With a high occurrence of low back pain within running sports – Can we attribute this to Lateral Ankle Instability and or the Wrong Footwear?
In previous articles I have suggested that the selection of footwear available for orienteers is quite limited in terms of functional medial support and that choosing a trail shoe from the likes of Mizuno, Asics, Saucony or New Balance from a running shop may lead to raising the heel too much, thus making the heel & ankle potentially more unstable.
Let us look at the mechanisms that occur during an inversion sprain of the ankle, with a view to attempting to link this action to the back and pelvis
In a typical inversion ankle sprain, the foot is suddenly inverted (rolls outward), straining the lateral ligaments and leading to a pulling downward of the fibula. In addition the lateral ligaments are placed under an enormous load and may be strained.
This type of strain may cause a substantial amount of soft tissue trauma and hence a lot of swelling and bruising. If the ankle has a history of chronic instability then no symptoms (inflammation and bruising may be present apart from pain and weakness.
Where is the link between the Ankle & the Back?
Lets first look at the Anatomy. As mentioned earlier the lateral ligaments of the ankle attach on to the end of the fibula at the outside of the ankle, whilst the other end of the fibula is located at the outside of the knee, attaching onto this we have one of the hamstrings (biceps femoris) muscles and the illiotibial band (ITB). Both of these structures attach above the hip joint onto the pelvis. So whilst the structures of the ankle support this area the effects of sprained ankle have far reaching effects into other parts of the body.
What happens next?
Once ankle stability has been altered there is a change in biomechanics to the other joints of the lower limb (knee and hip) and pelvis, these changes alter the way that forces are transmitted through the ankle.
One of the main changes that take place is an inhibition of the lateral hip stabilisers (Abductors) of which results in:
- Weakness to the abductors
- Increased loading to the hip joint
- Decreased stability of the Hip/Pelvic region
- Altered proprioception to the Sacroilliac & illiolumbar regions
- Increased femoral rotation
- Increased Stress to the Inside of the Knee joint
- Tightening of the ITB
- Increased Pronation (rolling in) of the foot
This all seems a little excessive for even a simple ankle sprain, but even though all of these effects happen in small proportion if left then we place an increased loading in areas that should be inherently more functional.
Is there a case for rehabilitating the injured ankle or should we just leave it to get better?
Some may say that rest is a good healer and that over time the ankle pain and swelling will disappear. I suggest that if left to heal on its own, the chances of recurrent and chronic issues would have a greater chance to prevail. So what should you do?
Summery of Treatment plan
- Immobilise the joint if necessary
- Reduce pain and swelling
- Maintain or increase range of movement
- Reintroduce loading of the ankle
- Increase flexibility of the calf muscles
- Increase balance at the ankle
- Introduce stability exercises to the knee, hip and pelvis
- Analyse walking/running technique
- Make sure the footwear is giving the correct amount of support
- Analyse the needs of the individual to return to full function and activity levels of that prior to the injury
Rehabilitation in most cases ceases once the individual is pain free and where most of the swelling is gone…… very little regard is placed upon a full functional return to activities for daily living let alone a full and safe return to sport. If you choose not to carry out any rehabilitation or your treatment programme finishes early (at the end of the blue writing) then questions must be raised namely
ARE YOU INCREASING THE POTENTIAL FOR FURTHER INJURY?