ANKLE STRENGTHENING INTRODUCTION EXERCISES SAFETY

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1 ANKLE STRENGTHENING INTRODUCTION Welcome to your Ankle Strengthening exercise program. The exercises in the program are designed to improve your ankle strength, fitness, balance and dynamic control. The benefit of investing time in this program is to improve your body awareness so as to prevent future ankle injuries. Rehabilitation requires the injured body part be fully integrated with the rest of the body, and the way it moves, so some exercises incorporate other elements of the body. This program is suited to all athletes particularly for those sports that involve sudden change of pace and change of direction movements, and especially for young athletes who are still developing. The exercises are listed in order of progression, commencing with some simple balance exercises on the ground, progressing to more dynamic exercises and finally using some plyometric techniques to challenge strength and power further. To prevent re-injury and to gain the most from this program, start at the beginning and follow the Rolling Program as described on page 2. It is recommended that you spend at least 5 minutes everyday performing your rehab exercises. S Included in the description of every exercise is the purpose, so that you can understand what you are trying to achieve; the starting position describing the position you need to adopt before commencing there is usually an image to help you understand; and the exercise describing the action required and again, the images will help. Progressions and variations are available once you are performing the exercise well and are ready for new challenges. SAFETY Should you experience pain with any of the prescribed exercises, stop, re-read the instructions and carefully try again. If pain persists consult your physiotherapist.

2 ROLLING PROGRAM HOW T O USE T HIS PROGRAM This program works on you being able to progress yourself as your pain allows. Once you can complete the first 4 exercises pain free, you will move down 1 exercise and work on exercises 2-5. Again, once these can be performed pain free then you will move to exercises 3-6, and so on and so forth. You should always have 4 exercises that you are working on, and your progression will sometimes be faster than others. Based on a diagnosis of a moderate-severe lower limb injury expect to spend on average, one week on each bracket of 4 exercises. NOTE if any of these exercises are painful to complete, continue with the exercises in the above bracket and attempt again in a few days. If after 1 week it continues to be painful, seek advice from your physiotherapist. STAT IC BALANCE PHASE 1. Standing Balance 2. Single Leg Bounce Ball 3. Body Balance DYNA MIC PHASE 4. Double Leg Squats 5. Double Leg Heel Raises 6. Double Leg Jumps 7. Double Leg Dynamic 8. Single Leg Squat 9. Single Leg Heel Raise 10. Hopping 11. Single Leg Dynamic PLYOMETRIC PHASE 12. Double Leg Plyometric 13. Single Leg Plyometric EXAMPLE Begin with exercise bracket 1-4, then move onto exercise bracket 2-5. If by adding exercise 5 it is painful, stay with exercise bracket 1-4. If you have any concerns please consult your physiotherapist.

3 THINGS TO CONSIDER W HAT YOU W ILL NEED To engage in this program you do not need any specific equipment; however some of the progressions refer to the use of a Balance Disc (Disco-Sit) or wobble board. You can use a pillow or piece of soft, thick foam as a substitute. For the sports specific components, a ball specific to your sport should be used. S Progress to the next rolling phase, or exercise bracket as your pain allows. If you are unsure please refer to your physiotherapist. The progressions have been developed to challenge and support your developing strength and aims to facilitate your recovery, and accelerate your return to sport. W HEN CAN I RETURN? The right time to return to your sport is generally when you are pain free. Timeframes are based on the degree of tissue damage and will likely not be before 4 weeks and can be as long as 12 weeks. A couple of key points to consider before taking to the court is; 1. Can you complete the Dynamic Strength Exercises in this program? 2. Can you complete a full training session pain free? 3. Has my swelling resolved and is my balance back to normal? If you answer Yes to these questions, you should be ready to return to sport. Also consider consulting your Physiotherapist regarding taping or bracing.

4 1. DOUBLE LEG BALANCE To improve body awareness and standing posture, and to retrain proprioception in the ankles. Stand in a tandem stance with one foot in front of the other with feet hip width apart and in a normal stride length. Balance your weight equally between the two feet and maintain a tall standing position. Extend your spine from the top of your head without arching your back or locking your knees. Maintain this position for a minimum of 5 breath cycles. Repeat with the feet swapped over. To challenge further reduce the base of support by bringing your feet closer together aiming to reach heel-to-toe position. 1 BALL WORK: Add bouncing a ball to your reportire once you can do the above exercises without pain. Repeat with each leg in front and mix up your ball work ie bouncing one hand, bouncing across the body and throwing and catching 2 EYES CLOSED: Stand in a Tandem stance as per above with the eyes closed and continue to reduce base of support as able. Maintain for a minimum of five breath cycles. 3 DISC or WOBBLE BOARD: Stand in a tandem stance on the disc trying to maintain your balance and control. Maintain for a minimum of five breath cycles NOTE To challenge further combine some of the above progression variables being mindful it would be hard to catch a ball with your eyes closed!

5 2. SINGLE LEG BALANCE To improve balance and coordination simultaneously. Stand on one leg with the weight balanced between the ball and the heel as you have been taught. Start holding a ball, specific to your sport, or that you are comfortable with. Bounce the ball at a comfortable speed, focussing on maintaining a balanced stance and control of the body. Stand on one foot with your weight equally distributed between the ball and heel of the foot whilst maintaining a tall standing position. Extend your spine from the top of your head without arching your back or locking your knee. Maintain this position for a minimum of 5 breath cycles. 1 BALL WORK: Add bouncing a ball to your reportire once you can do the above exercises without pain. Repeat on each leg and mix up your ball work ie bouncing one hand, bouncing across the body and throwing and catching 2 EYES CLOSED: Stand on one leg as per above with the eyes closed and maintain for a minimum of five breath cycles. 3 DISC or WOBBLE BOARD: Stand on one leg as per above on the wobble disc and maintain for a minimum of five breath cycles. NOTE To challenge further combine some of the above progression variables being mindful it would be hard to catch a ball with your eyes closed!

6 3. BODY BALANCE : To improve body awareness and challenge balance and proprioception. Begin standing on one foot balancing with 60% weight in the heel and 40% in the forefoot. 1 AEROPLANE: Begin with parts a) and b) separately, maintaining each stance for 5 breaths. Then progress to moving through one and into the next in a smooth, controlled fashion. a) Standing balanced on one foot, simultaneously, extend the free leg straight out in front of you as you bend the other knee into a mini squat and extending the arms out to the sides. Ensure the standing leg is bent slightly and all joints are in line. Move back to the centre, standing tall. b) Simultaneously, extend the free leg out behind you as you bend forward from the hips extending the arms out in front of you. Ensure the standing leg is straight, but not locked and all joints are in alignment. Maintain for 2 breath cycles. 2 REACHING FOR A STAR: Begin with parts a) and b) separately, maintaining each stance for 5 breaths. Then progress to moving through one and into the next in a smooth, controlled fashion. a) Standing balanced on one foot, extend the free leg out to straight, and the arms out to the sides into a T position. Keeping the star shape with your body, tip over to the side that you are standing on. Return to the centre and check that the standing leg is straight, but not locked and all joints are in line. b) Take the free leg around behind you and reach the arm on the weight bearing side in front and across your body. 1 UNSTABLE SURFACE: repeat the squat exercise above standing on either an air filled disc, wobble board, a pillow, or a folded towel. Maintain the same pressure in the heels and upright posture.

7 4. DOUBLE LEG SQUATS To acquire antiquate range of motion in the ankles to perform a jump. Stand with both feet on the floor with 60% weight in the heels and 40% weight through the forefoot. Standing tall, as you have been taught, bend your knees, like you are sitting onto a low chair. Press up imagining your heels are the heaviest part of your foot until the legs are straight with all joints in line. S 1 UNSTABLE SURFACE: repeat the squat exercise above standing on either an air filled disc, wobble board, a pillow, or a folded towel. Maintain the same pressure in the heels and upright posture.

8 5. DOUBLE LEG HEEL RAISES To acquire antiquate strength in the calves to perform a jump. Stand on both feet with 60% weight in the heels and 40% in the fore foot. Press up onto the forefoot keeping the weight distributed across the toes equally. Lower back down to tap the heels then push up again. Ensure on the upward phase, the ankle stays in line with the foot, for example the weight is maintained across the ball of the foot, not moving onto the small toe side. Complete 10 repetitions. 1 UNSTABLE SURFACE: repeat the heel raise exercise above standing on either an air filled disc, wobble board, a pillow, or a folded towel. Maintain the same pressure in the heels and upright posture. NOTE- Stability and alignment is key to this movement, speed is not important. Concentrate on maintaining a tall standing position almost like the top of your head is floating up toward the sky and then lowering as the tide moves in and out.

9 6. DOUBLE LEG JUMPS To improve the dynamic stability, strength and control of the ankle. Thus prepare the ankle for the shock absorption required for running. Start standing with an imaginary line drawn in front of you. Stand directly behind it with equal weight on both feet. a) DOUBLE LEG JUMP - Forward & Back: Standing tall on a level surface, jump with two feet forward then back ward to the place you started from. You should be aiming to contact the whole foot on each landing, not just the ball of the foot. Ensure you are standing tall and adopting a good postural position before you begin. b) DOUBLE LEG JUMP - Side to Side: Standing tall on a level surface, imagine a line drawn in front of you, jump with two feet from one side to the other. The jumps should be deliberate and controlled to complete contact with the whole foot each time, not just the ball of the foot. Ensure you are standing tall. Start with small distances, eg 50 cm, and progress to 1 m. c) CROSS THE SQUARE: Standing tall on a level surface, imagine a box drawn out on the ground in front of you. Jump with two feet across the square to the opposite far corner. Then Jump straight back to the corner behind you. Jump diagonally across to the far top corner opposite your starting place. Jump directly back to the start. The jumps should be deliberate and controlled, and to complete contact with the whole foot each time, not just the ball of the foot. Ensure you are standing tall and adopting a good postural position before you begin. Repeat x 5 in each direction. a) Face the cone opposite and jump over the imaginary line and back again. b) Start side on to the line and jump from one cone to the other. (iii) START (ii) (i) VARIATION: Try jumping around in an imaginary figure of 8. 1 Add a ball to your jump practice. Work with a partner or facing a wall that you can throw a ball against. Throw the ball against the wall then jump up and forward, timing your jump to catch the ball before landing. Similarly if working with a partner, time your jump to land on the catch.

10 7. DOUBLE LEG DYNAMIC To improve the biomechanics of jump landing, and to strength the ankle in preparation for running. You will need a step about 20-30cm in height. a) JUMP LANDING FROM A HEIGHT: Begin standing on a step or strong box. Jump from two feet off the box, landing with both feet simultaneously. Ensure the position of the knee does not move past the toes on landing. The hips and shoulders should maintain level to ensure the weight is taken equally on both feet. Repeat x 10 repetitions. Attempt to jump as high as you can Then attempt to jump as long as you can

11 8. SINGLE LEG SQUATS To acquire antiquate range of motion in the ankle to perform a hop. Stand on one leg balancing with 60% weight in the heel and 40% in the forefoot. Standing tall, as you have been taught, bend your knee, like you are sitting onto a chair. Press up imagining your heels are the heaviest part of your foot until the legs are straight with all joints in line. Limit the range of the squat to ensure a good technique. Complete 10 times on each leg. NOTE the range of movement of the Single Leg Squat will not be as great as the Double Leg Squats. 1 UNSTABLE SURFACE: repeat the squat exercise above standing on either an air filled disc, wobble board, a pillow, or a folded towel. Maintain the same pressure in the heels and upright posture.

12 9. SINGLE LEG HEEL RAISES To acquire antiquate strength in the calf to perform a hop. Stand on one leg balancing with 60% weight in the heel and 40% in the forefoot. Press up onto the forefoot keeping the weight distributed across the forefoot equally. Lower back down to tap the heel then push up again. Limit the range of the lift to ensure a good technique, and that the hips and shoulders remain level. Ensure on the upward phase that the ankle stays in line with the foot, for example the weight is maintained across the ball of the foot, not moving onto the small toe side. Complete 10 repetitions on each leg. 1 UNSTABLE SURFACE: repeat the heel raise exercise above standing on either an air filled disc, wobble board, a pillow, or a folded towel. You may need to begin with using a wall to assist your balance. NOTE- Stability and alignment is key to this movement, speed is not important. Concentrate on maintaining a tall standing position with the hips and shoulders level.

13 10. HOPPING To improve the dynamic stability, strength and control of the ankle. Thus prepare the ankle for the shock absorption required for running. Start standing with an imaginary line drawn on the ground in front of you. Stand directly behind it. a) SINGLE LEG HOP- Forward & Back: Standing tall on a level surface, hop with one foot forward then back ward to the spot you started from. You should be aiming to place the whole foot on the ground on each jump, not just the ball of the foot. Ensure you are standing tall and adopting a good postural position before you begin and throughout. b) SINGLE LEG HOP - Side to Side: Standing tall on a level surface, imagine a line drawn in front of you, hop with one foot from one side to the other. The hops should be deliberate and controlled to complete contact with the whole foot each time, as above. Ensure you are standing tall. Start with small distances, eg 20cm, and progress to 50cm. c) CROSS THE SQUARE: Standing tall on a level surface, imagine a box drawn out on the ground in front of you. Hop with one foot across the square to the opposite far corner. Then hop straight back to the corner behind you. Hop diagonally across to the far top corner opposite your starting place. Hop directly back to the start. The hops should be deliberate and controlled, to complete contact with the whole foot each time, as above. Ensure you are standing tall and adopting a good postural position before you begin. Repeat x5 each direction a) Face the cone opposite and hop over the imaginary line and back again. b) Start side on to the line and hop from one cone to the other. (iii) START (ii) (i) VARIATION: Try hopping around in an imaginary figure of 8. 1 Add a ball to your jump practice. Work with a partner or facing a wall that you can throw a ball against. Throw the ball against the wall then hop up and forward, timing your hop to catch the ball before landing. Similarly if working with a partner, time your hop to land on the catch.

14 11. SINGLE LEG DYNAMIC To improve the biomechanics of landing. You will need a strong box or step about 20-30cm in height. Begin standing on both feet on the box. a) WOBBLE BOARD STEP UPS: Start standing behind a wobble board or box with a balance disc or pillow secured on top. Step up onto the wobble board ensuring the hip, knee and ankle stay in line. Push up thinking more about the heel as you press up to standing, ensuring the glutes are activated. To return, maintain the hip, knee and ankle control to keep the alignment. Repeat x 15 on affected side. Repeat x10 on non-injured side. b) Begin standing on a step or strong box. Jump from two feet off the box, landing with one foot. Ensure the position of the knee does not move past the toes on landing. The hips and shoulders should maintain level to ensure the weight is taken equally on the foot. Repeat x 10 repetitions on each side. a) SINGLE LEG TAKE-OFF: Hop from one foot off the box, landing on the same foot.

15 12. DOUBLE LEG PLYOMETRIC To improve explosive power and improve the functions of the nervous system. You will need a strong box or step about 20-30cm in height. a) DROP JUMP begin with 2 feet standing on top of the box, then drop off with both feet. As soon as your feet touch the ground, imagine you have springs on your shoes and rebound straight up into a second jump. Repeat x 10 times. b) JUMP THROUGH start standing behind the box. Jump up onto the box and use it like a spring-board, jumping immediately off the box landing on the ground in front of the box. The aim of this exercise is to produce power and speed while maintaining ideal technique on take off and landing. Repeat x 10 times. c) SIDE JUMP Start standing next to the box. Jump up with 2 feet onto the box. Again, imagine the box is a spring board and bounce off the box to the opposite side. Repeat x 10 Right to Left followed by, x 10 Left to Right. NOTE - For exercises a, b and c, use you re arms to facilitate the movement, assisting the power up onto the box, and to propel forward.

16 13. SINGLE LEG PLYOMETRIC To improve explosive power and improve the functions of the nervous system unilaterally. You will need a strong box or step about 20-30cm in height. a) DROP HOP begin standing on one foot on top of the box, then drop off the box, as soon as your foot touches the floor, imagine you have springs on your shoe and rebound straight up into a second hop. Repeat x 10 times. b) HOP THROUGH start standing behind the box. Hop up onto the box and use it like a spring-board hopping immediately off the box landing on the ground in front of the box. The aim of this exercise is to produce power and speed while maintaining ideal technique on one foot take off and landing. Repeat x 10 times. c) SIDE HOP Start standing next to the box. Hop up with one foot onto the box. Again, imagine the box is a spring board and bounce off the box to the opposite side. Repeat x 10 Right to Left followed by x 10 Left to Right. NOTE For exercises a, b and c, use you re arms to facilitate the movement, assisting the power up onto the box, and to propel forward.

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