Archive for the ‘Recovering from Injuries’ Category

It is unavoidable that physical activities are packaged with injuries. When participating in physical activities, the possibility of injuries can never be removed but can definitely be reduced. And when an injury occurs, we can always make something positive out of it. Physical activities and sports enable a participant to enjoy & express themselves. There is a big return of investment when it comes to fitness, mental health, social interaction, and emotional well being. Physical activities makes us faster, stronger, and better as long as done in a consistent and progressive way. But they have inherent risks which may be perceived as a threat or a challenge. The process of overcoming the challenges offered by the physical activities makes them tools for self-improvement. We feel a sense of accomplishment when we finish a marathon, sail across the oceans, and climb mountains. But sometimes, when we cannot finish the race due to an injury, do we just sit back and feel sorry for ourselves? Or do we get back up? This is not only for guys and gals who are injured and are recovering, but for anyone interested in improving themselves thru training. It refers to works by psychologists and scholars and shares some personal stories, observations and experiences.


Physical activities require some degree of skills, physical fitness, and mental resilience. If the cumulative demands of all our activities exceed our capabilities, a breaking point will be reached.

Related:Setting initial training expectations by understanding a natural process called GAS

In the exhaustion phase of the General Adaptation Syndrome, the body is not able to cope with the stress and its function starts to decline. Injuries can be a manifestation of this phase. Understanding how we react to stress enables us to have a sense of control over our injury and not the other way around. Scientists suggest many models, like the GAS, that helps us understand the processes that we undergo. Kubler-Ross (1969), identified a five stage grief reaction response: denial, anger, bargaining, depression, and acceptance or reorganization. It was again discussed by Pederson and Gordon (1986) as how athletes may respond to injury.

Basing on the 5 stage reaction response model, being angry is a part of the process but it does not stop there. The process starts like a dark tunnel wherein negative emotions like anger and depression are expected after injury, but as we learn how to deal with it, we can see the light at the end of the tunnel. We begin to accept the situation and then reorganize. If you have been recently injured and you are reading this part of the blog, probably you are past denial stage, maybe getting over bargaining & depression and likely beginning to accept & most likely reorganizing and looking for ways how to recover fast. Those who did not get past the first paragraph and quit reading may still be angry or in denial of their condition.

In a study conducted by Tracey, they interviewed recently injured athletes who also had previous injuries. They discovered that thoughts of the future were influenced by thoughts of past injuries and their successful recovery from the injury. “Knowing what to expect” was reported to give further peace of mind and had a “calming” effect that allowed them to stay positive and focused on recovering.

We can also learn from the experience of others. When I was 15 years old, I broke my collarbone just before the summer holiday started. Before the accident, I was really looking forward to going back to the local YMCA to continue my Karate training. I cried because of the pain, of the thought of missing the chance to train, and most of all because I was uncertain if I will ever be able to do things I like to do again. Being young, I did not know what was going to happen. But I was lucky that a kind Medical Intern talked to me. He said he broke around 23 bones before he reached the age of 20. But he is there standing strong and healthy. His words worked a lot better than the medicines. It made me stop crying when I realized that, like him, I can recover and still be strong. I must have gotten past the “Angry” stage at that point thanks to his story! I was also very lucky to have a bodybuilder for a brother-in-law and who was my first mentor in lifting weights. He had bodybuilding & fitness magazines. Since it was already summer holiday and I had nothing else to do, I read his magazines & came across articles by champion bodybuilders (of that era) like Kevin Levrone. He wrote about his injury that required surgery. Bodybuilders are judged according to their muscular development. He had great chest & upper body development but his calves needed improvement and while he was waiting for his wound to heal, he trained his calves. When he fully recovered, he ended having a more proportioned built because he was able to use the time to work on his weakness while allowing his chest to recover from the surgery. Another bodybuilder wrote about his long road to recovery after falling down from a powerline to a train track and breaking most of his ribs, his legs, and dislocating his ankles. He might have died if he was not physically fit. And he was lucky to have a loving wife who encouraged him to go through the slow and painful process of learning how to walk again. Because of his wife’s support, he eventually regained his health, trained again, and became one of the great bodybuilders of his time.


VALstrengthtraining weak to peak2

An athlete with a fractured leg is still being trained. The purpose of training is to minimize leg atrophy and also to give him something to focus on instead of just feeling sorry for himself. He recovered and became one of the best badminton players in Hong Kong. To make him feel better, I told him my experiences recovering from my fractures.

After I read those stories, I began to see hope. I also read a bit about fractures and even if I understood then that there is a slight deformation of the bone due to a misalignment, it did not matter much. What mattered was that I can be as physically active as I would alow myself to be and less than a year later, I was able to top the physical fitness test of our class. It was a big achievement for me after the injury. After a few years, I again had an accident while rappelling. I was already a Physical Therapy student at that time having my semestral break. I broke my left fibula, chipped the tibia, broke 3 metatarsals, and snapped a tendon on one of my fingers (which I discovered after about 12 years later). I was actually happy after the accident. Not because I was injured but because I did not break my spine nor injured my brain from the impact of falling. I became my first patient and trained myself in my brother-in-law’s gym, that is after he mentored me on how to lift weights. Four months later I was jogging, although with a slight limp, and 1 ½ months on I went on an expedition to the second highest mountain of my country. It was a goal I set prior to the accident and decided to stick to it to motivate myself.


Looking back at my experience as well as those of others, it reinforces the Integrated Model of Emotional Response to Injury as developed by Wiese-Bjornstal (2). It suggests that events prior to injury would have an effect to the response to injury. The work of Tracey(1) further supports this. They interviewed injured athletes. Quoting a part of her work, it says:


⌈The influence on their emotional experience was described by the participants as a“learning experience.” They learned that they must take care of themselves and “not to take anything for granted.” The experience of sustaining and recovering from a moderate to severe injury was marked by a variety of emotional responses by the participants. Most participants referred to the idea that “injuries just happen,” with a few mentioning that “things happen for a reason” and they had to “listen and learn to take care of themselves.”⌋

Thoughts and affect changed over time to view the injury as a challenge which participants approached with a positive attitude. The experience of the participants was acknowledged as a process in which they learned about themselves and the many emotions involved with being injured.2


And here is a quote from the internet. It says it is from Bruce Lee:



but again, the problem with quotes from the internet is that we do not know if they are genuine. So here is my own quote:



This is for a friend who is recovering from an injury who is on another part of the globe. We have been through some of the toughest challenges that we faced and we came out smiling.



  1. The Emotional Response to the Injury and Rehabilitation Process, Journal of Applied Sport Psychology Volume 15Issue 4, 2003; Tracey
  2. An Integrated Model of Response to Sport Injury: Psychological and Sociological Dynamics. WIESE-BJORNSTAL et al.

This is the second part of the preparation for Standing Balance and tolerance for amputees. (Click here for the initial preparation.) Strength here is not about how heavy the individual can lift yet. It is focused on the strength needed to enable him or her to support herself/ himself in standing and eventually to ambulate with walking aids and/or prosthesis depending on the case. The ultimate goal is to enhance the quality of life. The initial steps are developing the required physical and mental strength to enable yourself to live your life to the fullest despite some setbacks.

New goals: Be stronger

As we accept our condition, we can move on with what we can do. There are many things which are out of our control and we should not waste our energy in trying to change those. We should focus on things that we can control. We can control our behavior and reaction, and we should. After initially preparing our torso, shoulders, elbows, and wrists, it is time to move further by improving their strength. For some, it may be an entirely new experience to train to be physically stronger. Take it as an exciting adventure with its ups and downs. What is important is to keep a positive outlook. Your goal may be to be able to move and walk with as little help as possible. Think about this when you are tired and tell yourself you are getting better.

It is not easy because you are not yet used to it. But your mind and body will be stronger as you persist and soon positive changes happen. It may be gradual but they happen. Here are some guidelines:

      1. To be able to develop upper body strength needed for bed mobility, transfers, and to support oneself on walker.

  • Sufficient arm strength is needed to safely transfer from the bed to the wheelchair or walkers or crutches. The arms will eventually bear the rest of the body weight with the aid of walkers or crutches. Using the wheelchair also requires arm strength. Using walkers and crutches require skill and strength. It takes time to develop strength so it is best to train for arm strength even before practicing using walkers or crutches. If you have sufficient strength, learning how to shift weight on the walker or crutches will be a lot easier. Improved strength also allows you to maintain or recover balance. It will be hard at first but it will become easier as the weeks pass by provided that you do them regularly- every other day to daily. Remember, do these exercise for yourself. If you really want to be able to move around, put in a lot of effort and the effort is very well worth it!

What to do:

1.1. Dips. This is a very good exercise to develop specific strength and strength endurance of the arms needed in using the walker and crutches. Sit on a hard bench and have blocks of wood on your either side. Make sure that the blocks of wood will not slip off. Press down on the blocks of wood to lift your buttocks off the bench until your elbows are straight. Try to hold for 1-2 seconds before you gently lower yourself down. Pushing yourself up and lowering is one repetition.

sitting dips

1.2. Shoulder pressdowns. A bit similar to dips but this time the elbows will remain straight. The fulcrum of movement will be on both shoulders. Start the movement by having the elbows locked in a straight position. Press down on the blocks by moving the shoulders downward as if trying to keep them away from your ears. Press (or push) until your buttocks come off the bench. Hold for 1-2 seconds before lowering yourself on the bench. Wide muscles attaching your arm to your back will work hard as well as the muscles on the back of your arm.

sitting shoulder press up 

   2. To be able to develop standing balance and tolerance.

  • Depending on the severity of the condition, some individuals would even have a hard time sitting up without support. But our friend, who we dedicate this post to, is able to sit up for some time. When sitting, practice having an upright posture like the one you do when doing the breathing exercises (see photo in the previous post). The next stage would be to develop standing balance and tolerance even without the prosthesis. While waiting for the stump to fully heal, we might as well work on other areas which are equally important.
  • Once you are stronger, your confidence in using your arms to support yourself in sitting as well as in standing also improves. It is best to have a Physical Therapist or caregiver or somebody who is able to support you initially to be present when you first attempt to stand on your leg. The first attempt would be challenging. But think of your goal. Think of being able to move around with more freedom and you will find the strength to continue.

What to do:

2.1. Aided Standing Balance. This is best done with somebody who can immediately assist you just in case you lose balance. Position your wheelchair next to a sturdy post or a grab rail. From your wheelchair, push yourself up using your arms (like in dips). Then shift your weight to your standing leg. Let your leg bear your body weight while using one arm to grab the pole or grab rail. Pull yourself upright with your arms while at the same time push the ground with your leg so you can straighten your knee. Your body weight is now supported by your leg and your arms pulling on to the grab rail. Stand upright and look straight forward. You may be wobbly at first but that is why you have to train for this. Stand upright while supporting your balance with your arms. Do this for 30 seconds before sitting down. Rest for 1-2 minutes before standing up again. If 30 seconds seem easy, do 1 minute. If it is easy do 2 minutes. Progress as you can tolerate.

Amp aided squat

Aided standing balance

2.2. Standing Balance. If you are able to support yourself standing upright for 2 minutes while grabbing on to the pole or grab rail,  progress by letting go of one arm, then the other until all your weight is supported by your standing leg. Your caregiver may initially assist you by wrapping a thick belt around your waist. Practice standing upright while balancing yourself. Your progress is dictated by your determination as well as by listening carefully to what your body tells you. If you feel dizzy, rest long enough until you can stand up again.

standing balance

Standing Balance


   3. To develop leg strength.

  • After a few days practicing standing balance and tolerance, it is time to train your leg to be able to tolerate longer standing time and to be able to support your body weight.

What to do:

3.1 Supported squats. Just like when you are about to stand up, shift your body weight to your leg while your arms grab the supporting pole in front of you. Stand up straight but do not let go of your arms. Then lower yourself to a sitting position but the moment your thigh or buttucks touch the chair, stand up again. That is one repetition. Repeat as described in the chart.

This exercise makes your thighs strong enough to be able to support you as well as to enhance your balance. Along with the dips and shoulder pressdowns, it also prepares you to climb up and down the stairs.

Aided squats

Supported Squats

Follow the accompanying chart for the number of repetitions and sets per exercise. Rest for 1-4 minutes after every set and exercise or until your breathing has returned to normal. Breath every time you exert effort and do not hold your breath. The height of the wooden blocks are adjustable. As you get stronger, increase the height of the blocks. Usually, it takes 2 to 4 weeks to develop sufficient strength. If there is a caregiver or Physical Therapist who knows how to train you for the walker and crutches, your progress may be faster. But there are individuals who, by virtue of their will to break free from perceived limitations, are able to progress quite fast. But be wary also of overdoing things. The progression as shown in the charts, gives you a target as well as guideline on how to progress. Take also into consideration other factors so if you do not feel well for that day, you can lessen the sets or prolong the rest. But as you become stronger try to progress.

This table is for one week (week 1 of these exercises). Follow the next chart for the succeeding weeks.

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 3 10 2
Shoulder pressdowns 3 10 2
Supported Squats 3 6 2
Aided standing balance 3 1minute 2

Week 2 to 3:

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 3 to 4 15 2
Shoulder pressdowns 3 to 4 15 2
Supported Squats 3 to 4 10 2
Standing Balance 3 to 4 1minute 2

Week 4 and until able to use crutches easily:

Exercise Set Repetition (rep) Rest between sets (minutes)
Dips 4 15 1
Shoulder pressdowns 4 15 1
Supported Squats 4 15 1
Standing Balance 3 As long as tolerated 2

The above tables are suggested guidelines to show how to progress. Many factors interfere with progress and sometimes it feels like you are not improving. But be patient and persistent. Do it for yourself and for those around you. Train Better, Live Better!

The main reason for this blogsite is to share useful information to improve one’s quality of life by improving health and fitness. This particular blog is for a friend who is willing to get past big challenges and improve her quality of life.  It is also for anyone who had lower limb amputation and wants to be able to stand up and move around again with independence using walkers or crutches. Many would be able to progress to using prosthesis but it is beyond the scope of this blog to determine prosthesis use. That is best discussed with your physician and other allied medical professionals.

The first steps start with your will to get better. After the surgery, let the natural process of wound healing take place and at the same time try to prevent infection of the wound and the development of sores. And during the first few weeks while you  are still limited in bed, you can do these:

Set and act on your goals Set small goals which will help you to progress and helps to keep you focused on recovering. Your recovery takes time. It is best to approach it as a step by step process which usually coincides with the natural healing process. Sometimes the stages take longer time than expected. Each situation is unique and these are just “guidelines” which provide some direction. Sometimes you and your caregiver may have to adjust depending on your ability. But remember, it is not easy. If it is easy, it may not be enough to trigger positive changes that leads to recovery and adaptation to your new situation. Here are a few goals with some plan of action on how to achieve them:

Goal #1: To be able to prevent pressure sores.

  • Pressure sores form when the skin over the bony parts of the body are pressed against the bed or chair for a long time. This is when you stay in only one position for an extended period of time. They start as red sores and if not addressed would progress to blisters then to open sores which require additional care and attention.

What to do:

  • Always check for pressure sores on the back of the head, the skin over the shoulder blades, the elbow, the sacrum, the buttocks, inner side of knees,and the heels. See the illustration on where to check. Take note that you may not feel anything on these areas so it is best to visually inspect and also run your hands on the areas that you can reach like the lower back and buttocks. Running your hands around these areas also acts as a mild form of exercise.

    pressure sores

    Image from google

  • If there is redness, or blister, or open wound on any of these areas, wash it with antiseptic. Keep it clean. It is best to tell it to your doctor as soon as possible.
  • If there are no sores, that’s great! To keep it that way, change position as often as you can. When sleeping, try sleeping on right side, left side, and on your back. On your waking hours, sit upright, shift weight side to side, and practice transferring from bed to wheelchair. Doing exercises below also lets you change position and redistribute pressure on the weight bearing areas of your body. And it helps you develop strength gradually as well as develop skills you need to be more independent in your activities of daily living.

Goal #2: To be able to recondition the body and maintain joint and trunk mobility.

  • After a few weeks or months of being confined in the hospital and being bedbound, the muscles surrounding the joints lose strength and flexibility. We need to recondition them again before subjecting them to more intense training later on. Depending on your current condition and level of motivation, it takes 1-2 weeks of doing these exercises before we can progress to the next level.
  • The following are mobility and breathing exercises to prepare your ribcage and other joints for strength exercises. You can do these exercises in bed as well as on chairs.

What to do:

1.1. Deep Breathing. Breath your stress out and breath in energy. Sit up straight and breath in for 3 counts. Hold the air in for 3-4 counts, and breath out for 3-5 counts. You can press the palm of your hand on your belly to feel its movement as you breath. Repeat for 10 to 15 times. Do breathing exercises before and after your exercise sessions.breathing exercise 1.2. Shoulder rolls. In the upright sitting position rotate your shoulders backwards by pulling them up as close to your ears as possible, then backwards by pulling your shoulder blades together, then downwards by pushing your shoulders a low as you can like trying to touch both hips with both elbows at the same time without hunching the back. You can also reverse the movement to roll the shoulders forward. Do 10-15 reps forward and 10-15 backwards. Do 1-2 sets. shoulder roll 1.3. Reaching upwards and to the sides. This is an exercise that involves almost all joints in your arm as well as the  shoulder complex, neck, and upper trunk. It also helps to develop and improve upright sitting balance and tolerance as well as improving overall trunk and arm mobility. Refer to the photos. Do 5-10 reps per side for 1-2 sets. upward reach up to sideward reach1

side lying hip abduction

Hip Abduction

1.4. Hip Abduction Lie on your side. You can use your arms as support for your head or you can use a pillow. If you are lying on your left side, you can slightly bend your hip and knee so as to be able to balance in this position. Now raise your right leg to the side. Do it slow and under control. Do it 10-15 reps. Then change position and lie on the other side (right side). Repeat the same process like you did on the other side. Do 2-3 sets per side.

knee extension

Knee extension

1.5. Knee extension Sit upright on the side of the bed with the edge of the bed almost on the edge of your knees and allow your legs to dangle. The bed is better since it is usually higher than a bench and allows your legs to move freely. While keeping a good straight posture, straighten one knee in a smooth controlled motion before lowering it to the bent knee position. All the while keeping the other leg relaxed in a bent knee position. Repeat 10-15 times before doing the same for the other leg. Do 2-3 sets for each leg.

prone hip extension

Prone Hip Extension

1.6. Prone hip extension Lie face down on your bed. Extend one hip up. The lower front of your thigh will be lifted off the bed. Hold on the highest position for 1-2 seconds before slowly lowering your thigh. Do 10-15 reps on one side before doing the same exercise on the other side. Do 2-3 sets for each leg.

Important things to know:

  • One complete movement of an exercise is called a “rep” (shortcut for repetition).  A group of repetitions is called a “set”. Rest for 1-4 minutes after every set and exercise or until your breathing has returned to normal.  Follow the accompanying chart for the number of repetitions and sets per exercise.
  • After a week or so, proceed to the next level if you do not feel dizzy doing these exercises. (Click here: Practical Strength Training for Standing Balance and Tolerance). Another sign that you are ready to progress to the next level is when these exercises feel boring and too easy! Congratulate yourself if you are able to do the above exercises with good control. You are a step closer to the bigger goal of being able to move around with greater ease and control! Train Better, Live Better!

Have you ever had experienced feeling pain on your heel when stepping off your bed in the morning or after long periods of sitting? The pain usually decreases after walking for a few minutes. This usually happens to people who stand for extended periods of time like teachers, security guards, and nurses. It can also happen to runners, flat footed or high arch footed individuals, and heavy individuals as well.


Plantar fasciitis is a painful condition. It is the inflammation and tightening of the plantar fascia of one or both fe280823885_640et. The plantar fascia is the strong fibrous sheet covering the muscles of the feet. It originates from the calcaneous or the heel bone and fans out and connects to the metatarsal heads (just before the toes). The hallmark symptom of this condition is the painful first step in the morning. The pain on each step causes discomfort and lessens productivity at work, performance in sports, and the satisfaction from leisure physical activities. It is not an emergency case but since it involves locomotion, it is not something that can be ignored.


What are the causes? Prolonged daily standing and frequent and regular hiking or running are the common activities associated with plantar fasciitis. img-blog-03The foot has an arch, or like a bow, and the plantar fascia is the bowstring. Some individuals have very tight “bowstring”. Some have flat feet- which makes for a weak plantar fascia. Prolonged standing, and constant running or walking stresses and irritates the overly tight or the weak plantar fascia. The constant irritation on the plantar fascia causes them to inflame and become tight. This pulls on their origin on the calcaneous and the fascia is strained mostly near the insertion. There may be small tears especially if the fascia is very tight.


plantar-fasciitis-shoes-sandals-5How do we ease the discomfort? Shoe inserts help to lessen the discomfort. Taping can also be done but just like shoe inserts, this is a temporary solution and is used usually by athletes who cannot use footwear when training. Buying athletic tape or kinesio tape and applying them costs time and money too. Although this is an option that would be done depending on one’s situation. The main solution however, is to prevent the plantar fascia from being irritated. Causes of irritation are usually  a combination of activities like prolonged standing, constant running or walking; conditions like obesity or simply being too heavy; weak and or tight plantar fascia due to flat feet or high arched feet; or running or walking foot mechanics that predispose the foot arch to excessive stress. It is not possible to change the foot from a flat foot to a normal foot. But the cause of the irritation can be addressed. The physical irritation is caused by the unnecessary  tightness and weakness of the plantar fascia. This magnifies the normal stress it encounters during daily activities like standing, walking, and running especially if it is prolonged. The best solution is to stretch the plantar fascia as well as to strengthen the foot intrinsic muscles so as to enable them to cope with the stress and thus avoid irritation and swelling and pain. It also helps to stretch the Tendon of Achilles.



Massage and stretch your own feet. Do it after your usual training routine.

There are exercises to stretch the plantar fascia, as well as the tendon of achilles. The exercises are simple and easy. They are best done after a training session during the cool down period. Better incorporate it into an existing routine which would increase its chances of being accomplished. The stretching exercises are best done with 20 to 30 seconds hold at the stretched position, then flex the joints and massage the sole of the foot. Repeat 5 to 10 times per leg. Do it with your regular training routine or around 2-3 times a week. It can be done more often since it is very light exercise.


golf ball massage

This can be done while typing in front of the computer. It makes you do two things at the same time!

An addition to the stretching exercise is foot massage. And this can be done with golf balls or similar hard balls. A practical way of doing the foot massage with the hard ball is to put the ball under your office or study table. Step on the ball and roll it back and forth and side to side with your foot. Do it when you can or around 5 to 10 minutes at a time. It can be pleasurably painful. It can be done while doing some paperwork too which makes work fun!


towel pullAnother exercise can be done to improve the function of the foot intrinsic muscles. This is called towel pulls. Put a towel on the floor with your toes on the bottom of the long end. Keep your heel on the floor while your toes pull the towel towards you. Do two to three towel lengths for each foot. It is best to do the stretching exercises after the towel pull.

Read here for other ankle exercises.



The calf stretch helps. Incorporate it into your usual cool down routine.

The discomfort caused by plantar fasciitis may take a few months to subside. It also takes time to stretch the tough plantar fascia. Sometimes it comes back which means the conditions leading to it are present again: weak and tight plantar fascia, prolonged standing, overweight. This basically means that we need to pay attention to ourselves. Injuries, whether due to acute trauma or through a slow build-up from many factors, are messages that we need to pay attention to. Acute injuries are mostly due to a big and sudden “error” on how we move.

(Read this for exercises to lower your ankle incidence)

Overuse injuries and inflammation of tendons and fascia are usually caused by a combination of repetitive movement and flawed joint mechanics. We feel the pain when damage has been done. Let your body recover and address tightness or weakness or both. Sometimes it means reducing training volume and intensity. Sometimes injuries and usual aches happen to let us re-focus and think. Heed your body’s warnings, Train Better, Live Better!

Once sufficient balance is established or re-established for those who injured their ankles, the next step would be to increase the ability of the muscles moving the ankle joint to tolerate fatigue. This is done by improving their strength and endurance. Since the ankles are both used for explosive movements, like jumps, and endurance movements, like running long distance, both types of activities should be prepared for. Majority of the population would benefit from preparing the ankle joint musculature this way. Take note that we may be referring to the ankle joint but the exercises that compose the training routine actually involves the whole body moving and working as one unit composed of smaller units working synchronously together. Emphasis is just placed on particular areas which might have been injured or is prone to injury.

Do it anywhere ankle exercises

1. Ankle eversionseversion

Stand on both feet flat on the ground. The distance between the feet should be around the width of your hip. Try to lift off the ground the out side part of your feet or the side of your little toe. You can do it one foot at a time or both feet at the same time. The inner part or the side of the big toe should of course be always touching the ground. This is a very small movement and if you watch yourself in the mirror, it may seem like you are just moving your feet to a beat of a catchy song. You should feel the outer side of both legs.

2. Toe raises (Ankle Dorsiflexion)df

Stand with both feet on the ground and like the first exercise, the feet should be hip width width apart. You may hold on to something or you can do it standing freely, although you may sometimes lose balance. Lift the toes up either both at the same time or one at a time. You would feel the front part of your leg just beside the shin bones.

3. Tip toes with (heavy) load (Ankle Plantarflexion) Tip toes  Like the first two exercises, do this standing up with the feet hip width apart. Since the calf muscles (gastrocnemius & soleus) are very strong muscles, you need extra weight to overload them so that they can adapt to become stronger. However, if you are recovering or have just recovered from an ankle related injury, your body weight would be just fine then progress to carrying some load if you notice that your ankles are already strong enough to tip toe without difficulty.

Like most of the exercises suggested in earlier posts, these exercises can be done indoors and outdoors. Outdoors is where running is supposed to be done anyway. They are just presented here in a way that an individual who loves the outdoors can go out and enjoy and train at the same time in a creative and effective way. The first and second exercises can actually be done while standing, say while standing in a bus, or simply standing in line queuing. You can even do it while browsing your smartphone. Talk about multitasking! They can be done by themselves while you are, say standing while commuting in a train. It saves you time. Ankle eversion is not a big movement anyway. It is not attention catching like bigger movements like jumping, but it is also an important component of ankle biomechanics. The first two (ankle eversions and toe raises) are supplementary exercises that can be done outside of a training routine. It is better to do Tip toes with load with your other routine exercises.


To explain a little bit about the exercises- the Ankle eversion trains the peroneal muscles on the side of each leg. The Toe raises trains the Tibialis Anterior on the front part of each leg. These are smaller muscles designed for finer movement of the ankle joint and not necessarily for strong and powerful movements. They help in stabilizing the ankle joint in every step when walking and running and in most moments we are standing upright. The Tip toes train the calves- those drumsticks behind each leg. The calves are actually composed of two strong muscles- the gastrocnemius and the soleus. They are thicker and stronger muscles with a very strong tendon designed for both powerful movements like sprinting and jumping and also endurance activities like running for long distance.


Recommended training volume, intensity, and frequency:

Four to five sets of 20 to 30 repetitions per set is recommended for ankle eversions and toe raises two to three times a week. This relatively high volume is to increase their tolerance to fatigue. Just think of how many steps you make in 5 km run. If they tire out easily, especially on uneven terrain like the downhills in a trail run, then the tendency of having a miss-step is higher which leads to ankle sprains. To help reduce the incidence of poor ankle biomechanics due to fatigue, train the ankles at a relatively high volume of low intensity. Low intensity means the load is relatively light and the movement is at a smooth and controlled speed. The load is just your body weight divided by two since it is carried by two legs and feet.


As for Tip toes with load the volume is three to four sets of 15 to 20 repetitions. Volume is lower but it has a relatively higher intensity. The heavier load you carry, the higher the intensity. Just carry something heavy, like your backpack, to offset your center of gravity a little bit to add to the proprioceptive stimulation to your ankles. If you always lose balance, reduce the load until you can balance most of the repetitions.

Until when will I keep doing these suggested exercises? How many training sessions for how many weeks?

There is no hard rule but do them until you feel it is not challenging anymore. This would be around one to four weeks (2 to 8 sessions) depending on your perceived improvement. It also helps to “revisit” these exercises once in a while even if you are already quite good again in doing your favorite physical activity. As their name states it- they are supplemental exercises. They can be added to your main training but they will not be your main training exercises especially if your level of physical activity is quite good. If you have some balance issues or you are recovering from ankle injuries, read Ankle Training Part 1. If you feel that these exercises are not challenging anymore, try doing the next level (Ankle Training Part 3: Low level Plyometrics).

Read about Torogi Squats.

Ankle training Part 1

Posted: February 26, 2015 in Recovering from Injuries

Ankle sprains are common especially in the physically active population. A survey showed that as much as 73% of athletes in Hong Kong (from recreational to competitive and elite level athletes) had recurrent ankle sprains. The good thing is that this type of injury can be mitigated through training. Described below are some exercises that can be used as a warm up routine while at the same time they serve as a prophylactic exercise against common injuries like ankle sprains. It is hitting a lot of targets with a single routine.


There are an endless types of exercises that can be used to prepare the ankles to absorb forces. Here are some exercises which would strengthen the leg muscles whose tendons cross the ankles. Aside from being very good exercises for dynamic warm-up for the whole body, these exercises also train proprioception in the ankle joints and also increase the tensile strength of the tendons and ligaments around the ankle joint. They can be used in your warm up or as assistive exercises. Mark two points on the ground which are around 5 meters away from each other. Travel the distance with the following exercises. Walk back to the starting position after each exercise. Repeat each exercise 3 to 5 times before moving on to the next exercise.

1. Knee hugs tip toe

Stand straight, be as tall as you can. Pull back your shoulder blades. Lift one knee as high as you can while pointing the toe of this leg as high as you can. With your arms, hug your knee as close as you can while pushing the ground with the toe of the other leg. Try to be as tall as you can. Maintain the position for 2 to 3 seconds before taking a step forward. Repeat with the opposite leg. Note that standing on your toes is an important part of this exercise.


Front View of the Knee Hugs to tip toe:valstrengthtrainingkneehugfrontvw

2. Flying T

Start with the same starting position as the knee hugs tip toe. Instead of hugging the knee extend your leg backwards as if you want to reach something behind you with your leg. Do not tip toe. Keep looking forward, not on the ground. Spread your arms to the side to form a letter T. Maintain the torso and “reaching” leg in a straight line and almost perpendicular to the standing leg. Stay on this position for 2 to 3 seconds before pulling in the reaching leg and stepping forward. Repeat the movement with the other leg.


Front View of the Flying T:


3. Knee Hugs to Lunge Stretch

The starting position is the same as the Knee Hugs tip toe. This time after hugging the knee, and standing on the toe, lower yourself on the other foot to a lunge position. Lunge as long and as low as you can without losing balance. Keep both arms directly overhead and keep your elbows as straight as you can, with each of your biceps touching the ear on the same side.


Front View of the Knee Hugs to Lunge Stretch:


Using these exercises for warm-up saves a lot of time since they address a lot of issues in one go instead of doing a lot of exercises to address balance, flexibility, and ankle stability. It also serves to increase body temperature and heart rate prior to doing your main training. This can be used prior to your Strength Training or prior to running or trail running. Runners and trail runners would benefit from these when it comes to ankle stability. There are other exercises that can be done outdoors to for stronger legs and general strength too.

Click here if you want to learn about an unusual, overlooked, but very effective strength training method. 

With good preparation, the incidence of sports related injuries can be lowered. And if an injury does happen, the severity most likely would be lesser and the recovery time would be faster. This is a big return of investment and it shortens training time while increasing quality of training. Train Better, Live Better!

Read Ankle Training Part 2

Here are a few quick stretches and some exercises to help reduce discomfort experienced by some people who have lower back pain and pain on the back of their thigh extending to the back of the leg. If the discomfort is caused by an irritation of the sciatic nerve by tight and weak muscles around your hip and lower back, loosening the tightness and improving muscular control of your torso may help ease the discomfort. The sciatic nerve may be irritated. It is referred to as sciatica. Try these exercises in 3 to 4 alternating days within 1 to 2 weeks and hopefully you would experience some relief. If it gets worst even before 1 to 2 weeks, the best way would be to consult your physician. Sciatica may also be caused by impinged nerve roots due to a prolapsed or herniated intervertebral disc. Pain may be more severe in this case and a proper diagnosis has to be established so that proper interventions can be formulated thus a physician should be consulted.

These exercises may have different names depending on who is describing them but the more important thing is that you do them with sufficient and appropriate intensity long enough to notice positive effect. You can rename these exercises if it helps you remember them. You may call them Benny or Roger, whatever makes you remember to get them into a regular routine. I just made up the names myself to help me visualize them.

  1. Figure 4 (and its variations)

This is very simple and as you can see, you are very familiar with it. You can do it anywhere where you can sit. What you need to emphasize is an upright back and “high” chest. If you do not feel enough stretch, then lean forward but do not slouch. The photos show in sequence from initial position to position to stretch hip internal rotators and hip external rotators to increasing intensity (by bending forward).


  1. Figure 4 went to sleep

When the first exercise does not provide enough stretch, changing position would increase the stretching effect.


  1. Hug your thigh

Since you are already lying on your back, might as well try hugging your thigh. Photo is shown above with figure 4 went to sleep.


  1. Number 7

If you felt some relief after doing the figure 4 exercise but want some more stretch, proceed to figure 4 went to sleep and hug your thigh. If you still need more stretch intensity, do what I call Number 7 (the position of the thighs and bent knee looks like number 7). Hopefully by this time you would have significant relief or there is no pain at all. Then you can start becoming more and more active, and start enjoying life more.valstrengthtrainingnumber7


For stretch exercises 1 to 4, hold the position for 20 to 30 seconds depending on your tolerance. Repeat 3 to 4 times in a session.

Here are some exercises to help you stretch further and at the same time improve muscular control of your torso:

a. Dog – bird

Needs a bit of coordination and balance. First photo is starting position. Then lift 1 arm and the opposite leg and touch your knee with the opposite elbow. Then reach with your arm as far forward as you can while kicking back as far as you can. Lift your leg higher than your butt. Eyes follow your moving hand. Repeat by touching elbows and knees.


b. Inchworm

It stretches your hamstrings and lower back as well as lets you use the front muscles of your torso. Do not try if your back is aching! And if you tried it and cannot maintain the position then try a less strenuous movement like the dog – bird (or bird – dog, or call it as you like).


Walk your feet as close to your hands as possible without bending your knees. You will feel a stretching sensation on your hamstrings and your calves.


Once your feet are as close as they can get to your hands, walk your hands as far away from your feet as possible while maintaining a stable torso.

For dog-bird do 30 to 40 repetitions  (15 to 20 per side) for 2 to 3 sets. For inchworm, do 5 to 8 meters for 1 to 2 sets initially then increase as you get stronger.

Remember, if you have a condition that can be made worst by a physical activity, it is best that you discuss with your doctor if you plan to start becoming more active. If you are cleared to participate in regular physical activities, start gradually and pick the exercises that you can do safely. And do the exercises with sufficient intensity and duration so they can work. The exercises shown above are suggestions and they may work well as long as they are done properly for those who are able to do them safely.

Try which position or variation provides you with some relief and try these exercises for one to two weeks to be able to observe if they work for you. But, if you feel something is wrong, or something hurts while doing the exercises, stop doing them and better consult a physician.


This blog is for those who had ACL Reconstruction surgery. It discusses why we do the squats and deadlift as tools in addressing Post ACL Reconstruction cases. Readers looking for detailed discussion about the mechanism of injury, anatomy of the knee, and types of surgical intervention are advised to look into other sources since this would be outside the scope of this short blog. This NOT a guideline. For those who plan NOT to have ACL tear, read on too. Other related blogs will be posted soon.

acl basket

Options in managing Post ACL Reconstruction

If the ACL is torn, the athlete/ patient has two options: either to have a conservative approach or to undergo surgery. The conservative approach means the knee would still be unstable. It may be ok to have this option if there are no other associated structures in the knee which were damaged and there is minimal instability. After a thorough discussion with their surgeon, athletes or patients who plan not be physically active anymore, may choose this option. The surgical intervention option presents the athlete with a more stable knee. Every procedure entails risk, and granting that there are no secondary complications, most of the outcome would depend on how well the surgical intervention was able to restore the previous function of the torn ACL. The rehab that follows as well as any strength training that follows later, would work on the foundation established by the success of the surgery. But no amount of Strength Training would change the knee anatomy into a very efficient and stable knee. It cannot change the inherent knee anatomy, the Q angle, patellar angle, etc. Strength Training and Conditioning, if done well, would serve to strengthen the knee – the structures that make up the joint, and the muscles that move it. A much stronger knee is more able to resist high amount of forces. Strong and powerful lower limb musculature enables the limb to generate sufficient amount of force repeatedly when needed. An appropriate conditioning work would enable the athlete to sustain a high amount of work before fatigue sets in. Fatigue affects the quality of movement and the crucial split second decisions in the playing field. If the athlete is physically prepared with a good strength training and conditioning program, he or she is able to resist fatigue better and able to absorb and deflect impact forces more efficiently. This lessens the chances of re-injury. It does not take away pain, but if the knee functions well, if the running and jumping mechanics are more efficient, then the pain caused by small damages brought about by inefficient movement, would most likely be lesser. For both options, arthritic changes may soon manifest later in life. Weakness brought about by degenerative changes would be lesser too if the athlete invested in keeping himself/herself strong and fit in earlier years. This can be addressed by a good Strength and Conditioning training program.

After Physical Therapy (or Physiotherapy), a good Strength and Conditioning training program that addresses the particular needs of the athlete is imperative if the athlete is expected to perform better. In one case, the Strength and Conditioning training was started immediately when the athlete was discharged from the hospital. But of course, this was under the surgeon’s recommendation and the involved knee was not yet trained. Training prevented a sudden drop in fitness level while awaiting for the involved knee to recover enough. Most of the athletes who we worked with were able to resume normal training after 6 months. An exceptional athlete managed to go back to training and compete for their major competition in less than 6 months.  And it is also worth mentioning that the Athlete, Surgeon, Physical Therapist, Strength and Conditioning Coach, other support staff, and the sports team were all working very well together in this particular case. It was a huge team effort. The effort paid off when the athlete and her team emerged as champions in that major competition.


Why Squats and Deadlift?

dl ladyThese two exercises are used to increase strength. They require some amount of technique, they use the whole body, and are ground based. Executing them requires coordinated movement of several major joints, and they require that the torso (or core as it is popularly termed especially in the commercial side) is in a good position, and is able to maintain a stable position under tension while the squatting or deadlift movement is completed. They require some amount of balance and a lot of proprioceptive awareness. They require a decent amount of mobility and flexibility, and they are fundamental movements. In short, the squat and deadlift are very useful and effective.

These are two main exercises that, when executed well with sufficient load and range of motion, would address a lot of issues. They may look plain and unsophisticated as compared to the standing on a pink balance disk while the other leg is hanging on a yellow TRX exercise, but they work. They require a lot of effort to do if a sufficient load with sufficient range of motion is used. That is one reason why they work.


What does the squat and the deadlift do?

back squatA lot! Knee injuries happen when impact or landing forces are higher than what the knee can absorb and deflect. Training the body to be in a good position even under tension helps it to react in the same way under playing conditions. That is what squatting and deadlifting requires – the lifter to assume a good posture and stance before the lift, during the lift and after the lift. The squatting and deadlifting positions are very similar to almost all athletic movements. Squatting and deadlifting are done in a controlled environment and load. Granting that the lifting technique is good, and the load and range of motion is higher than what is usually encountered in the playing field, then athlete is able to keep up with the demands of his/her sport. That principle is what enables athletes,  with repaired knees, perform very well upon returning to training and competition. Some of them even performed better after retraining probably due to better biomechanics ingrained in strength training.


Is it that simple?


Yes and no. Squats and deadlifts are complex exercises that takes time to learn. They do a lot for the athlete who wants to perform well after an ACL repair. If executed properly with sufficient load and range of motion, these two exercises do wonders. These two exercises address fundamental components which are usually wanting in injured and injury prone athletes. We do not need to look for very complicated exercises with fancy routines. All the other fancy exercises also have their uses but they can not replace the squat and deadlift. If squats and deadlifts make the main course, the other exercises are side dishes. Enjoy your meal!

Val R. Jr., PTRP, CSCS