The Stabilisation Academy

Strength is important, but simply prescribing more strengthening is not always the whole answer.

When a patient’s pain keeps returning or their rehabilitation has stalled, we may need to look more closely at:

✔️ How the whole person moves
✔️ Where they find stability
✔️ How they manage and transfer load
✔️ How the foot interacts with the rest of the body
✔️ Whether footwear is changing the task
✔️ Whether the exercise matches their current capacity

The diagnosis matters, but it does not automatically explain the movement strategy or determine the best intervention.

The next step may involve movement retraining, modifying the task, hands-on treatment, footwear or device changes, education, or choosing a different exercise rather than simply adding more load.

👉 When progress stalls, don’t automatically prescribe more. Reassess, reason and adapt.

Follow The Stabilisation Academy for a more individualised approach to foot and ankle rehabilitation.

Calf raises.

Bands.

Balance exercises.

Foot strengthening.

Mobility.

Stretching.

There are thousands of exercises we could prescribe.

But the question isn’t simply:

“What exercise is good for this condition?”

A better question is:

“What am I trying to change in THIS person’s movement, and WHY?”

Are we trying to improve:

Control?

Stability?

Timing?

Load tolerance?

Movement variability?

Strength?

And after we’ve chosen an intervention, there’s another important step:

REASSESS.

Did it actually change what we thought it would?

Because rehabilitation shouldn’t simply become a collection of exercises.

It should be a process:

OBSERVE → INTERPRET → INTERVENE → REASSESS

And then we reason again.

👉 CTA: Save this post and try this with your next rehabilitation session:

Before prescribing an exercise, finish this sentence:

“I’m choosing this because I want to change ______.”

If you can’t answer it, ask yourself why you’re prescribing it.

Protocols have their place.

But patients rarely arrive in the clinic looking exactly like the textbook.

They have different histories.

Different bodies.

Different movement strategies.

Different goals.

And different reasons for moving the way they do.

That’s why one of the things I’ve become increasingly passionate about - both clinically and through teaching - is helping clinicians move beyond simply asking:

“What exercise should I use?”

Instead, I want them to ask:

“WHY would I choose this intervention for THIS person at THIS point in their rehabilitation?”

It might be exercise.

Footwear.

Load modification.

An orthosis.

Manual therapy.

Education.

Or sometimes simply reassessing before doing anything at all.

Knowing WHAT we can do is important.

Understanding WHY, WHEN and FOR WHOM is clinical reasoning.

And that’s a conversation I’m very excited to be having much more of.

👉 Clinicians and students - what’s one clinical question you wish you’d been taught to ask more often?

Tell me below.

We often talk about compensation as though it’s automatically something “bad” that needs to be corrected.

But compensation can give us incredibly valuable information.

It may be the body’s solution to a problem.

A way of finding stability.

A response to pain.

A way of getting around a restriction.

Or simply the most effective strategy currently available.

So instead of immediately asking:

“How do I stop this compensation?”

I prefer to ask:

“WHY has the body chosen it?”

That question changes clinical reasoning.

Because once we understand why a movement strategy exists, we can make a much better decision about whether it actually needs changing - and if it does, where we should intervene.

Movement isn’t random.

It’s information.

👉 Watch the video again.

What do YOU see?

Don’t diagnose it. Don’t fix it.

Just observe.

Are we strengthening the foot- or improving how it functions?

The intrinsic muscles of the foot contribute to dynamic support, sensory awareness, balance and the ability to respond to load.

But strengthening them in isolation doesn’t automatically mean a patient will use them effectively during standing, walking or running.

We need to observe the whole movement strategy, interpret what may be driving the compensation, and then choose the most appropriate intervention.

That is exactly what my new From the Feet Up Movement Reasoning Framework™ is designed to support. It’s a clearer, repeatable way to understand movement and make more confident clinical decisions.

Follow Tracy Cooke | Injury & Rehab Podiatrist | Educator as I begin unpacking the framework and showing how it can guide foot and ankle rehabilitation.

Pain location gives us a starting point- not a complete explanation.

If assessment stops at the symptomatic structure, we may miss the movement strategy, loading pattern or wider context contributing to the presentation.

Start locally. Then deliberately zoom out.

Save this reminder for your next assessment.

I’ve spent nearly three decades working with feet and lower-limb problems.

But one thing has become increasingly clear throughout my career:

You can’t understand the foot properly if you only look at the foot.

The foot interacts with the ankle.

The ankle with the knee.

The knee with the hip.

The pelvis and trunk influence what happens below whilst the ground influences what happens above.

Movement is interconnected.

That’s why From the Feet Up has become much more than the name of my clinic.

It describes the way I think.

Start at the feet.
Observe the whole person.
Understand the strategy.
Then decide what actually needs to change.

And there’s a lot more coming around this idea.

👉 If you’re a clinician who already finds yourself looking beyond the site of pain, save this post.

Over the next few weeks, I’m going to show you more about how I connect what I’m seeing to the clinical decisions I make.

Two people can walk into the clinic with the same diagnosis.

Same painful area.

Similar symptoms.

Even similar imaging findings.

Yet they may be using completely different movement strategies.

So should they automatically receive the same rehabilitation program?

A diagnosis can help tell us WHAT we may be dealing with.

Movement helps us understand HOW that individual is managing it.

That’s where clinical reasoning becomes so important.

Instead of only asking:

“What hurts?”

I also want to know:

What is this person doing to create movement, stability and load transfer , and WHY?

Because when we understand the individual strategy, our intervention can become much more individual too.

👉 Clinicians :- do you find yourself treating the diagnosis first, or the movement strategy in front of you?

I’d love to hear how you approach it.

One of the biggest changes in my career wasn’t discovering another exercise.

It was realising I needed to spend more time observing before intervening.

How does someone choose to move?

Where do they find stability?

Where do they lose it?

What changes with speed, load or direction?

And importantly - why?

Every movement gives us information.

The more carefully we observe, the better our questions become, and the better our clinical decisions can become.

Over the coming weeks, I’m going to be sharing more about how I look at movement, rehabilitation and clinical reasoning - and why understanding the WHY has become such an important part of the way I practise and teach.

👉 Next time you watch someone move, don’t immediately think about what you would change. First ask yourself: What am I actually seeing, and why might it be happening?

Save this one and follow along - we’re going to build on this.

Can your client efficiently transfer from the ground to standing… or are they compensating the whole way up?

One of the most underrated movement assessments in rehab?
The transition from Tripod - high kneeling to standing.

From a Dynamic Neuromuscular Stabilization perspective, this movement tells us a huge amount about:
✔️ stability
✔️ foot function
✔️ weight transfer
✔️ trunk control
✔️ hip strategy
✔️ nervous system organisation

The body should be able to coordinate this movement efficiently using integrated stabilisation patterns developed through developmental physiology.

But what do we often see instead?

❌ collapsing feet
❌ poor pressure transfer
❌ hip shifting
❌ trunk instability
❌ momentum strategies
❌ compensation through the lumbar spine or knees

Adding a small amount of load during a Czech get-up progression is not just “strength work.”
It becomes a way to assess and facilitate efficient movement organisation through the entire kinetic chain.

This is why rehab should move beyond isolated exercises.

The foot, trunk, pelvis, and nervous system must work together.

Because sometimes the issue isn’t weakness…
It’s poor movement coordination.

Comment MASTERCLASS and I’ll send you the link to my free Foot & Ankle Stabilisation Masterclass.