and then up to 20 minutes after the foam rolling.  The authors found that ankle range of motion was improved up to 20 minutes after foam rolling in both the treated and untreated ankle.  The improvement in ankle motion in the non treated leg is contributed to the cross over effect seen in resistance training. The ability of a one sided treatment to improve both legs flexibility indicates a central nervous system adaptation is at work.  Patients who foam roll are improving their nervous systems ability to tolerate stretch on both legs.   


Ankle Mobility and Achilles Tendon Injury

The achilles tendon is a strong, durable structure capable of absorbing and producing large loads as we walk, hike, and run.  When the tendon is overloaded without adequate recovery periods this structure is prone to painful and limiting conditions such as achilles tendonitis and tendinopathy.  One of the important risk factors for achilles injury among athletes and patients is a lack of ankle mobility.  If the ankle is unable to bend adequately during functional movements the achilles is placed under increased load leading to tendon injury.  In our Boulder Physical Therapy practice, we commonly see a loss of ankle mobility among patients with achilles tendon injury.

During our Physical Therapy examination we often see a loss of rear foot or ankle mobility and a compensatory increase in motion at the mid foot or arch (pronation).  A recent study in the journal Clinical Biomechanics confirmed our observations (Chimenti, R. et al. 2016).  The authors assessed individuals with and without achilles tendinopathy to determine their ability to bend their ankle as well as which areas of the ankle and foot where contributing to this movement.  The group with achilles tendinopathy had significantly less ankle mobility than the control group.  Importantly, this group compensated during testing with increased mobility of their arch instead due to an inability to move through the rearfoot.

This study highlights the importance of treating the ankle in patients with achilles tendon injury.  To learn more about how to safely and effectively treat this condition contact your local PT.

Prevention of Low Back Pain
low back pain-prevention-back pain-exercise

The 3 inevitable events in our society include death, taxes, and low back pain.  Many of us will experience a significant episode of low back pain in our lives but the vast majority of these symptoms are not associated with serious pathology such as fracture or cancer.  In our previous posts on low back pain we have detailed the risk of false positive findings on imaging (MRI and CT scans) and the cost of early, unnecessary imaging which contributes to the > 100 million we spend on low back pain each year.  This cost is greater than what we spend on cancer or foreign aid each year.  The high incidence of symptoms and money associated with low back pain has driven all types of passive treatments (electrical stimulation, creams, back braces, postural supports) and gizmos designed to reduce the symptoms of low back pain.  Thankfully, there is an inexpensive, powerful tool which has the greatest ability to reduce the incidence of low back pain in our country.   

Previous research has shown staying active with a strengthening program after an episode of low back pain can significantly reduce a client's risk of recurrence.  Exercise has consistently been shown to be the most effective treatment available to reduce a patient's first time or future risk of low back pain.  A recent review article in the Journal of the American Medical Association confirms these findings (Steffens et al. 2016).  Authors reviewed 21 randomized controlled trials of various interventions for low back pain including a total of 30,000 patients.  They found overwhelming support for exercise, regardless of type, to reduce a patient's risk of low back pain.  Patient's who exercised had roughly half the risk of symptoms compared to their sedentary peers.  

To learn more on how exercise can reduce your risk of low back pain contact your local Physical Therapist.  

Ankle Mobility Techniques

Ankle mobility is essential for both daily walking tasks as well as higher level athletics and sports participation.  In our Physical Therapy practice in Boulder we see a loss of dorsiflexion, bending, among athletes with lower extremity injuries and conditions.  A lack of ankle bend, dorsiflexion, has been associated with many conditions including heel pain, plantar fasciitis, ankle sprains, stress fractures, achilles tendonitis, and ACL injuries.  An example of the impact of ankle mobility on performance can be found with a squat test.  Try to squat as deeply as you can keeping your heels on the ground, then repeat the squat with your heels lifted on a weight plate.  If the latter is easier you may not have the 10-20 degrees of bend required during many athletic tasks, stair climbing, or walking.  

One of the most effective ways of restoring ankle dorsiflexion in our physical therapy practice involves the use of manual therapy.  These interventions allow a Physical Therapist to passive mobilize the areas of restriction decreasing your sensations of tightness and improving your ability to move through a more full range of motion.  Often the squat test is dramatically improved after mobilizing the joints of the foot and ankle to improve ankle bending.  

boulder physical therapy ankle mobility treatments

In our experience, ankle mobility is more quickly restored when these manual therapy techniques are followed by home exercises designed to move through the newly acquired range of motion.  A recent study examined the impact of two exercises designed to restore ankle bending in individuals who lacked the normal amount of motion in their ankle.  Jeon et al. randomized 32 individuals to either a static stretching group or a group performing a similar stretch using a band (J Athletic Training. 2015).  Individuals underwent the stretching protocol (15 reps x 20 second holds) 5 days a week x 3 weeks under the supervision of a Physical Therapist. 

boulder physical therapy ankle mobility with strap

The authors reported both groups improved their ankle range of motion after 3 weeks, but greater improvements were noted in the group utilizing the strap.  The strap may help localize the movement to the area of joint restriction making the exercise more specific to the individual.  To learn more about the examination and treatment of your ankle mobility contact your local Physical Therapist. 

Hip or Knee Strengthening for Knee Arthritis

Knee arthritis (knee OA) is the most common form of osteoarthritis and affects many individuals in middle to older age.  This condition can be found on x ray or MRI testing in both asymptomatic and symptomatic individuals.  The high rates of false positive imaging findings require a thorough subjective and objective examination in order to make a proper diagnosis.  Physical Therapy remains an effective first line treatment for patients with knee OA and has been shown to reduce or eliminate the need for a knee replacement.  At our Physical Therapy office, patients will receive manual therapy to reduce pain and improve mobility, as well as, exercises to strengthen the hips and knees.  Until recently we have known if working on the hip or knee was more effective. 

Lun et al. randomized 72 patients with knee OA to either a hip or knee focused exercise program consisting of stretching and strengthening exercises (Clin J Sp Med. 2015).  Patients exercises in clinic 3-5 times per week for 3 weeks then were placed on a 9 week home exercise program.  The impact of this 12 week program on the patients' symptoms and function was measured at the end of the trial.  The authors found improvement in both groups of patients, but no differences were found between groups focusing on either knee or hip exercises.  

This study adds to the positive impact of exercise in patients with knee OA.  In our experience, treating the entire lower quarter in patients with knee OA accelerates recovery and improves function.  To learn more about which exercises are most appropriate for your condition contact the experts at Mend.

Effectiveness of Foam Rolling

I would imagine the foam roller is slowly taking the place of the exercise ball as the most common piece of exercise equipment in people's homes.  Its' low price and versatility for both exercise and self treatment make it very popular among clients and patients alike.  The foam roller is an effective piece of equipment for restoring mobility to body regions like the middle back and flexibility to upper and lower extremity muscles prone to tightness including the quadriceps, hamstrings, calves, and hips.  As its' popularity increases, researchers are looking closer at the effects of foam rolling on pain, soreness, and mobility.  

A recent review article in the International Journal of Sports Medicine examined the impact of foam rolling on range of motion, delayed onset muscle soreness (DOMS), and performance (Cheatham et al. 2015).  The 14 combined articles supported the use of foam rollers to improve short term flexibility and range of motion.  In addition, foam rolling was found to not have an negative impact on muscle performance and thus may be used safely before exercise sessions.  When used after intense exercise foam rolling may help accelerate recovery by reducing DOMS and improving subsequent athletic performance.   

Athletes should focus on utilizing the foam roller as part of their cool down following intense exercise to improve recovery.  The foam roller self treatment should be performed for 2-3 bouts of 45-60 seconds to affected muscle groups and can be followed by static stretching for further benefits.  Another area of research includes the effectiveness of foam rolling prior to performance.  Research has indicated foam rolling in combination with a dynamic warm up is an effective way to improve athletic performance.