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The Beginning

 

Start working on range of motion AS SOON AS YOU CAN.  The longer your limbs remain immobile the longer it takes to get back to normal range of motion.  

 

My Toes

 

When I was approved to to start working on my range of motion I immediately started trying to move them as much as I could.  I remember mobility in my ankles being almost non-existent and wasn’t able to move my toes at all.  I almost felt paralyzed as I would try and twinkle my toes but nothing would move.  My at-home occupational therapist at the time advised me to not give up and more or less ‘will’ them to move.  I assimilate it to something like Luke Skywalker in Star Wars learning how to use the force when he didn’t know he had the skill.  I remember being concerned at the lack of mobility but just like everything else I ‘Did what the doctor ordered’.  I don’t recall how long it took for mobility to start to return, but it was something I did every hour I was awake and I saw progress which made it worth being as diligent as I was.  It wasn’t until I was weight bearing and had Graston applied to my toes that mobility improved dramatically.  

FR Post Chain Stretch

- Roll out your legs from your ankle to your buttocks.  I counted until about 15 for each section of each leg.

  • Calves

  • Hamstrings

  • Glutes

Medicine Ball Stretches

- Roll out the inside of each thigh .  I counted to 30 for each leg.

Clamshells

Go until exhaustion or as directed by you PT.  Eventually rubber bands should be introduced to increase difficulty.

PSOAS Strength

- Go until exhaustion or as instructed by PT.  Eventually ankles weights will be introduced to increase difficulty.

CA Hip Abduction

- Go until exhaustion or as instructed by PT.  Eventually ankles weights will be introduced to increase difficulty.

Bird Dogs

- Go until exhaustion or as instructed by PT.  Eventually ankle weights will be introduced to increase difficulty.

Bridges

- Go until exhaustion or as instructed by PT.  Eventually ankle weights will be introduced to increase difficulty.

Fire Hydrants

- Go until exhaustion or as instructed by PT.  Eventually ankle weights will be introduced to increase difficulty.

Four way ankle

- I loved this exercise.  It focuses on strengthening the muscles around your ankle to gain stability back.  I had the exercise specialist pull on bands as hard as they could until I could feel the muscles activating / burning.

Ab roller

- Basic exercise for abdominal muscles.  If you are unable to perform these your PT will be able to supply you with some alternatives.

Planks

- Basic exercise for abdominal muscles.  If you are unable to perform these your PT will be able to supply you with some alternatives.

Side Planks

- Basic exercise for abdominal muscles.  If you are unable to perform these your PT will be able to supply you with some alternatives.

Core heel taps
- Basic exercise for abdominal muscles.  
Calf stretch off step

-  I did this exercise constantly.  Home, Pool, Physical Therapy, gym, etc...

ECC HR on step

- Ankles stretching and calf strengthening.

Ankle mobility
Hip Burners
Single leg stance on foam

- Great for strengthening but a really frustrating exercise.  Be prepared to struggle but an exercise not work skipping.

Lunge Matrix

- Personally hated this exercise but they all have a purpose!

ER Series
ER Series - Skaters
Tug Boats
- Personally hated this exercise but that all have a purpose!
Air squats with heel support
Trampoline Jump
Single leg ball toss on foam
Cone pickup from foam

- Personally hated this exercise but that all have a purpose!

Cone pickup on foam...continued
Single leg cone taps on foam
- Personally hated this exercise but that all have a purpose!
Hurdle jump on foam
Step-ups
Jump squats

- Not my greatest.

Hurdle jumps

- Really good to help gain more range of motion from impact.

Hurdle jumps...continued
Bosu Step Overs

- Loved these.  A great exercise to get you ankles moving again.

Bosu Air Squats
Bosu Air Squats...continued
Palloff Press
Smith Machine Squats
Single Leg TRX Squats

Agility Ladder

Agility Ladder

more Agility Ladder

Four Cone Sprint Drill
Single leg chop on disc
Single leg chop on disc
Running again
My training montage for Samir to bring to Conference he was speaking at.

 

My Ankles

 

There was some mobility but very minimal.  I remember pulling on them as hard as I could with elastic bands but progress was very slow but just as I did with my toes I pulled on them on the hour every hour I was awake.  

 

One thing I never expected was what happens to your feet when are elevated for as long as mine were.  It was explained to me that essentially your body forgets how to pump the blood back out of your feet, so I needed to spend a lot of time getting used to not being elevated.  I recall hanging my feet over the side of my bed for as long as I could but at the beginning could only tolerate 10 seconds or less.  My feet would balloon up and turn purple and experience a burning sensation.  I was told as soon as I could bare weight on my feet and ankles, mobility would improve so I kept at it until they could be down for long periods of time.  Pushing the envelope, I eventually got to to the point where I would stand on the steps (holding on wall and staircase) without my heels bearing any weight to help speed up the process.  I recall doing it so much that It started impacting my sleep as I would find myself counting 0-60 in my head even when I wasn’t doing any stretching.  Standing on the steps when I wasn’t approved to bear weight on my heels is NOT RECOMMENDED.  In hindsight I shouldn’t have been doing that but I was overly cautious and was confident I could perform the exercise without risking injury.  

 

I also did a lot of stretching.  Having prior experience with my Chiropractor and Physical Therapist, they were able to stop by my house one night after work.  After a quick assessment they noticed my back was in really bad shape.  Based on me sitting in bed for so long with my feet elevated my lower spine had curved the wrong way and when they asked me to kneel straight up and I could only get to 45 degrees.  They both immediately told me how paramount stretching would be and quickly made that a daily activity.  Fortunately, my Chiropractor lived in the same neighborhood as me and would stop over every couple days and stretch me out thoroughly.

 

I asked my chiropractor to describe my back condition in medical terms.

 

    “Following the fall you were left with two hairline fractures and a disc herniation, along with a back that had to remain completely immobile due to your inability to walk/move, your lower back became kyphotic.  Having a kyphosis in the lumbar spine is the opposite of normal positioning/curvature, which is called a lordosis.  With that said, your lower back was essentially rounded in the wrong direction.  PT, decompression, along with the usage of at home devices like the Denneroll allowed your spine to slowly resume a more normal position.  And although it may never be what it once was, it is now much improved upon what is was following several months of laying in bed and recovering from reconstructive foot surgery. “  ~ Jason Green, D.C.


I also spent time everyday working out my upper body by working with bands, 10 lb plates and pushups.  Most likely didn’t have a major impact on my recovery but it did help me from a mental perspective doing some of the things I used to do.

 

 

 

 

 

 

Even though progress from exercises at home are not as quick or substantial as you will get with outpatient therapy, it is still very important. My chiropractor told me to start moving my extremities as soon as I could as the longer they are immobile the harder it is and the longer it takes to regain that range of motion or mobility.  I believe they said for every week a joint isn’t moved results in roughly 1 month of physical therapy to regain what once was.

 

Pool

 

As I mentioned, my chiropractor lived in the same neighborhood as me and I was fortunate enough to have the option of him picking me up on the way to the gym for me to do pool exercises that I learned in my couple physical therapy sessions where they had an indoor pool.  I was proficient getting in and out of the wheelchair and loved the independence, but if you need help don’t hesitate to ask.  I got a pair of strap-on sandals so I could concentrate on high impact movements to help with range of motion and mobility and  give me more grip when performing exercises listed below.  I would have went barefoot but the bottom of my feet provided me no grip based on not having walked barefoot in such a long time.  

 

Exercises:

 

Pool

  • Walking

  • High Steps

  • Calf Raises

  • Doggy Paddle - I did not have enough strength to hold my legs up from sinking so couldn’t go straight to freestyle.

  • Freestyle

  • Breaststroke

 

Hot Tub

  • Ankle manipulation

  • Calf Stretch

 

Outpatient Physical Therapy

 

When I was finally cleared for outpatient physical therapy, my physical rehabilitation finally got kick started.  With my Physical Therapist and Chiropractor already aware of my injuries I quickly settled into being there 4 days a week for typically a little over 2 hours.  I would spend the first 30 minutes or so being manually manipulated by both physicians and then would transition to exercises aimed at mobility, range of motion and strength training.  My specific exercises are listed below but I went into every exercise or movement with a goal of doing more than what was required.  If something was too easy I would ask how can I make it harder or if I was executing proper form.  One of the biggest reasons I chose to do physical therapy at Performance Spine and Sports Medicine - Newtown was that they wanted me to recover just as much as I did and had no issues pushing allowing me to go heavier or do more repetitions if was within reason.  To me there was nothing better watching me during exercises saying I didn’t execute proper form or knew without me asking that I was ready for more.  

 

Graston Technique

 

Graston Technique is an innovative, evidence-based form of instrument-assisted soft tissue mobilization that enables clinicians to detect and effectively break down scar tissue and fascial restrictions, as well as maintain optimal range of motion.

 

Explanation from my chiropractor of why this Graston Technique was used on me.

 

“Due to the extensive amount of fibrotic tissue (similar chemical makeup as scar tissue) that existed in the foot from the fall and reconstructive surgery, it was necessary to mobilize these areas in an effort to optimize movement and range of motion, minimize chronic inflammation, and decrease pain within the foot and surrounding tissues.” ~ Jason Green, D.C.

 

By far and away the most excruciating thing I endured the physical rehab process.  It was explained to me that the lack of feeling and hyper sensitivity in my feet was due to the nerve damaged caused from injuries and scar tissue being wrapped around the regenerating nerves.  Essentially Graston was used to break up the scar tissue and force it to heal itself.  This healing of the tissue allowed feeling on my feet SLOWLY come back.  I don’t want to sugar coat this at all.  It’s TORTURE.  So much so that I would grunt and scream to the extent other patients in the clinic would ask what was going on with me.  

 

Back

 

To help fix the curvature problems in my spine I was advised to get a Lumbar Denneroll.  You can learn more about the this product by clicking HERE but essentially it was used to help stretch the ligaments in my back that were too tight and causing my back to have become kyphotic.  As the ligaments loosen up my spine slowly returned to a normal curvature.

 

Denneroll Exercises - Instructional Video

 

I started with only being able to tolerate 30 seconds at each gap between vertebrae, but eventually got to a point where I did 10 minutes each gap.  I’d recommend bringing your phone or reading material with you.  It gets boring fast but is necessary if have a similar back problem.

 

Denneroll Placements

  1. Between L5 and L4 vertebra

  2. Between L4 and L3 vertebra

  3. Between L3 and L2 vertebra

 

Physical Therapy Exercises

 

Some of these videos were filmed when I was actually still in the middle of my physical rehabilitation as Dr. Mehta asked me to create some videos of my rehabilitation process as he was going to a conference to speak at.  The other videos were filmed strictly for purposes here.  I was battling some lower back pain during filming so I wouldn’t consider some of them to be ‘perfect’ form.  

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