Rehabilitation Technique: ASR

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The ASR Program: Improving Foot and Ankle Alignment

Pronation and supination are normal foot movements that occur during walking and running, but when they exceed normal ranges, the stability of the entire musculoskeletal complex is at risk. Excessive pronation hampers the body’s ability to stand, walk and run. Excessive supination makes the ankle more susceptible to twisting and sprains. An unstable ankle joint can result in many different types of injuries,1 and repetitive stress will eventually affect the weightbearing joints and, possibly, lead to osteoarthritis.2

Imbalances in the feet and ankles can cause problems throughout the body. Activities such as running and training for most athletic activities increases the forces on the foot and ankle by up to 3 times, making even minor imbalances a problem for athletes.3

Proper alignment of the feet and ankles is critical to good postural health. The feet and ankles provide the support for the entire body, and they also absorb and adapt to loads, shocks and uneven surfaces. Imbalances in the feet and ankles are not always painful; they may manifest instead as stress and pain at the lower leg, knees, hips or spine.

Clinical Management with the ASR Program

ASR – Adjust, Support, Rehabilitate

ASR – Adjust, Support, Rehabilitate

The A-S-R (Adjustments, Support and Rehabilitation) Program is a 3-step approach that allows you to provide comprehensive patient care by adjusting misalignments, supporting permanent structural faults using rehabilitation to address soft tissue concerns. Each component of the program works together to help your patients achieve lasting recovery.

Step 1: Adjust

The adjustments that you make are the most important part of the A-S-R Program. When joints of the feet and ankles are not moving sufficiently, specific extremity adjustments should be performed. Begin by motion palpating the foot and ankle joints, checking for hypo- or hypermobility. Adjust each joint specifically to restore normal motion and alignment, and continue evaluating and adjusting up the Kinetic Chain and throughout the spine.

Step 2: Support

Since either excessive pronation or supination can interfere with the bio­mechanics of the foot and ankle, custom-made functional orthotics should be an effective part of your care. Orthotics improve foot and ankle stability by:

  • Providing shock absorption with viscoelastic materials to ease the impact at heel strike and reduce the forces on the foot and ankle joints.
  • Decreasing abnormal pronation to reduce the medial rotation force transmitted into the knees and spine.
  • Improving alignment and mobility of the arches, with less muscle and connective tissue stretch.
  • Providing more accurate proprioception for better joint alignment and foot placement.
  • Increasing forefoot support and flexibility for rapid and smooth toe-off.

Step 3: Rehab

Once joint motion is normalized and arches are supported by orthotics, muscle strengthening must be incorporated for improved long-term outcomes.

Rehabilitative exercises work in conjunction with your adjustments and orthotics to achieve better results for your patients. For foot/ankle misalignments, I recommend the THERA-CISER® exercise system. Use the THERA-CISER to optimize muscular tone, re-educate muscle action, relieve pain, improve venous and lympathetic drainage loosen adhesions. Rehabilitative exercises are particularly important for ankle injuries, because they promote healing and reduce the risk of re-injury.


Imbalances in the feet and ankles can increase your patients’ risk of injury and cause stress and pain in the legs, pelvis spine. Over time, this stress can lead to joint degeneration and osteoarthritis. The A-S-R Program gives you the tools you need to restore proper alignment to your patients’ feet and ankles. Good postural health starts with the foundation of the body-the feet and ankles.


  1. Hartley A. Practical joint assessment: a sports medicine manual. St. Louis: Mosby YearBook; 1991. p. 571.
  2. Radin EL, et al. Mechanical determinants of osteoarthritis. Sem Arth Rheum 1991; 21:12­–21.
  3. Subornick SI. Ed. Injury prevention. In: Sports medicine of the lower extremity. New York: Churchill Livingstone; 1989. p. 67.