By Dr. Andrew Crellin- West Warwick, Rhode Island
Or as I like to call it, “My Vindictive Ankle”. I did something bad to it a long time ago and to this day it never lets me forget. Yes, ankles can be unforgiving, especially if you ignore them after an injury. Now the aim of this column is general advice. Assumptions are made in order not to make this a text book length article and bore the unaffected . So let’s just say you “twisted” your ankle several months/years ago and it is still problematic. Initially it was swollen, painful to walk on and now it is mostly OK but you don’t trust it. It hurts when you go up/down stairs, walk on uneven ground (beach) or move side to side with any enthusiasm. Maybe you had it x-rayed and it was negative (not broken or dislocated), regardless it’s been long enough, and its better now, so you know it’s “OK”.
So what we have here is a formally sprained (ligaments)/strained (muscles) ankle that is now chronic in nature and has failed to return to its former robust self.
There are 2 approaches A. self care B. see a professional.
Let’s start with self care. At this point it’s not swollen or tender and you can walk on it for the most part. We start with stretching (see last month’s article). Hips, hamstrings, Achilles tendon and soleus muscle (often ignored). If you do not have good flexibility in the Achilles tendon complex you may not be dorsiflexing (bending your foot up) enough during gait causing you’re foot and ankle to roll over.
Strengthening is equally as important. The peroneal muscles on the outside of your lower leg get stretched/damaged along with the ligaments during the lateral ankle roll injury (90% of ankle sprains happen on the outside) and need to be rehabilitated. Strengthening calf muscles and gluteal musculature (your buttocks) also play a large role in the rehabilitative process. Exercises and programs for these muscle groups are all over the internet.
Interestingly the low back often comes into play with chronic ankle problems. The gluteal muscles become weak and do not offer their full support to the spine. This weakness can lead to a sacroiliac joint becoming unstable or lead to a lower lumbar joint dysfunction, both causing pain.
Sensory proprioception! This part is cool. In your body, and especially in your ligaments are nerve endings that tell you where your body is in space. For example, If I close my eyes and hold 2 fingers up, there are sensory receptors telling me I have 2 fingers up, not 3. If I move my fingers, there are sensory receptors telling I am moving my fingers, and telling me how fast I am moving and them and when I have stopped moving them. If ligaments are injured, the sensory receptors are not working at the speed they were intended. If you are walking on an uneven surface and your ankle begins to roll, the sensory receptors kick in, causing a reflex that sends a message up your leg to your spinal cord, it connects with a motor nerve and causes an appropriate reaction from the muscles in your leg to right the foot, not letting it roll. This reflex prevents you from spraining your ankle. If not properly rehabilitated, the ankle will roll. Thus the birth of a chronic ankle sprainer.
This is how you are going to fix this. Stand on one leg, have your hand close to a table in case you begin to fall. Balance on that one leg. You will sway. Keep working it. After that becomes less challenging, take away the other sensory feedback system you have by closing your eyes. Obviously sight also tells us where we are in space. When you close your eyes you shift the entire burden on to the sensory proprioceptive system. This challenges the system and makes it stronger. Make sure you have something to grab on to should you start to sway too much. Do this every day for about 5 minutes, more often if you think of it. You will notice a difference in how long you can go without falling the first week.
There are many features to a complete rehab program. Try this advice, if it doesn’t get you to where you want to be. You can always give me a call. And remember, as an old Irish friend of mine (Tom G.) used to say…
May those that love us, love us.
And those that don’t love us
May God turn their hearts.
And if He doesn’t turn their hearts,
May He turn their ankles,
So we will know them by their limping.
Dr. Andrew Crellin is a chiropractic physician and physical therapist with more 30 years of experience treating sports injuries. His office is located at 328 Cowesett Ave. West Warwick, R.I. and can reached at 821-6091