THE ANKLE SPRAIN – A CORNERSTONE TO UNRESOLVED PAIN

If there is one common injury whose long-term effects are largely under-estimated, it is the common ankle sprain. For those who have sprained or injured their ankle, you know how your ankle swells up, gets discolored and, for a few weeks, it is difficult to move it and put weight on it. Slowly but surely the swelling goes away and you feel like you can move it again. Soon thereafter, you are walking and eventually, as you no longer feel pain, you resume life again. 

All good, right? Well, it is very easy to just assume that when you no longer feel pain that everything is fine again, as if nothing ever happened. But as you know, in many cases, whether it be a part in your car that started to rattle and went away or even a painful conflict with a friend or loved one where the tension dissipates over time, you know eventually those pains commonly resurface and potentially worsen if the core of the matter is not addressed. Injuries, like an ankle sprain, especially if they happen multiple times, can be a cornerstone to a growing number of injuries and intensifying pain in the rest of your body. 

Even though your ankle is basically a simple hinge joint that normally should bend back and forth to allow your foot to do things like walk, run and squat, the rest of your leg and even the rest of your body rely on that simple joint to give you the motion it needs. For example, when you walk, the ankle needs to bend approximately 10 degrees of what is called ankle dorsiflexion. More ankle dorsiflexion is needed when you run and squat.

From there, there is a sequence of joints that then need to work together to give you the movement that you are doing. The knee and hip joints need to bend back and forth as well, to allow you to walk a normal stride. When you squat or jump, there is even greater motion required by all of these joints. 

So now imagine if your ankle no longer bends 10 degrees. At an extreme case, imagine you had a cast on your ankle that did not let it bend at all. What would it look like and how would it feel if you could not longer bend at the ankle? You would probably notice that you walk by twisting your knee or hip to keep the motion going. When you squat you probably aren’t able to squat as low and even if you can, you probably feel your knee or hip doing more of the work. 

So, what does that have to do with a healed ankle sprain? Well, the basic take-home message is that swelling turns into scar tissue. Most people know that scar tissue is not a good thing in the long run. It may not be painful, but scar tissue can make your joints, muscles and other tissue become more restricted. In the case of your swollen and sprained ankle, as the swelling and pain calm down, you are left with scar tissue around the ankle that can limit the motion of the ankle. 

Many of you who have sprained your ankle may not even notice that change in motion and even if there are some slight changes, you’re probably thinking, so what if I lose 2-3 degrees of motion? Surely that should not matter much. 

And perhaps 2-3 degrees of lost ankle dorsiflexion should, essentially, not have a major impact on your body. But for every 2-3 degrees of motion that you lose with one of the major joints needed just to walk, squat and run, that motion needs to be compensated for somewhere else in your body. 

For a short term in your life, this is not a big deal, as your knees, hips and back can all take up the slack for that lost motion. But now think about the number of steps you take a day, especially with this day and age of step counters measuring if you did your 10,000 steps a day. How much is that 2-3 degrees of motion and stress being placed, not only on your ankle, but also the rest of your body? Have you ever noticed that the ankle you injured way back in high school is the same leg your knee or hip is now hurting after years of an ankle that does not move as well as it should have? 

Now think about those times when you had more severe ankle injuries and you lost much more mobility in the ankle. Rather than losing only a couple degrees of motion, you may now have lost 5-10 degrees of motion. In cases like that, not only might you find more pains popping up like plantar fasciitis in your foot or bunions in your big toe, but you may also experience pain in your low back and even up into your neck or shoulders. Think about the way you walk. Normal walking requires your opposite arm and leg to swing together for a normal stride. Have you noticed that, when your ankle is stiffer, your opposite arm swings differently? Think about how much strain that can put on your arm or even your neck. You may be seeking medical care because you cannot raise your arm or pain in your neck that limits you from turning your head correctly or even numbness and tingling down your arm. Yes, you need to address your symptoms and mechanics in your arm or neck, but what happens if you can trace it back to the ankle injury you suffered long ago and how it affects the way your upper body now works? If you knew that, would you not want to also get to the core cause and cornerstone that affects all your injuries and pain? Seems logical, right?

But again, there is something that makes us believe that we should just treat the place where we experience pain and not take a step back and look at the bigger picture. 

If this sounds like you, then I encourage you to act on getting those roots of your pain and injuries addressed, as I think you will find much more relief and success in the care you are seeking. In my experience, the ankle injury is the one that is most dismissed. In most cases, ankle mobility can be restored by a good hands-on physical therapist that can help loosen up the ankle from scar tissue and promote better movement. There are many other injuries we can incur that we also overlook. You will have to make the effort and take ownership to determine the root causes that are creating repercussions elsewhere or find a practitioner that can assist you in doing so. 

I firmly believe that if you find ways to treat these root causes, you will experience a much fuller relief and recovery of the injuries and pains that have been plaguing you for so long.