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ESSENTIAL SKILLS Inner-Ankle Lift This exercise requires the use of props—either weights that attach to the foot in some way or a small plastic shopping bag containing a 1- to 5-pound weight. To begin, have the client sit in a chair and cross the injured leg over the good leg, with either the weight apparatus or the loaded shopping bag across the front part of the foot, just behind the toes. Now instruct the client to raise the foot toward the ceiling 5–10 times, take a brief rest, and repeat (Image 4). Don't use too much weight to start; begin with a lighter weight and gradually build up to using 5–10 pounds over the course of the treatment. The client should begin to feel tired after 5–10 repetitions. If the exercise causes pain, it means the person either is using too much weight or is not yet ready to begin exercising. Outer-Ankle Lift This exercise requires the same props as the Inner-Ankle Lift, but is done from a side-lying position on a couch or bed. Have the client start with the knees bent, injured ankle on top, and then extend the top leg off the edge of the couch or bed (while wearing the weight or the shopping bag). Then have the person lift the outside of the foot toward the ceiling—10 times with the foot in plantar flexion, and then another 10 with the foot in dorsiflexion (Image 5). Build up slowly to three sets of 10 repetitions in both foot positions. Heel Raises Start with the client standing, feet parallel, holding on to something for balance. Have the person rise up onto the balls of the feet, without bending the knees, and stay there for a moment before coming down again (Image 6). After five repetitions, repeat this same exercise with the knees slightly bent. Build up slowly to eight repetitions of five, for a total of 40 repetitions. SUPPORTING A LASTING RECOVERY Successful recovery from a posterior tibialis injury requires not just getting the appropriate treatment, but also taking steps to avoid future strains. It's important to check the balance in the client's feet; excessive pronation puts more of the weight load on the medial side of the lower leg, thus overworking the posterior tibialis, underworking the peroneous, and creating a high vulnerability to injury. If the client's feet are pronated, be sure that the person does corrective strengthening exercises and gets orthotics if necessary. This is a critical investment in the long-term health of the feet and the lower body as a whole. In addition to foot and ankle injuries, excessive pronation predisposes a person to knee, hip, and back pain. By encouraging clients to address this underlying issue, you can help interrupt a chronic cycle of recurring injuries and help protect long-term balance and mobility. education and sports medicine. He is founder of the Muscular Therapy Institute. Benjamin has been in private practice for more than 45 years and has taught communication skills as a trainer and coach for more than 25 years. He teaches extensively across the country on topics including SAVI communications, ethics, and orthopedic massage, and is the author of Listen to Your Pain, Are You Tense? and Exercise Without Injury, and coauthor of The Ethics of Touch. He can be contacted at 4bz@ mtti.com. Ben E. Benjamin, PhD, holds a doctorate in Editor's note: Massage & Bodywork is dedicated to educating readers within the scope of practice for massage therapy. Essential Skills is based on author Ben E. Benjamin's years of experience and education. The column is meant to add to readers' knowledge, not to dictate their treatment protocols. visit massageandbodywork.com to access your digital magazine 97