The Ankle: The overlooked Cause of Back Pain

With summer approaching it is the time of year we all tend to get the running shoes out of the cupboard and try to get a little fitter. One of the consequences of this is an increase in the amount of turned ankles we see at the clinic.

The swollen-ankle stage of the sprain will go with time but if there is insufficient rehabilitation of the ankle it will lose its full range of movement, especially that of bringing the foot up towards the shin or facing the sole of the foot outwards. (dorsiflexion and eversion). After such an injury you may also lose some of the balance and control of the ankle. This means not only are you more likely to turn the ankle again but it also changes the way you walk and this can result in a torsion through the lower back. This is often the cause of underlying back pain developing for ‘no apparent reason’ many years later. To avoid such problems it is important not to ignore minor ankle strains.

Fortunately, with treatment, improvements can be made quite quickly, even years after the event.

What to do after an ankle sprain?
The first thing to do is to make sure there is nothing broken and to find out which ligaments are strained. The following advice is for a mild ankle sprain.

The ‘boy scout’ advice of rest, ice, compression, elevation (R.I.C.E.) is correct with the exception of ‘rest’. Using the ankle as normally as possible, as soon as possible, is key to both speeding up recovery and fully rehabilitating. There are 12 muscles that cross the ankle and using them ‘pumps’ and squeezes out the swelling very quickly.

Walking helps the ankle ligaments repair in the correct fibre direction and helps keep the body’s ability to know where the ankle is in space (motor patterning and proprioception). Strapping, braces or crutches can be helpful to take some of the body weight to help use the ankle normally as soon as possible.

Rehabilitation:
The old fashioned view of just using a wobble or balance board is very limiting and does not lead to full function. Wobble boards can be useful if used correctly but a much more effective and functional way to improve the ankle is to stand and balance on it.

Here are some simple exercises to do at home, these can be done no matter how long ago your ankle injury occurred as long as they do not cause pain: All of these exercises require you to stand and balance on the affected leg then:-

A) Rotate your head in large circles both clockwise and anticlockwise.

B) Reach as far as you can with your hands. Forwards, backwards, to each side and then rotate away from the leg you are standing on (not towards the side of the sore ankle).

C) Reach as far as you can with the opposite foot to almost touch the floor without putting any of your weight through.

The nice thing about these exercises is you can see how one ankle compares to the other and you can mark your improvement by the range of movement achieved. The more you do them the quicker your ankle will improve. When the range is about even you can further fine-tune the ankle co-ordination by hopping and playing catch at the same time.

Full ankle function will greatly reduce the chances of future knee and back problems, In the case of an old ankle injury some manual therapy may be required to achieve full range of movement and complete rehabilitation. If you have any questions or would like to discuss anything written here or borrow a wobble board (with instructions) please feel free to contact us.

Steyning Osteopathic Clinic - Keeping Steyning Healthy. 01903 813500

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