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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
You can train the foot and the ankle in this half kneel position actively by teaching them the short foot in this position. Now have them hold the short foot, and then you can start to vary the rotational challenge. So have them pick up a light ball, put it down, pick it up, put it down. All the while I'm contracting and holding the short foot. Welcome to the Doctor.
Dr. JJ Thomas:JJ Thomas Podcast. Hey, everybody. Welcome to the Doctor. JJ Thomas Podcast. Podcast.
Dr. JJ Thomas:I'm JJ Thomas. Happy to have you here today. Today, we're gonna talk about balance. And specifically, we're going to talk about helping your patients with balance from all spectrums, whether they're the geriatric older patient who is slightly decontititioned and, you know, having a hard time and maybe higher risk or incidence of falling. And also, your athlete that sprained their ankle and you have to get them back.
Dr. JJ Thomas:Right? A pet peeve of mine is when I hear or see about people working with patients on balance, and they evaluate them, and they're like, oh, you know, single leg. Woah. This test where one foot's in front of the other, oh, they're limited. And then all of a sudden, they just put them right to the foam pad, and they were doing this, and they're throwing stuff at them and doing all these things, and they didn't check to see what happens at the hips.
Dr. JJ Thomas:So, today I hope to impart upon you the importance of before you even go to the ankles. Yes, their ankles may be weak, but we have to see what's happening above the ankles first. So, I'm going to give you some tools for that. The first thing, essentially, you're gonna do is put them in half kneel. Now if it's an older person and you and they're, you know, you're nervous about this for them, put them near a wall, help them along.
Dr. JJ Thomas:Honestly, fall risk decreases in an older population when they can get up and down off the floor anyway. Body mobility through primal and foundational patterns, as we harp in all our courses and everyone in our staff utilizes here at Primal Physical Therapy, is getting up and down on the floor is a life scale. So if they have a hard time getting up and down off the floor, that might be more important than their ankle balance anyway. So you're gonna find a way to get them safely to a half kneeling position. For your athlete, boom, it's easy.
Dr. JJ Thomas:Get in a half kneel, they're like, why are they putting me in my half kneel? I sprained my ankle. You'll see. So put them in half kneel. The way to standardize it is, at first, you're gonna have their hip over their knee on the base leg.
Dr. JJ Thomas:And you can standardize either. You can either have them with their feet like this or like this. For most people, like this, tuck toes, it's gonna be a little bit easier. But if they have, like, a toe, sometimes people have toe issues too. So if you wanna take it out of it, it's fine, as long as you standardize it every time you go to test it.
Dr. JJ Thomas:So the base leg knee is under hip. The front leg, in terms of medial lateral or this plane. You're gonna have ankle in line with knee, in line with hip at first. You're gonna have the knee flexed to 90 degrees. From there you're going to guide them to walk that front leg.
Dr. JJ Thomas:I'll roll this up so you guys can see my ankle. Walk that front leg over so it's in line with the base knee. Okay? And then they're going to hold their balance there. In that position you're going to see what happens, are their arms rigid and stiff?
Dr. JJ Thomas:If their arms are rigid and stiff there, they're not stable in that position, they're not stable in that narrow. I actually got less stable as I was rigid and stiff. But if they're rigid and stiff there, they're compensating, okay? Then from there you're gonna have them shut their eyes, just like you would in a normal, you know, standing balanced test. But in half kneel position, in this narrow half kneel position, what you're actually seeing is what's happening at the pelvis.
Dr. JJ Thomas:Is their pelvis responding to changes in mediolateral rotational forces? That's what the ankle is going to have to do for them. So if they're limited in those patterns, whether it's with eyes closed or eyes open, then you 100% would not want to put them on that foam pad yet until you've cleaned up this pelvic area first. And so you're going to start testing that if you aren't already. And when you find these deficits I'm gonna give you some exercise options you can do with these people.
Dr. JJ Thomas:So the first one, actually, and this is not necessarily in a particular order, but I'm gonna try to do it in a particular order. For easy, like for your, for your, maybe, your older population patient, or someone who's generally deconditioned, you're gonna have them in this position. And you're just gonna take a light ball or something, and you're just going to challenge their, challenge their balance through moving the ball. So you might have them pick up the ball, like that, pick up the ball. Right?
Dr. JJ Thomas:You might have them pick up the ball and throw it at you, if they're safe with that. I want to make one note, the test position was the narrow half, Neil. Right? When you're training it, you're gonna have them back in that original position, knee at 90 degrees, ankle, knee, hip in line, knee, hip in line on this side. Okay?
Dr. JJ Thomas:So just play with the ball. Straight plane, sagittal plane would be the first progression there. And then from there you could start having them put it on the outside. Pick it up from the outside, now that's going to challenge, you'll see my foot even though I have decent balance, you'll see my front leg working in rotational stability here. Another thing to add is you can use this opportunity to integrate the foot by having them do have you heard of the short foot?
Dr. JJ Thomas:Right? So if you zoom in on my foot here, the short foot is when you take the arch and you take the toes. I tell people to imagine you're a lizard suctioning onto a onto a window. And so you're gonna use your toes to grab and suction, keeping the base of the big toe down, until you form a little bit of an arch there. And so you can train the foot and the ankle in this half kneel position actively by teaching them the short foot in this position.
Dr. JJ Thomas:Now, have them hold the short foot, and then you can start to vary the rotational challenge. So have them pick up a light ball, put it down, pick it up, put it down. All the while I'm contracting and holding the short foot. Maybe I'm going to have them weave the ball like this, right? I'm getting short foot, I'm getting hip, hinge.
Dr. JJ Thomas:I got me on that one. Hip, hinge, hip hinge. Right? It's just a light weight. It's not even a weight, it's just an object.
Dr. JJ Thomas:But their gaze is changing, their forces are changing, their rotation is changing, They have to adapt. And in half kneel, it's in a position that they can accept, that they can tolerate, that they can meet that challenge and grow in that position. If you try to have them do all these things in single leg stance on a foam right away, they're not meeting that challenge. You're just training a pattern in an individual instant, but you're not going to make them less susceptible to injury in a real life scenario in that way, if you haven't treated the pelvis proximally. So let's go through some more scenarios.
Dr. JJ Thomas:You can, I would say, go to actually, I would say the next step would be, like, a heavier ball? Right? So this is an 8 pound ball. So you can do the same things. Grab with the foot, like lizard foot, short foot, and then same things, you could regress them to throwing, catching, if it's now we're talking athletes, right?
Dr. JJ Thomas:So short foot, clean it, throw it, catch it down. Clean it, throw it, catch it down. Right? You can go here, rotation. Here, rotation.
Dr. JJ Thomas:Right? You can have them in this position and you can have a catch of them. So now they're gonna rotational into the wall, or with you. They're gonna catch it, they're gonna swing it, throw it, catch it. Swing it, throw it, catch it.
Dr. JJ Thomas:Training these rotational patterns, also still not forgetting about the ankle and the foot, getting foot engagement, but regressing it to a point where you're challenging this in a way that it's not going to just jump to a compensation, it's actually to give them deliverable, improvements. So those are variations with the ball, with the kettlebell. You can do the same kind of patterns here, clean it up. Here, clean it up, press it, maybe come down. Right?
Dr. JJ Thomas:So all these rotational patterns are gonna be good for lumbopelvic stability, which will translate into single leg stance stability, and then eventually working it towards more dynamic. I wanted to give you one more option here. If the heavy ball is too much, you can have them do similar things in this half kneel position. You can have them just for, for a more deconditioned patient. You can use a small, you know, these TheraBand balls.
Dr. JJ Thomas:You can get them online for very inexpensive. I had a patient make one out of, a wiffle ball, and she filled it. She cut it, filled it. She's a very awesome patient, and taped it, and it works. So it's a 1 pound ball.
Dr. JJ Thomas:So you can go like this, hip hinge, you can have them, like, catch it, catch it all around, like, they can do their own. So they're just adapting, and they can be a little creative with it, or you can have a catch with them. Okay? So changing the pattern up between more control to less control, and then eventually you can even get them, if you wanna put them on the foam pad, in half kneel. Now that's gonna challenge them a little differently, right?
Dr. JJ Thomas:Another way I like to do this is bring a band, and now you can resist rotation with a band. Once they prove to you that they're more stable in the half kneel position, before you before you still put them on this single leg stance on a foam, work up from half kneel to, like, raised leaning lunge position. Right? Then you can do all those same variables. You can do you can do a single leg clean in the static position, rotational, so you can do non rotational clean, you can do rotational clean, right, or you can do a dynamic one.
Dr. JJ Thomas:Still, I'm not using the foam but I'm challenging stability. Right? You can do a dynamic one where you're here, clean it, and step back. And then stand up, step back. Or you can do it in reverse, you can clean it and step up.
Dr. JJ Thomas:And that's more of a single leg stance rotational stability. Right? Or you could snatch it and come up. So all of these things are really gonna challenge their balance. And I'll give you one last one.
Dr. JJ Thomas:All of these things you can do without a foam pad from here, like, I call we call this like a tactical lunge. You're weaving on the inside. You're getting rotational stability without having them just do single leg stance balance activity. Hope that helps. I hope, you got to see some today, maybe some that were new exercises for you, or just got you thinking outside the box a little bit on how you can address your, patients with balance deficits, or either from deconditioning or from coming back off an ankle injury.
Dr. JJ Thomas:Till next time, looking forward to hearing from you guys in the comments below, and, don't forget to click the subscribe button so that you don't miss out on future content. Take care.