Monday 26 November 2012

Clinical Pearls: Function Applied : Pre-positioning in Ankle Rehabilitation

Posted by at 8:05 AM



Clinical Pearls: Function Applied : Pre-positioning in Ankle Rehabilitation


Although I developed TRI-STRECH® for tri-planar stretching of the calf, hamstrings and iliotibial band, it has become one of my favorite tools for functional strength training progression through the use of pre-positioning. 


Pre-positioning is exactly what it says it is.  Placing the joints and muscles in a pre-postion..a position that is held while  performing the exercise.  Pre-positioning allows the therapist or trainer to put a joint or a muscle at a mechanical advantage or disadvantage.  TRI-STRETCH® puts numerous pre-positioning possibilities in to the hands of the clinician.  TRI-STRETCH® allows the clinician to have a methodical progression to a functional strengthening and rehabilitation program. 


An example of pre-positioning for a rehabilitation program could be:

Diagnosis:  6 weeks post right lateral malleolus avulsion fracture and anterior talo-fibular ligament sprain

Exercise: Single leg balance opposite foot reaches at ankle height

Progression: 1- Begin with right single leg balance on TRI-STRETCH® with TRI-STRETCH® in preposition of tipped inward (calcaneous everted-protecting the lateral ankle structures).  

2- Perform first left posterior lateral reaches which allows more hip flexion and therefore posterior hip muscles assisting the lower leg while keeping the right lateral ankle structures in a protected position. 

3- Progess to left lateral reaches which will lessen the assist from the hip yet still keep the TRI-STRETCH® tipped inward to protect the right lateral ankle.

4- Then progress to  left anterior lateral reaches further lessening the assist from the posterior hip. 


The  pre-positioning concept can be used to progress the lower extremity reach program to methodically add greater stress to the lateral ankle structures. 


To learn more about TRI-STRETCH® for rehabilitation: click here.