Unresolving ankle strains
(June 2004)
by Mr. Marc Jones DO (UK), BSc(Hons)Ost, Osteopath (UK)
The picture below is taken from Ithaca College, New York at www.ithaca.edu.
It shows the lateral (outer) right ankle dissected down to the anterior talo-fibular ligament (most commonly strained) and the calcaneo-fibular ligament. The tendo-calcaneus is the achilles tendon.
A 27 year old man turned his ankle when playing basketball and strained the lateral (outer) ligaments of the ankle joint. After having physiotherapy treatment for 8 weeks, the ankle was pain-free and stiff whilst walking, but was very painful and limited if he tried to play any sports or put force through it. An ankle brace was being used which gave some relief, but sport was still impossible to play.
The patient was referred me to buy his physiotherapist to see if I could offer a solution. This I was able to do. After one treatment session the ankle was 75% improved and by the third it was 99% pain-free and ready to play basketball. The patient was then returned to physiotherapy for a final assessment.
Discussion:
When the patient came to me, the healing process itself was relatively complete (my physiotherapy colleague had done an admirable job in this department). However, although the tissue was "healed" and the balance and strength were relatively good, he was still unable to return to intense exercise without pain.
As an osteopath, the structure and function of the ankle joint was my immediate focus of attention. The ankle joint itself was very stiff and this is the most common cause for unresolving joint strains. The strong ankle support that was being used was dispensed with in favour of a very basic elasticated ankle support so as to offer more range of movement. (There is always a trade-off between stability and flexibility, as you cannot truly have both).
Six weeks after such an injury, most pain is from scar tissue that is being stretched, so strong manual treatment techniques were used to increase the range of motion. Osteopathically, it is not only the major movements that concern us, but probably more importantly, the smaller accessory movements such as "tilt and glide". For example, consider a 2mm restriction of movement: if the possible range of movement is 2 cm then 2mm of tightening becomes a 10% limitation; if the possible range of an accessory movement is 5mm, then 2mm becomes a 40% limitation, which can be more debilitating.
The strong local techniques at the ankle were also supplemented with osteopathic assessments and treatments of the lower back, hip, knee and foot to aid adaptability. (A common sequel to any injury is "second injury syndrome", especially with ankles, which can lead to achilles, calf, knee, back or hamstring problems.)
As part of the treatment plan, special strength plyometric ("jumping") exercises were needed to aid the restoration of structure and function and a graduated return to exercise meant that basketball was played 2 weeks later. Two "maintenance" visits over the following 6-8 weeks were given to ensure the injury was stable.
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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