It’s been a week since my first post on self-treatment from yet another running injury. That post explained that I have three simultaneous problems: 1. The infamous Iliotibial Band Syndrome (AKA IT-Band syndrome). 2. Lateral Chronic Ankle Instability (LCAI, AKA Repeated Rolled Ankle). 3. Posterior Ankle Impingement (This really isn’t very commonly discussed and so is likely to just be called rear Ankle Pain).
I believe the the precursor to my own issues with ITB-Syndrome, and Posterior Ankle Impingement is my repeated rolled ankles. I had many of them when I was younger. They typically occurred in Basketball. Almost always with my left ankle.
I would often wear a brace when they occurred, however never more than for a few weeks. Luckily, none of them resulted in me sustaining a tendon rupture.
So what really happens with a repeated rolled ankle? Why is this important?
Well, there are a few different types of rolled ankles, but the one I’m referring to here is called an inversion sprain. It’s actually a very common injury. Would you believe that 23,000 rolled ankles occur every single day in the united states?(1) EVERY. SINGLE. DAY. That is a staggering number.
What really happens during a rolled ankle is that the there is a loss of muscular control of the position of the ankle, and because the muscles can no longer sustain an appropriate position, the individuals ankle turns inward (called supination). Because the muscles (Active tissue) can’t hold the position, the passive structures called ligaments have to do so. The force of this movements is often too much for the ligaments and because all of the stress is moved to them (when the forces should be shared), they become injured. That could mean they are stretched out or even fully torn.
When this happens over and over, we start to use to the term chronic ankle instability.
Let’s take a break from the biomechanics and talk about my progress.
Update on progress: Over the recent week, since really honing in on my problem, I have begun stretching the tight areas of my left ankle. Specifically, I have been stretching out the ligaments in the back of my ankle and my calf muscles. I have completely avoided stretching out the lateral ankle active or passive structures, because that movement is already too much. That is what happens with a rolled ankle, afterall!
While completing my exercises, I often notice that this is not a continuous linear process. I have to repeat my exercises on a daily basis because what I gain, the swelling and inflammation will take back. Two steps forward, one step back. This is typically of exercising injured tissues however. Even so, this is going to take some time!!! Accepting that is just a part of the process and an act of good self-care.
I often tell patients that truly regaining structure and balance control can take months. This is just as true for me as it is for them.
By stretching the over-tight (hypomobile) regions and leaving the over-loose (hypermobile) regions I am starting to create a structural tension balance in my ankle. This is exciting! Finally treating what I’ve needed to treat for such a long time. No more pushing my own limits too far!
Next week I will explain a bit more about two different types of lateral ankle instability and how they can differ.
Benjamin Rich, PT, DPT