Why am I exercising right now?

“Why am I exercising right now?”  I ask myself this question every time I start to warm up for anything that’s not a game of basketball.  I do enjoy the traditional workout, specifically the part where I’m done and full of feel good chemicals.  The difficulty for myself, and most people I come in contact with is getting going.  To get oneself to the actual workout space and then to not just sit in the change room for a half hour, shower and go home.  I think most of us understand that exercise is good and we should do it.  There is enough scientific evidence to show that being physically active and fit has long-term health (mental and physical) benefits.  The question I want to try and shed some light on is: “Why do we need to exercise?”  Once again, this is not a debate about the benefits of exercising, this is an investigation into why good health is dependant on exercise.  For example, we need to eat to stay healthy and sustain life.  Aside from those of us with issues around disordered eating, it tends to be an enjoyable experience that most of us look forward to.  No other animal I can think of needs to schedule time in their day to exercise, in fact most of the ones I see use any spare time they have to relax.  Where does this need for exercise come from and more importantly can I use this information to help people change their relationship with exercise in a positive way?  Well I went looking for answers.  After going down the rabbit hole of paleoanthropology, here is what I found out:

Preface:  I’m not “that paleo guy” walking down the street barefoot in January eating raw buffalo marrow on his way to cross fit.  My diet often consists of the food that my kids throw on the floor and leave on their plates. I exercise whenever I can with no real program and I wear shoes…always…unless its summer when I wear sandals.

Question:  Why do we need to exercise? 

Answer:  Maybe you don’t, it depends.  Do you source all of your food from the natural environment without the aid of machinery and agriculture?  If so then you probably don’t need to do any more exercise because you’re already doing a lot.  Oh you don’t do that?  Ok well you used to, I mean in the sense that all humans used to.  Throughout the vast majority of human history as we evolved through natural selection from apes to homo sapiens and everything in between (a process that took millions of years) our energy output was directly linked to our energy input.  We acquired energy from the food that we had used energy to obtain.  In other words, you had to spend energy to get energy.  These evolutionary pressures shaped our cardiovascular, musculoskeletal and energy systems over that long history and eventually selected us in our current form more or less.[i]   Modern humans likely evolved from a common ancestor some 200,000 years ago in Africa.[ii]  Modern human behaviour started sometime between that point and 50,000 years ago.[iii]  Essentially, we are not so genetically different from people that lived 50,000 years ago and probably earlier than that. 

Agriculture became prominent around 12,000 years ago allowing humans to do things other than hunt and gather food.[iv]  Agriculture created food surplus and security paving the way for modern human civilizations.  Farming has become so efficient that very few humans have anything to do with the production of the food they eat.  This is not a bad thing because it freed up a lot of time for us.  All of the progress of the human race in the last 10000 years can be attributed to this newfound time to think with that rather large brain we have. 

So, humans that walked like us, looked like us and for the most part were like us genetically spent roughly 200,000 years hunting and gathering.  They likely walked great distances often carrying a child or food.  In current hunter-gatherer societies the average child is carried 1500 km in the first two years of its life![v]  Bending, squatting and stooping to collect seeds or other food from the ground would be common.  They would likely climb trees to acquire fruit and nuts.  The occasional run to catch or not be caught by something as well as lots of throwing rocks or spears to kill small and sometimes very large animals.  Evidence suggests that these nomadic humans would spend 3 or 4 nonconsecutive days a week hunting and gathering performing strenuous physical activity for much of the day, followed by a few days of rest and recovery.  During this time they would still be active erecting huts, preparing food, making tools and partaking in leisure activities such as vigorous play and ceremonial dancing[vi]

Lets try to make some sense of this in terms of caloric energy expenditure and intake.  Your typical late Paleolithic hunter-gatherer expended about 21.8 kcal/kg of body weight doing activities of daily living.  Today that number is 8.7 kcal/kg of body weight[vii]. That is a huge difference!  Pre-historic humans used almost three times the amount of energy relative to their body weight as we do.  To put that in context, the average 70 kg male would have to add a 15 km walk to his day to equal the energy expenditure of a typical hunter-gatherer[viii].

Unsurprisingly, these people were likely much more physically fit than the average person now.  We know this from studying current groups of humans that still practice a hunter-gatherer lifestyle.  Cardiovascular (CV) power measured by V02 max for these groups averages 50% greater than the average in industrialized societies (57.2 ml/kg/min vs. 37.2ml/kg/min).  A V02 max of 57.2 ml/kg/min is elite athlete territory!  Shockingly they were also way stronger than the average person is today, to the tune of 20%[ix]

That is our potential: 50% better CV fitness and 20% stronger muscles on average!  Imagine the societal benefits if everyone could attain these fitness numbers.  It’s safe to assume we would be spending less on health care to say the least.  I would imagine these people likely didn’t smoke and drink very much either, but that’s a conversation for a different day.  

It appears that humans have continued to evolve in more recent time (the last 12,000 years).  The ability to digest lactose from dairy products is one example of a post agriculture genetic variation[x].  Other recent adaptations in the human genome are often related to disease resistance[xi].  While we are likely still evolving in some ways, the rate of change in the way we live has greatly outpaced the rate at which we can adapt on a physiological level.  We are still hunter-gatherers deep down where it counts at the genetic level[xii].

There you go, no need to wonder whether you should be exercising or not.  Your body is capable of a level of physicality far beyond current averages.   As a car has been built to be driven, you have been built to exercise.  Just like a car, if you leave your body in the garage too long, it will seize up.   Understanding how our body works and why is the only way we will develop a better relationship with exercise and food.  Hope this helps!

 

 

[i] S.B. Eaton, S.B. Eaton.  An evolutionary perspective on human physical activity:  implications for health.  Comparative Biochemistry and Physiology Part A 136 (2003) 153–159.

[ii] Vigilant L, Stoneking M, HarpendingH, Hawkes K, Wilson A.C.  African Populations and the Evolution of Human Mitochondrial DNA

Science, New Series, Vol. 253, No. 5027. Sep. 27, 1991 pp. 1503-1507.

[iii] McBrearty S, Brooks A.S,  The revolution that wasn’t: a new interpretation of the origin of modern human behavior.  Journal of Human evolution.  39.  2000.  P. 453-563.

[iv] Barker, G.  The Agricultural Revolution in Prehistory: Why did Foragers become Farmers?  Oxford University Press.  New York.  2006.

[v] Cordain L.  Gotshall R.W.  Physical Activity, Energy Expenditure and Fitness:  An Evolutionary Perspective.  International Journal of Sports Medicine.  19.  1998.  328-335.

[vi] Eaton S.B. 2003.

[vii] Eaton S.B. 2003.

[viii] Cordain L.  Gotshall R.W. 1998.

[ix] Eaton S.B. 2003.

[x] Bersaglieri T.  Sabeti P.C.  Patterson N.  Vanderploeg T.  Schaffner S.F.  Drake J.A.  Rhodes M.  Reich D.E.  Hirschhorn J.N.  Genetic Signatures of Strong Recent Positive Selection at the Lactase Gene.  American Journal of Human Genetics.  74(6) June 2004.  1100-1120.

[xi] Stephens J.C.  Reich D.E.  Goldstein D.B.  Shin H.D.  Smith M.W. Carrington M.  Winkler C.  Huttley G.AAllikmets R.  Schriml L.  Gerrard B.  Malasky M.  Ramos M.D.  Morlot S.  Tzetis M.  Oddoux C.  Di Giovine F.S.  Nasioulas G.  Chandler D.  Aseev M.  Hanson M.  Kalaydjieva L.  Glavac D.  Gasparini P.  Kanavakis E.  Claustres M.  Kambouris M.  Ostrer H.  Duff G.  Baranov V.  Sibul H.  Metspalu A.  Goldman D.  Martin N.  Duffy D.  Schmidtke J.  Estivill X.  O’Brien S.J.  Dean M.  Dating the Origin of the CCR5-D32 AIDS-Resistance Allele by the Coalescence of Haplotypes.  American Journal of Human Genetics.  62.  1998.  1507-1515.

[xii] Eaton S.B.

So, you're a bit sore

This is one of those times of the year when people are either returning to their long lost exercise routines or trying to get active for the first time.  It may be clichéd but January is resolution time for a lot of people.  Hey whatever your motivation is I’m just glad you’re adding some more healthy behaviors to your life.  If that included some gym time or some running for the first time in a long time (or ever) you may be experiencing the phenomenon of Delayed Onset Muscle Soreness (DOMS).  DOMS has been known to end many fitness journeys before they even really get going.  It can be debilitating in terms of the pain and stiffness it can induce.  You likely had to take a few days off, which have turned into a week and consequently killed any momentum you had going in this exercise thing. 

            First lets learn about what DOMS is, knowledge is power!  The muscles in your body are accustomed to and adapted for the activities you normally do.  When you do something novel with your muscles such as lifting weights, a new stress is placed on them that they are not adapted for.  This new stress will cause microscopic damage to the cells of your muscles.  It is this damage that is most commonly believed to be the cause of DOMS[1].  These are like tiny injuries and all injuries lead to an inflammatory response involving swelling, heat, redness, altered function and pain.  Why would your body do this to you?  Well, this is a necessary and natural process that helps your muscles get bigger and stronger.  So while it seems like a bad thing at the time its actually a good thing as long as you are able to continue with your daily life while its happening.  The pain from DOMS usually peaks 48 to 72 hours post exercise[2].  The discomfort you feel while actually working out is not DOMS but generally the more discomfort you experience during a workout the worse your DOMS will be.  DOMS is most attributed to eccentric muscle contractions or very intense isometric contractions[3].  Eccentric contractions refer to movements where a load is placed on a muscle while it is lengthening.  Think the lowering part of a biceps curl.  Isometric contractions occur when a muscle contracts against a load but no movement occurs.  Think of holding that biceps curl at the midpoint as long as you can.  Running downhill places much more eccentric load on the muscles in your legs in comparison to running uphill, hence why you get more sore after running downhill than running uphill.  Increased repetitions and increased loads will increase the amount of damage done to muscles. 

            Now that you know why you’re so sore let’s talk about what you can do about it.  Unfortunately this is where the news isn’t so great.  Once you have a good case of DOMS going on there is very little evidence that any of the interventions normally prescribed have any real impact on levels of pain or duration of symptoms.  Studies done on ice water baths[4] and stretching[5] have shown no real impact on DOMS.  NSAID’s such as ibuprofen will reduce pain from DOMS for a period of time but will not decrease the length of symptoms and may negatively impact the necessary healing process that is the underlying cause of DOMS[6].  Low intensity exercise has been shown to decrease discomfort during the exercise and for a short period of time afterward but DOMS symptoms return a short time after[7].  Lastly, massage has been shown to decrease the swelling caused by DOMS thought to be partly responsible for the associated pain.  This aids recovery, as with any injury where swelling is present, significant reductions in pain seem to be transient however[8]

            So what can you do to ease this painful condition?  A certain amount of DOMS is probably unavoidable when beginning novel exercise routines, however it doesn’t have to be debilitating.  For resistance exercises, stick to one set of repetitions and don’t go to complete failure the first time you try an exercise.  Keep your exercise tempo moderate; mainly you don’t want to do really slow eccentric contractions at first.  For instance when doing a squat, don’t go too slow on the lowering part at first.  Once you are accustomed to the exercise you can start to play with long eccentrics as they do have a place in weight training.  If you are doing some running for the first time in a while or at all, make sure it’s on a flat surface or even uphill as opposed to downhill.  Downhill running will make you sore due to the increased eccentric loads placed on your muscles.  Essentially, take it easy for the first few workouts back.  The temptation is to get back into the gym with a fury.  A more moderate approach will allow you to get more work done in that first week than doing one hard workout and then not being able to move for 48-72 hours!

            Finally, if you have a raging case of DOMS and you want to feel better for a while, hop on a bike or elliptical for and easy cardio session.  You should start to sweat a bit but keep it to 20 minutes or so, it should feel fairly effortless.  You’ll be feeling a bit better now so do some very light stretching if you wish.  Now head to your favourite RMT and get a light effleurage massage (they will know what to do).  After that go for a long walk and stay moving as long as you want to feel better because as soon as you sit down your DOMS will come back until your muscles are healed.  Next time just take it easy for the first few workouts!

 

[1] https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf

[2] https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf

[3] https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf

[4] Gulick D.T. et al.  Various Treatment Techniques on Signs and Symptoms of Delayed Onset Muscle Soreness.  Journal of Athletic Training.  June 1996 P.  145-152.  31(2)

Sellwood K.L. et al.  Ice‐water immersion and delayed‐onset muscle soreness: a randomised controlled trial.  British Journal of Sports Medicine.

 June 2007 p.  392-397.  41(6)

 

[5]  Gulick D.T. et al.  Various Treatment Techniques on Signs and Symptoms of Delayed Onset Muscle Soreness.  Journal of Athletic Training.  June 1996 P.  145-152.  31(2)

 

[6] Gulick D.T. et al.  Various Treatment Techniques on Signs and Symptoms of Delayed Onset Muscle Soreness.  Journal of Athletic Training.  June 1996 P.  145-152.  31(2)

 

[7] Gulick D.T. et al.  Various Treatment Techniques on Signs and Symptoms of Delayed Onset Muscle Soreness.  Journal of Athletic Training.  June 1996 P.  145-152.  31(2)

 

[8] Ernst, E.  Does post-exercise massage treatment reduce delayed onset muscle soreness? A systematic review.  British Journal of Sports Medicine.  1998 p. 212-214.  32.

Weight Loss Strategies

9 strategies to help with weight loss

 

Specifically, it is fat loss that we are interested in but weight loss is a generally accepted term for this.  Most are diet related, as it is hard to out train a poor diet.  Research has indicated that diet is more important for weight loss than exercise however combining the two is the best option.  It is important to remember that exercise has benefits that go far beyond weight loss. 

 

1.     Limit your sugar and refined carbohydrate intake. Carbohydrates (carbs): to eat or to not eat?  First, we need to clarify what a carb actually is.  Carbohydrates are found in three basic forms in food:  sugars, starch and fibre.  These carbs are broken down into glucose during digestion, which is used by the cells of your body for energy.  Carbs are found in nearly all foods in some form: fruits and vegetables, grains, legumes and dairy all contain sugars, starch or fibre in varying amounts.  So hopefully you can see that if you don’t want to eat any carbs, your diet is going to be seriously limited in taste and nutrition (taste trumps nutrition in my books! ).  So you can’t really eliminate carbs from your life because you ‘sort of need them’ and the nutrients in the foods that contain them to live.  I hear comments like this about carbs often: “carbs are making me gain weight” or “I can’t lose weight if I’m eating carbs”.  It’s not carbs that are the problem; it’s the amount of carbs and the types of carbs that are the problem.  If you’re trying to lose weight you need to limit your sugar and refined carb intake.  These types of carbs stimulate your insulin response and that is a bad thing for fat loss.  Insulin is the hormone in your body that helps you store excess energy as fat.  Complex carbs from whole grains, vegetables and a moderate amount of fruit do not cause as great of an insulin response. 

2.     Use the glycemic index to police your carbohydrate intake.  The glycemic index is a tool that can help guide your food choices based on how they affect your blood sugar levels and therefore your insulin response.  Carb rich foods are ranked with a number, the lower the number the better.  You can search glycemic index on the internet and you will find lots of info on it.  You will notice that most of the sites reference using the index for diabetes management.  You don’t have to have diabetes to use the glycemic index to your advantage.  Find a good list of foods with their corresponding glycemic index and start making better choices!

3.     Limit your alcohol intake.  Alcohol is not your friend in your weight loss ambitions.  Protein and carbs = 4 Calories/gram, fat = 9 calories/gram, alcohol = 7 calories/gram.  Also, most alcoholic beverages contain a good amount of sugar as well.  I never said this was going to be easy!

4.     Stop consuming empty calories.  Empty calories refer to foods that contain calories but no real nutritional value in terms of protein, fat, fibre, vitamins or minerals.  Examples include soft drinks, candy, sport drinks and most juices.  But juice is supposed to be healthy right?  Sure a bit of juice is not the worst thing you can consume but lets have a look at what juice actually is.  Juice is the sugar and water from your fruit in an easily consumed and digestible form.  The most important nutrient from fruit (fibre) has been removed and you consumed just the sugar.  To lose weight, eat the fruit whole. 

I don’t think I need to explain the evils of soft drinks. Avoid them.  Have a diet one if you must, or how about some water with lemon and lime squeezed into it?  Sounds good to me!  Finally, let me talk about sport drinks.  These drinks are sugar, water and some electrolytes.  The average person does not need sugar and salt in their water to perform perfectly in a physical activity setting.  Your body needs is water and that is all.  If you are eating a balanced diet at regular intervals you will have enough stored energy and electrolytes to get through your workout no problem.  For recovery from your physical activity sessions ditch the shake and just eat food.  You should eat foods that mimic the contents of a post workout shake but they will take a bit longer to eat and digest. 

5.     Eat slowly and chew your food.  You will notice you get full from less food and you will enjoy your food more.  Eating with our friends and family helps because talking forces us to eat more slowly.   

6.     Eat smaller portions of food at regular intervals throughout the day.  Try not to let yourself get really hungry.  We tend to over eat when we are too hungry.  Eating every two to three hours will help you stay satiated and will also help to keep your blood sugar and therefore your insulin levels more even. 

7.     Avoid weighing yourself daily.  Your weight will fluctuate throughout any given day due to hydration levels.  Water is heavy and can affect your weight by a few pounds depending on your size.  This can be discouraging if your weight goes up for no apparent reason.  Weight loss is a battle of the mind as much as anything and staying positive is key to staying consistent with your strategies. Weekly weigh-ins are a better way to monitor your progress.

8.     Exercise and lift weights. Exercise combined with healthy eating habits will help you to lose weight better then exercise alone.  Plus, exercise has benefits that reach far beyond simple weight loss.  Your body is meant to move and work and it usually feels better when it is allowed to do so.  There are also mental health benefits to regular exercise.  Exercise and good dietary habits also go hand-in-hand.  In my experience, you will be less likely to cheat on your nutrition if you have been working hard in the gym.  Losing weight is hard to do well.  Congratulate yourself for good days with some kind of reward, it doesn’t have to be food but can be. 

9.     A common rule in the fitness industry is the 90/10 rule.  It refers to sticking to a strict nutritional program (of your choice) 90 percent of the time and allowing some leeway 10 percent of the time.  It comes out to a few meals a week depending on how many meals a day you are eating.  Having the odd “cheat” meal likely has some benefit in the long run even if solely psychological.  Just ensure your math is good with respect to calories.

Weight loss

Weight Loss

 

Weight loss is easily the number one most common goal in any new personal training client that I see, even if they don’t say so.  Many people would like to lose a few pounds of fat whether they want to acknowledge it or not.  Our motivations for weight loss can be different.  Some people may come to this decision for health reasons, while others are motivated by aesthetics or some other reason personal to them.  The specific motivation and what type of motivation that is (intrinsic vs extrinsic) is very important for achieving any goal but I’m not going to get into that for this discussion. 

 

For this post I just want to talk about the physiology of how to lose weight.  I’ll start with some background info so we have an understanding of some of the basics of metabolism.  Your body needs energy to survive and work properly.  The energy your body uses comes from the food you eat.  The measurement for this energy is the dietary calorie (calorie), one calorie is the amount of energy needed to raise the temperature of one kilogram of water one degree Celsius. 

 

The foods we eat have varying amounts of calories depending on their composition.  Food comes in three basic forms called macronutrients:  1.  Protein 2.  Carbohydrate 3. Fat

Protein and carbohydrate contain 4 calories per gram, while fat contains 9 calories per gram. 

 

Metabolism in a basic sense refers to how many calories your body uses to function.  The tissues in your body use energy to function, how this happens is a long discussion that we don’t need to get into right now.  Tissues such as muscle use calories while fat does not, fat is actually an energy reserve.  The muscles of your body use lots of calories while they are working, therefore a body that has more muscle mass will have a higher metabolism.  Your basal metabolic rate (BMR) represents the amount of calories your body will use to simply survive in a day.  Your activity level will add to this amount.  You can calculate your BMR with this equation:

 

For men: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) + 5

For women: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) – 161

 

(if math is not your thing you can find calculators online that will do the work for you – just search BMR calculator!)

 

You can now use the Harris Benedict formula to calculate your daily caloric needs based on your activity level.

 

   If you are sedentary (little or no exercise) : Calorie-Calculation = BMR x 1.2

   If you are lightly active (light exercise/sports 1-3 days/week) : Calorie-Calculation = BMR x 1.375

 

   If you are moderately active (moderate exercise/sports 3-5 days/week) : Calorie-Calculation = BMR x 1.55

   If you are very active (hard exercise/sports 6-7 days a week) : Calorie-Calculation = BMR x 1.725

If you are extra active (very hard exercise/sports & physical job or 2x training) : Calorie-Calculation = BMR x 1.9

 

(note:  these calculations are estimates to be used as a guide)

 

When you know these basic principles, weight control becomes easy to at least understand.  You eat food to acquire calories for the cells of the tissues in your body to use.  Your body will use a certain amount of calories in a day that can vary depending on how much activity you do.  If you consume more calories in a day than your body uses, it will store those calories as fat.  If you consume less calories in a day than you use, your body will access its calorie reserves in the form of fat and sometimes protein.  In the most basic way this is how you gain or lose weight.  Consume more than you use and you gain weight, consume less than you use and you lose weight, it’s that simple.

 

So why is it so hard to lose weight?  The reasons are abundant and different for everyone but I believe that education is the foundation to overcome weight control issues.  Counting calories is not a weight loss strategy that generally works very well on its own, however knowing how your body works in at least a basic sense is the first step to healthy and sustainable weight loss.

 

Next post, strategies for weight control.

I sprained my ankle, what do I do pt. 3

So, you’ve sprained your ankle or are rehabbing some other injury.  How do you know when to progress your exercises and try more challenging tasks?  As a therapist I can tell you that this is the hardest part of helping someone rehab an injury.  You want to push them so they progress as quickly as possible, but you definitely don’t want to push them too hard causing a setback.  The line between progressing to quickly and not quickly enough is very fine but there are some rules you can use to guide you. 

 

Rule 1 – Rehab exercises should be pain free.  Pain is your body’s way of telling you that what you are doing is potentially harmful and damaging.  That being said, you may have some mild discomfort with some exercises.  You need to be able to distinguish between the discomfort of challenging a healing tissue and the pain of damaging a healing tissue.  Err on the side of caution with pain, sharp pain is a definite ‘stop what you are doing’.  You also need to assess how you are feeling in the hours and day after you do your rehab exercises.  The inflammation and accompanying pain of overdoing it may not reveal themselves until later. 

 

Rule 2 – Do the same exercise routine twice on two separate days before you progress the exercises.  For example, on Monday you might do 3 sets of 15 repetitions of a new exercise at a certain resistance.  You experience no pain during or after.  On Tuesday you should do the same routine again and if you experience no pain during or after and are able to perform all of the prescribed repetitions you can progress the exercise.

 

Rule 3 – Only increase one variable of a given exercise at a time.  Variables are the sets, repetitions and resistance in a typical exercise.  Lets say you are doing calf raises to help strengthen your ankle.  On Monday and Tuesday you do 2 sets of 10 reps with your body weight on the floor with no pain during or after.  On Wednesday you could add one of these next three things: 

1.     An extra set of 10

2.     More reps within your two sets

3.     Add some extra resistance to your original 2 sets of 10

 

In terms of exercise prescription for an ankle sprain, in the last post we got as far as doing isometric strengthening, active range of motion and single leg balancing for proprioception.  Now we need to add strengthening through a full range of motion (ROM).  Resistance bands are perfect for ankle rehab exercises.  The exercises are the same as the isometric strengthening in part 2 except now you actually move your ankle through a full range of motion with resistance in each direction.  When you can achieve 3 sets of 15 reps with a certain resistance you should use a stiffer band to continue to challenge the muscles of the lower leg. 

 Resistance band strengthening for ankle plantar flexion, dorsi flexion, inversion and eversion.

Resistance band strengthening for ankle plantar flexion, dorsi flexion, inversion and eversion.

 

Calf raises are a great exercise to strengthen the ankle while also working on range of motion and balance.  Start on the floor with just your body weight. Progress to doing them off of a step letting your heel drop below the level of the step to stretch your calf and promote increased dorsi flexion.  Add resistance as tolerated by holding onto some weights at your sides.

 Calf raise from step

Calf raise from step

 

You should be doing some walking as well, you can use a treadmill and add some incline to actively stretch your calf muscles and improve dorsi flexion.  Treat walking like any other rehab exercise and use the progression rules outlined above. 

 

Multi joint leg strengthening exercises such as squats and lunges can be done once you have full pain free ROM and have progressed through full ROM strengthening with resistance bands.  Once again, use a conservative approach to adding these exercises and progressing them. 

 

Light jogging for short durations can be attempted as well as long as its pain free, progress as tolerated within the guidelines outlined above.  

 

By no means is this an exhaustive list of exercises to rehab an ankle, so do your own research and enlist the help of a therapist if in doubt or if you are not getting a bit better every day.