An Osteopath’s Approach to Ankle Pain and Injury
Most people who know about osteopathy know that osteopaths treat back pain but not everyone is aware that we treat joint pain all over the body. One of the most common areas of pain due to injury or age is the ankle. This article will explain to you a little bit about ankle anatomy, ankle pain and its causes and the approach to treatment that you might expect if you saw an osteopath.
There are many causes of ankle pain from injury to arthritic changes and depending on the cause pain, stiffness and even swelling may occur. Occasionally you may not even be able to put your weight on it. All of these can affect the way you walk or your participation in sport.
Typically ankle pain resolves by itself with home care but it is useful to understand what that home care might entail, what should be done and what should be avoided. In all cases it is wise to seek advice and if an injury is sudden and traumatic then it is advisable to go to A&E to rule out fracture. Once the initial swelling of a new injury has begun to ease physical therapy will help you back to regular usage.
A Bit of Anatomy
The bones of the lower leg (below the knee) come together to meet a bone just above the foot called the Talus. This joint is one of the most congruent, close and well fitting joints in the body. That does mean that if it gets damaged then there is a high likelihood of some sort of arthritic change later in life, unfortunately. The talus sits of the heel bone, called the calcaneus and these two bones together attached to the next sets of bones of the foot called the tarsals. These are arranged in such a way as to from both a rigid arch or a looser more adaptable section in order to accommodate for the different sorts of terrain we encounter in our every day lives. Actually because we live in a world of concrete and hard ground and we wear shoes to deal with these, our feet are not required to work as hard as they were designed to. Some argue that this is the reason we have foot and ankle problems as our resilience and accommodation o different
surfaces is less precise that it used to be.
All these bones are held together by ligaments while muscles tendons and other soft tissues allow the foot and ankle to move.
It is common to find ankle issues in older people, those who play sports that require jumping or sudden changes of direction and in those who are overweight. There are many causes of ankle pain, all of which can cause problems walking and running.
The most common is a sprain. This is usually occurs when you roll over on your foot. You can sometimes feel a click and a sprain will typically swell up very quickly, within minutes. A spain is the tearing of a ligament and the swelling is the bleeding that occurs. There is usually a significant amount of pain and from both the damage but also from the volume of swelling.
Occasionally the same movement can cause fractures. The tell-tale sign here is that the swelling takes longer to appear, maybe over a couple of hours. These can happen in the foot and ankle but also in the bone on the outside of the lower limb, called the fibula.
Tendons can be a problem in the ankle. These can be irritated and even torn. The Achilles tendon, connecting the calf muscles to the heel bone can tear and even rupture completely. The former can be very painful for some time. The later is very painful immediately but is then less so. The patient usually describes a sensation of being kicked or even shot and when it happens will look around to see if anyone near them has seen or done anything.
Arthritis: as I mentioned above the elderly and those who have had previous injuries can develop arthritic changes that end up limiting the range of movement in the ankle complex leading to pain and altered walking styles.
Although infection and gout are other causes of ankle pain it is unlikely that you will come to an osteopath if you have a hot red swollen ankle of joint. In such cases it is best to see your GP.
What to do with an ankle pain:
If the onset is sudden, like a sprain, where the ankle swells quickly then the advice follows an acronym: PEACE and LOVE
Protection: avoid activities and movements that increase pain in the few days after
Elevation: Elevate the limb higher than the heart, if possible to encourage drainage and minimise swelling
Avoid anti-inflammatories: this may be a surprise to you but these actually reduce tissue healing
Compression: use an elastic bandage to keep the swelling down
Education: Avoid unnecessary passive treatments and medical investigations and let nature play its role
Load: Let pain guide your gradual return to normal activities.
Optimism: condition your brain for optimal recovery by being confident and positive
Vascularisation: chose pain-free activities to increase blood flow to repairing tissues
Exercise: restore mobility, strength and proprioception by adopting an active approach to recovery
Some or many of the above may be a bit of a puzzle and you may not be able to make decisions about what exactly to do. This is actually where an osteopath can help. Helping you to understand what is meant by, for example, vascularisation; knowing what exercise is OK etc.
But even in the acute stage there are things that can be done and this is where the unique approach of the osteopath comes into it own. For example:
Who you roll an ankle you instinctively try to stop yourself from falling. This first effort comes from the muscles at the side of the hip. You will contract these to keep yourself upright. This can cause strain all the way down the outside of the leg. An osteopath can identify this and treat plus advise on how to ensure that you restore good function to this overstressed set of muscles and connective tissue.
If you roll onto the outside of the foot you are putting stress on the small of the two long bones in the lower leg, called the tibia. This is attached to the bigger shin bone higher up, just below the knee, on the outside. This area can also be stressed and affected by the strain of the roll and become inhibited in its normal movement. Also, attached to this is one of the 3 hamstring muscles and as a result fo the strain through the top of the fibula, the hamstring can become tight.
As you can see there are things that can be worked on and helped while you are going through the acute phase of recovery after injury so it may be worth consulting with an osteopath once you are feeling mobile.
Once things begin to settle the osteopath can then begin to work on the movement of the ankle and foot to help you restore normal range of motion. For example a roll over onto the outside can create jamming and restriction in movement through the ankle mechanism as well as in the mobility of some of the bones of the feet. This can lead to changes in the way the foot moves as it strikes, flattens and leaves the ground cause discomfort and even pain locally as well as higher up into the knee, ip and even low back.
When comfortable movement has been restored then a programme of exercise to help to maintain proper movement as well as restore balance and control should be implemented. This will eventually evolve into strength and power so that return to normal activities can happen in a safe and progressive way.