There are few things in this world more difficult to overcome than repeated failure. In my case, repeated failure has come in the form of an unflinching desire to run, but finding myself in a chronic state of injury. I’m just plain tired of it. I am a physical therapist, and I know how to take care of the problem (unless it’s bad enough it will require surgical intervention) and so I’m going to leave a running case study here. I’m going all the way back to the beginning. This case study is of myself, but will help those multitude of injured runners out there begin to understand a little bit about the way things can be processed from the viewpoint of a patient/therapist.
My most recent injury was sustained approximately 5-6 weeks ago. Somewhere along that time frame. I knew it was coming honestly. I have been struggling with iliotibial band syndrome for a very long time, maybe 12 years or so. I thought that I had bested it, and honestly I had, but I had not bested the reason I had IT-Band syndrome in the first place. My left ankle was unstable.
As it turns out, all of the times that I had rolled my ankle in High School during basketball were the reason that I had a faulty gait pattern, which eventually, during my long runs in college(typically about 10-miler on Saturdays), led to ITB- Syndrome and several other deficits.
Well, as is often the case, lateral ankle instability, one of the technical terms for repeated rolled ankles, can take part in setting you up for other ankle injuries.
While visiting family in Florida, I was running around a sandy wooded path and very nearly rolled my ankle. It pissed me off so I decided to make this the last time that happened and finally do balance training to solve the problem. I was going to get into the pool and do aquatic therapy on my ankle to finally start the stabilization process, which I knew was a problem but had been avoiding for years. Don’t ask me why. Inertia.
So I get into the pool and do about 2-hours of really good work. About an hour and 45 minutes in I start to feel pain deep in my ankle behind my achilles, just to the outside. Uh-oh. I stopped.
I had given myself POSTERIOR ANKLE IMPINGEMENT! It’s been almost 6 weeks now, and the pain is only just starting to really subside.
Basically, because my ankle doesn’t have normal flexibility for certain movements (Dorsiflexion-toes-up, and eversion-toe’s out) and has too much movement in other directions (inversion-toes in, and plantarflexion-toes down) my bones got too close and started to impact each other. I can tell it’s bone because when I push them together it hurts, but when I do it with the muscles in my legs it’s not nearly as bad.
I had given myself a bone bruise. Ok. So I overtrained something that I hadn’t focused on… ever. Is it truly Os Trigonum syndrome? Maybe, but I don’t plan on getting surgery unless I have to and I know there are better ways.
The truth is my ankle is unstable and so the retraining has to start there. I need to regain normal ankle movements (gain where I’m tight, stabilize where I’m weak).
How do you help return the stability to an ankle? See you next week.
Benjamin Rich PT, DPT