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N Am J Sports Phys Ther. 2007 February; 2(1): 51–54.
PMCID: PMC2953284

Unique Positioning for Using Elastic Resistance Band in Providing Strengthening Exercise to the Muscles Surrounding the Ankle

James P. Fletcher, PT, MS, ATCa and William D. Bandy, PT, PhD, SCS, ATC

Abstract

Ankle sprains are among the most common injuries incurred by participants in athletics. Conservative management of the patient after an ankle sprain includes a comprehensive rehabilitation program of which the resistance exercises are a part and are frequently advised by the clinician, many times as part of a home exercise program. The purpose of this Clinical Suggestion is to present a unique method of using elastic resistance band to provide strengthening activities to the inverters, ever-tors, plantarflexors, and dorsiflexors of the ankle. The method is unique, as well as convenient and efficient, as it allows the subject to perform all four exercises with a minimum of change in position, while staying seated in a chair.

Keywords: ankle, sprain, resistance training

PROBLEM

Ankle sprains are among the most common injuries among athletes, frequently leading to impairment in joint stability, proprioception, and muscle strength.1,2 Conservative management of ankle sprains includes cryotherapy,3 bracing,4 taping,5 elastic bandaging,6 mobilization,7,8 balance/proprioception training,912 and resistance exercises.2,4,13

As part of different case studies, Kern-Steiner et al11 and Glasoe et al2 reported the use resistance exercises as part of their treatment regime in the successful treatment of two patients with ankle sprains. Although stating that ankle resistance training was incorporated, the authors did not provide specifics as to the techniques used for these strengthening activities.

Docherty et al13 examined the effects of six weeks of ankle resistance exercises on strength and joint position sense in 20 subjects with “functionally unstable ankles” using elastic bands “attached to a table.” The authors concluded that training using elastic bands increased isometric strength of the muscles around the ankle, as well as increasing joint position sense in the ankle.

Given that evidence exists that resistance training is an important component to a comprehensive rehabilitation program for the individual following an ankle sprain, it is incumbent upon the physical therapist to introduce this activity to his/her patient in the clinic, as well as in a home exercise program. To that end, a unique method of using elastic resistance band to provide resistance training to the inverters, evertors, plantarflexors, and dorsiflexors of the ankle is proposed.

SOLUTION

In undertaking the strengthening portion of the rehabilitation program for a patient following an ankle sprain, it is imperative for the therapist to implement a home exercise program using resistance activities that are not only kinesiologically sound, but are also convenient for the patient to perform in terms of the type of resistance and positioning of the patient. A simple strengthening program using an elastic resistance band, with all exercises performed while sitting in a chair, has been found to meet such demands. Additionally, these techniques are potentially an improvement upon other common methods of using elastic band for strengthening the low leg muscles in that they establish an appropriate angle of resistance without the patient having to tie the band to an immovable object or hold the elastic band with his/her hand(s); the exception being the plantarflexionexercise. These exercise techniques are best suited for a population of individuals who have at least functional levels of strength and joint range of motion in both upper and lower extremities for positioning/holding the involved extremity or the elastic band. The intent is that these exercises are for the early stages of rehabilitation and that more functional strength and neuromuscular training is required in the later stages of the rehabilitation program after an ankle injury.

The challenges presented by the use of elastic band as a form of resistance for strengthening activities have been expounded upon in the literature.14 Using his/her knowledge, clinical expertise, and the available research evidence, the physical therapist should first determine the level of elastic band resistance, meaning color and length, appropriate for the patient's needs and goals. For each exercise technique, the band should be tied in a loop and the patient should sit on a stationary chair, specifically on the front half of the seat. The patient should be wearing sneakers (if possible) and the band should be placed around each foot in the midfoot-forefoot region and both feet placed on the floor.

The technique to strengthen the muscles of eversion is performed with the uninvolved foot firmly and flatly on the floor to stabilize the band on one end. On the involved side, the patient extends the knee enough to rest that foot on the floor only by contact of the heel. The band should be wrapped around the lateral portion of the forefoot, specifically in the region of the fifth metatarsal, on the involved ankle-foot. Given that the distance between the feet will impact the amount of tension/resistance generated by the elastic band, the band should be stretched enough initially so that the ankle-foot, at rest, is pulled into a starting position of full inversion. The patient then forcefully (concentrically) everts the ankle-foot through full range of motion (pivoting on the heel) against the resistance of the band, with the other foot continuing to anchor the other end of the band. No femoral or tibial rotation or abduction-adduction movement of the hip should be allowed during the eversion; the thigh and low leg should remain stable. The patient then slowly returns (eccentrically) to the starting position; this completes one repetition. (Figure 1)

Figure 1.
Technique to strengthen the muscles of eversion

The technique to strengthen the muscles of dorsiflexion is performed with the uninvolved foot still firmly and flatly on the floor to stabilize the band on one end. To position the involved side, the patient flexes, adducts, and externally rotates the hip so that the leg is snugly crossed over the uninvolved leg; a so called “crossing the legs at the knees” positioning that is commonly observed in a person's sitting posture. The elastic band is wrapped over the entire dorsal aspect of the forefoot on the involved side. The band should be stretched enough initially so that the ankle-foot, at rest, is pulled into a starting position of full plan-tarflexion. This position is achieved by the patient grasping the involved leg at the knee with two hands and reclining back onto the chairback, thus pulling the involved hip into flexion and positioning the involved ankle-foot further from the floor. At this point, subtle adjustments in the positioning/alignment of the feet can be made so that the line of resistance is optimal, such as to resist a pure dorsiflexion movement. The patient can now forcefully (concentrically) dorsiflex the ankle-foot through full range of motion against the resistance of the band, with the uninvolved foot on the floor anchoring the other end of the band. The thigh and low leg should remain stable during the dorsiflexion. The patient then slowly returns (eccentrically) to the starting position; this completes one repetition. (Figure 2)

Figure 2.
Technique to strengthen the muscles of dorsiflexion

The technique to strengthen the muscles of inversion is performed with the uninvolved foot still firmly and flatly on the floor to stabilize the band on one end. To position the involved side, the patient flexes, abducts, and externally rotates the hip so that the distal low leg of the involved side is crossed over and resting on the distal thigh of the uninvolved leg; yet another positioning of the lower extremities that is commonly observed in a person's sitting posture. The elastic band is wrapped over the medial side of the forefoot, specifically in the region from the navicular to the head of the 1st metatarsal, on the involved ankle-foot. The band should be stretched enough initially so that the ankle-foot, at rest, is pulled into a starting position of full eversion. This position is achieved by the patient pressing on the involved leg at the knee to place and maintain the hip in full external rotation, thus positioning the involved ankle-foot further from the floor. At this point, subtle adjustments in the positioning/ alignment of the feet can be made so that the line of resistance is optimal, such as to resist a pure inversion movement or perhaps to even incorporate resistance against an inversion and dorsi- or plantarflexion combined motion. Once positioning is complete, the patient can now forcefully (concentrically) invert the ankle-foot through full range of motion against the resistance of the band, with the other foot continuing to anchor the other end of the band. The thigh and low leg should remain stable during the inversion. The patient then slowly returns (eccentrically) to the starting position; this completes one repetition. (Figure 3)

Figure 3.
Technique to strengthen the muscles of inversion

The technique to strengthen the muscles of plantarflexion is not unlike traditional methods already in use clinically. The patient holds the elastic band on one end with his/her hands and places the other end around the plantar surface of the forefoot on the involved side. The band should be stretched enough initially so that the ankle-foot, at rest, is pulled into a starting position of full dorsiflexion. The patient forcefully (concentrically) plantarflexes the ankle-foot through full range of motion against the resistance of the band. The thigh and low leg should remain stable during the plantarflexion. The patient then slowly returns (eccentrically) to the starting position; this completes one repetition. For this exercise, the knee of the involved side can be placed in a fully extended position to exercise the gastrocnemius and soleus muscles together (Figure 4) or flexed to exercise just the soleus muscle. (Figure 5)

Figure 4.
Technique to strengthen the muscles of plantarflexion; knee extended
Figure 5.
Technique to strengthen the muscles of plantarflexion; knee flexed

DISCUSSION

As indicated, this exercise program for strengthening the muscles of the ankle can easily be independently performed by the patient, with minimal changes in position while sitting in a chair. It should be emphasized that strengthening the muscles around the ankle is but one component of the rehabilitation of a patient after an ankle injury. In addition, all four of the exercises listed in this Clinical Suggestion do not have to be used. The clinician may choose to have the patient only use a subset of the exercises dependent on the needs of the patient.

REFERENCES

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Articles from North American Journal of Sports Physical Therapy : NAJSPT are provided here courtesy of The Sports Physical Therapy Section of the American Physical Therapy Association