Issue link: https://www.massageandbodyworkdigital.com/i/68178
ESSENTIAL SKILLS with one or two exercises, add the others in one at a time in subsequent sessions. The general principle is to start slowly, with a light weight and small number of repetitions, then build up the weight and the number of reps as the person gets stronger and the exercises begin to feel easier. Heel Walking Have the client try walking on his or her heels, with shoes on, for increasing periods of time. Start with 30 seconds and build up to three minutes. ankle Flexion From a sitting position on a table, with legs dangling down, have the client dorsiflex the ankle so the toes come toward the knee. Ask the person to hold this position for one or two seconds, then point the foot into plantar flexion and hold that position for one or two seconds. Begin with five repetitions of flexing and pointing, and then rest and repeat 8–10 times. After a week or two, or when that becomes easy to do, tie a long, tubular sock containing a one-pound weight around the anterior forefoot, just behind the toes. Now repeat the exercise, with the action of the foot lifting this weight and then slowly lowering it. Begin with just two sets of five, eventually building up to 30 repetitions. When this becomes easy to do, add another half-pound or pound of weight. 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 one to five 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, Without an understanding of what's happening, it's likely that the person will continue to aggravate the injury. take a brief rest, and repeat. 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. 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. 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. A CLEAR PATH TO HEALING For any client with an anterior tibialis tendon strain, the most valuable service you can provide is giving an accurate assessment. Without an understanding of what's happening, it's likely that the person will continue to aggravate the injury. When the feet are excessively pronated, even walking can put significant strain on this structure. The good news is that once you've made your assessment (which is relatively easy to do), the prognosis for healing is quite good. Of the many different structures athletes injure, the anterior tibialis is one of the easiest to treat and quickest to heal. 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. 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. connect with your colleagues on massageprofessionals.com 107 Ben E. Benjamin, PhD, holds a doctorate in