Higher Level Ankle Rehabilitation For Sports Physios – Ankling And Return To Play Progressions

At the core of what we do as therapists is getting athletes to return to play. But this is never a quick process, it is a methodical one.

You should know every step and every progression your patient needs to take, before they take it.

Today, I’ll share with you an incredibly powerful exercise I use in my graded exposure treatment plans to progress my patients toward their return to play.

This is a critical exercise in getting your athlete back to running or higher level rehab. Of course, if you’re not using this exercise as part of a solid treatment plan you won’t get the long-lasting results your patient needs. If you feel a little lost or in the dark go back to previous parts of our ankle series and learn more about how we got to this level of rehab.

One of the keys in returning to play is the progressions and steps we take to make sure the athlete is happy and safe to get back on the training ground.

One of the first things you need to do with an ankle injury is to restore range of motion. After restoring range you need a strong calf raise. Once you’re at that stage your athlete will need to build good intent through the foot and stiffness. This will become important when your patient needs to run and change direction.

To restore good intent and stiffness I use an exercise called ankling. Ankling is essentially pushing the foot into the floor, as you push you perform a hip hitch and end up going into a walk.

I tend to stay away from the classic hip hitch we were all taught at university, it can cause problems when the athlete focuses too much on hip hitching rather than delivering that intent through the midfoot.

What we do at the Pro Sport Academy is we look for the hip hitch to occur naturally. You should not be coaching the hip hitch. If your patient has more intent through the foot then that hip hitch will occur naturally with the gluteus medius doing most of the work.

What you’re looking to do with this progression is get that stiffness and aggression back, showing the nervous system it is safe to push off the big toe, little toe and other areas of the foot. The nervous system needs this reassurance so when the athlete is back on the field they can run with thoughtless and fearless movement.

Ask your athlete to put their hands on their hips, and as their foot reaches the floor you want them to attack it. Start with a tap initially, they need their foot to feel stiff, hitting the floor as one.

Next you want your patient to go one step further on from the tap. You want them to lift their whole body weight with one foot, attack the floor with aggression but keep that ankle stiff as the motion is performed.

This time get as much of the foot involved as possible. When running, your athlete is not going to be limited to just using their toes. We need to encourage the athlete to use as much of the midfoot as possible.

Tip – In my clinical practice, I use my voice to cue my patient. Each time the athlete puts pressure on the floor I say push. I want a little aggression in my voice to encourage aggression in the movement.

Your athlete should be performing this in a walking motion on the spot still pushing into the floor and building that intent.

Ask your patient to do three ankling steps on the spot and then three forward. It is important to see the stiffness and intent through the exercise. Ultimately these are the movements that we will need to acclimatise to if the athlete is going to run. Introducing them now will allow us to introduce the nervous system to these efforts.

Ankling is a key step in your patient’s progression and their return to running. You need a good range of movement, a strong calf raise, ankling and onto hopping. This is the first step in promoting the stiffness that the athlete needs when getting back to running.

Ankling is an incredibly powerful exercise to produce good intent going through the big toe and the rest of the foot. It is an important stage in getting your athlete back to running and returning to play.

This whole process isn’t just about ankling and a strong calf raise. I say time and time again in the mentorship program you need to look at the whole story. There is always far more going on than we think. That peroneus longus needs to build tension up to the gluteus medius. If you have issues with these or the lower back you need to revisit past parts of our ankle series.