Apr 22 2013

Dorsiflexion, or lack of!!

Published by trin74 at 3:22 PM under Uncategorized

I have been very diligent in doing my physio set exercises since I have been in 2 shoes, however one exercise I just can’t do. Standing with my feet in parallel (in my shoes with heel lifts) I have to bend at the knees. I just can’t do it! The amount of bend is so minimal it’s barely noticeable.. I am loathe to use more pressure than I am currently comfortable with.. Which led me to the question, does everyone really struggle with this?? I know I am only 4 days into 2 shoes, but it’s more just wondering if I am alone here. All the other exercises are going really well, but I know that of I can do this one my walking is going to be so much better. I also know not to force anything!! Feedback much appreciated!

10 Responses to “Dorsiflexion, or lack of!!”

  1. Stuarton 22 Apr 2013 at 8:25 PM

    The lack of dorsi flexion at 8 weeks is not of great concern and I wouldn’t try to push it to get more just yet. Why some get it back quicker than others is beyond me. I struggled with it but it is fine now. Keep up your regular exercises and walk. Walking gives a natural movement and tension. If you overstride your body will tell you and you will limp. An easy way to measure your flexion is to stand in front of a wall with your hands supporting you on the wall. Put your injured leg forward barefoot straight, flat on the floor touching the wall. Now touch the wall with your knee if you can. If you can’t touch the wall with your knee then you can measure the distance from your knee to the wall. That distance is called negative cm (metric units). If you can touch the wall then move your foot back from the wall a few cm until you can just touch it with your knee. That puts you in the postive. +7cm is what my physio wanted from me before I started running again. Record your measurements and you will see improvement. That will give you encouragment. You can expect the measurement to change throughout the day depending on swelling etc. So don’t be discouraged if you lose a little after exercise. You are doing fantastic but you are vulnerable for a month or more so be careful.

  2. Ripraproaron 22 Apr 2013 at 9:11 PM

    Hi trin,
    We are in shoes same day, my ATR was 9 weeks.
    I’ve got a few frustrating things I can’t do, walking one of them, I. Still hobbling it hurts to roll the foot, I’m not diligent on my excercise, but today did hydro and that was good really worked my calfs, I did the squeeze text when I got home, good foot movement now.
    Trin if I understand your frustrated exercise I just tried it and I can bend at the knee quite good. But not sure if I’m doing it right, here’s what I did trainers feet parallel to shoulder bend at the knee, I also tried it feet together.
    Stuart tried the knee to wall , I was no where near I could feel the stretch too much. But good idea to keep monitoring the distance,
    Trin, I think it would be good to compare excercise .
    Just tried massaging lump on side of tendon inner ankle , very painful, this lump been there 2 weeks now from first day of pt, it does worry me a bit.
    Take care all

  3. trin74on 22 Apr 2013 at 9:43 PM

    Thanks guys, it’s good to know that it is not of great concern - and I know I am doing so well in other things - can even juggle stress balls balancing on the bad leg, but this one exercise just does my head in! I really do not want to push it, as I think it’s actually quite a strong exercise to be doing on it at present. RRR - I am jealous that you are getting further than me - but I am at least able to walk rolling through the foot with no pain - but it’s definitely not a fast walk by any standards.. I tried that exercise against the wall earlier today - and am definitely in the negative - measuring it is a great idea - and will make it easier to see some progress - thanks for that! Spending about 40minutes in the evening doing bike, core and upper body exercises which feels good - will add swimming (or sinking) to my regime from Friday. Hoping I’ll be driving by then. Oh - and great you are getting some good movement on the Thomsen test! I am getting more now too which is great. The physio added the following exercises to my regime last week

    1. Balance on the bad leg, try to toss/catch a ball/pillow
    2. Place good leg on a step and try to balance, if ok put weight on ball of foot only (good leg) to balance
    3. LIGHT dorsiflex stretch
    4. Transfer weight onto toes (will transition into just lightly lifting heels by <1cm)
    5. My dreaded feet in parallel knee bend

  4. normofthenorthon 22 Apr 2013 at 9:46 PM

    Trin, there are two different reasons why it can be painful or scary to drop down to a bent-kneed position while standing up straight: #1 is that your ankle is so stiff (DF ROM so limited) that moving your knee ahead of your ankle — with or without WB — is uncomfortable or painful. #2 is that doing so while FWB puts something approaching 50% of your FW on that DF ankle, i.e., on your healing AT and calf.

    The easy way to tell which of the two it is, is to separate the WB from the DF flexion. E.g., while you’re sitting in a chair, stick your left (healing) foot in the air and gently DF it using just your leg muscles. Are you past neutral when it hits a “stop” or feels uncomfortable or scary? Can you estimate how far past?

    Stuart’s trick (above) can measure and track your DF, as long as you don’t put any weight on that foot while you’re measuring it. Stand on the other foot, 100%, then put your left toe up to the wall and see if you can move your knee ahead of 90 degrees without scaring yourself or your AT. . .

    8 weeks is still early times, and “healing short” is usually only a problem post-op, if your surgeon trimmed your ATR ends too short. You’re post-NON-op, and I’d be very patient about DF. It’ll come, and you don’t want to get too much of it. (That CAN happen post-non-op.) You can gently work it — check bit.ly/UWOProtocol to see how much they worked it at 8.5 weeks — but be gentle and incremental, ESPECIALLY with DF stretching (IMHO).

  5. trin74on 22 Apr 2013 at 9:57 PM

    Thanks Norm - when I try to dorsiflex while seated I get it maybe 5 degrees past neutral I reckon. It’s not like it’s painful to do either exercise - it’s just really uncomfortable! It’s like there is something solid (which I suppose it kind of is) where my Achilles is that prevents me from moving it further. And it feels tight at the sides of my ankle and kind of at the top of the tibialis anterior.. And yes - I am concerned about the whole healing long thing which is another reason why I’m loathe to push it Will just keep working at it slowly and as always INCREMENTALLY :) I think I am going to learn to loathe yet love that word…

  6. Ripraproaron 22 Apr 2013 at 10:03 PM

    Hi trin
    I don’t feel ahead of you , I feeling left behind, put it this way ill swap k nee bend for walking without the pain, and you excercise seems ahead of mine so I think your doing just fine ,

  7. trin74on 22 Apr 2013 at 10:17 PM

    Hey RRR - I suppose we are all unique and some things we will do worse at, some better! I reckon my many years of dance training has helped me heaps with the balancing - and the ankle strength. And probably the ROM to an extent - I always had issues with dorsiflexion anyway due to several ankle sprains over the years - was something I’ve always had to work on (and probably a reason why the Achilles went?). My physio also has me doing strengthening exercises with the theraband - making sure they are slow controlled movements both ways in the dorsiflex, plantarflex, inversion and aversion of the foot. I moved up a theraband strength last week, and reckon I’m almost at the limit of this one - holding it pretty close to my foot now. The amount of exercises I do certainly takes up a lot of evening time that’s for sure! It’s hard to be diligent - but what is driving me is getting back onto the dance floor. I know for what I do that that is realistically 7 or more months away, but I’m in count down mode! And my skis keep staring at me at the front door… I’d move them but for the fact that they are motivating me. Why Scotland had to have such a “good” season this year is slightly annoying…

  8. kkirkon 22 Apr 2013 at 10:40 PM

    I wouldn’t worry, because many other have a lack of dorsi-flexion at this point. Stuart is also right about not rushing it. Just keep dilgent with your PT and walking and it should come back with time.

  9. Ripraproaron 23 Apr 2013 at 6:50 PM

    Hi trin
    Just got in from a long days meeting , inner ankle side of tendon is hurting so going to rice, your spot on we will be worse on some things better on other, as long as we all recover that’s what counts and I’m rooting for us to cross the finishing line pretty close together.
    My goals , love walking climbing ladders, DIY renovating , just want to get back to doing what I did and once I get there want to do an half marathon.

  10. trin74on 23 Apr 2013 at 9:50 PM

    RRR - sounds good to me! One step at a time! :)

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