Unsteady Surfaces

Eils and Rosenbaum14 reported that patients with chronic ankle instability who performed a multistation therapeutic exercise program displayed improved joint position sense, postural sway,

Figure 72-3 Backward walking on a treadmill.

and neuromuscular reaction times compared to a control group. Postural control through the ankle is of primary importance during relatively stationary single leg stance on firm, foam, and multiaxial surfaces.15 Wobble board or soft disk training does more to improve neuromuscular responsiveness and balance than it does to improve proprioception. The benefit of this type of training is that the patient improves his or her ability to discriminate different degrees of active subtalar joint inversion and ankle plantar flexion moments.16,17 Wobble board training

Figure 72-4 Single leg standing trunk twists with medicine ball.
Figure 72-5 Punching with dumbbells during single leg stance.

improves the foot and ankle motor control processes that occur below the level of conscious attention, but the effect is relatively short and may need to be performed daily for the effect to continue.18

Footwear may attenuate the deformation, shear, and mechanical transients that provide foot position information through mechanoreceptors during wobble board or soft disk training4; therefore, as previously mentioned, in a protected environment, barefoot training is recommended, particularly early during ther

Figure 72-6 Single leg step-ups and trunk twists with dumbbell resistance.
Figure 72-7 Forward stepping across an uneven matted surface.

apeutic exercise performance.4 Dynamic functional stability at the articulations of the foot can be emphasized to a greater extent when the patient is asked to perform these activities barefoot. Forward (Fig. 72-7) and lateral (Fig. 72-8) walking across an uneven obstacle course first with the eyes open and then closed can facilitate protective neuromuscular responses from foot and ankle musculature. The knee and hip joints have an increased postural control stability function under more challenging conditions such as hopping down to perform a stable, one-foot landing (Fig. 72-9) and should be eventually evaluated in synergy with the involved ankle and/or foot, particularly in regards to frontal plane knee position.

Figure 72-8 Lateral stepping across an uneven matted surface.
Figure 72-9 Single leg hop down and stabilize.

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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