Medium to severe ankle strains are common and should be treated with manual therapy, combined with stretching, strengthening, and proprioceptive exercises to retrain for balance.
Foot pain, ankle pain, and ankle instability are almost always associated with trigger points
Weak ankles, ankle pain, and ankle instability are all common (together and separately) in runners, and people who spend a lot of time on their feet at work - especially women who stand or walk for long periods in high heeled shoes.
Foot pain, ankle pain, and ankle instability are typically associated with trigger points, and trigger point therapy can often provide both short and long term relief.
Medium to Severe Ankle Sprains
Ankle sprains can be quite nasty and are often associated with trigger points that have developed as a result of trauma, injury, poorly fitted footwear or prolonged wearing of high heels.
Over time, trigger points make their host muscle shorter, weaker and less efficient.
When treating clients with ankle sprains we will usually be looking for trigger points that form in the tibialis anterior, tibialis posterior, fibularis (group), and extensor digitorum muscles, as part of the treatment.
The ankle joint and bones are held together by ligaments which prevent the ankle from twisting and turning in an abnormal fashion.
The ligaments, which have an elastic structure, usually stretch but then return to their usual position.
A sprain occurs when these ligaments are stretched beyond their usual range. A severe sprain is the result of ligaments actually tearing.
What Are the Symptoms of Ankle Sprain?
The symptoms will depend upon whether the ligament is stretched or torn, with a tear being more painful than a stretch.
As a general rule, the worse the sprain, the worse the symptoms.
Most will feel an immediate pain and notice swelling around the ankle and there may be some bruising. In some cases the client will report having heard a popping sound or feel a tearing sensation.
The ankle may feel tender when you touch it.
Where the ligament is torn or the ankle joint dislocated, the client will suffer a loss of stability.
A major tear may render the client unable to walk or apply weight to the foot.
With minor sprains, the pain and any other symptoms will subside fairly quickly and most likely not require treatment.
Who Is Prone to Ankle Sprain?
Often we see clients who have previously sprained their ankle and where the ligaments did not have a chance to fully heal. These cases are generally more prone to twisting their ankle again.
Apologies to all you ladies who like wearing high heels, but we see so may cases of ankle sprains as a result of (1) weakened ankles due to prolonged wearing of heels; (2) high heeled shoes that don't fit correctly nor offer sufficient support; and (3) walking on uneven surfaces in high heels.
In addition to the above, "weekend-warriors" are a definite high risk group, especially those who play soccer, tennis, squash and runners.
Stretching & Strengthening
Following an ankle sprain the joint often becomes very stiff and the range of motion at the joint is reduced considerably.
Mobility exercises for the ankle can start very early in the rehabilitation process, usually from day 2 in mild to moderate sprains.
Lateral movements should be avoided in the early stages so as not to put any stress at all on the injured ligaments. Later when pain allows, exercises with lateral movements involving sideways motion can be performed.
Ankle strengthening exercises can begin as soon as pain allows. In the early stages of strengthening any exercises which involve sideways movements of the ankle should be avoided.
Exercises for balance, proprioception and function
Balance can be a challenge even after treatment for an ankle sprain, and proprioceptive exercises can address this issue.
Proprioceptors are small structures within the ankle joint that provide information about position, coordination and agility. Proprioceptive exercises retrain proprioceptors to provide feedback on joint position, coordination and agility.
This feedback is crucial to performing mobility, recreational exercise and sports safely. Remember, when an ankle is sprained, proprioceptors also sustain injury and malfunction.
Below you'll find details of some strengthening and proprioceptive exercises that we often prescribe to clients who we treat for ankle sprains.
1. Chair Sits
• Perform a slow chair-sit exercise twice daily to build strength in your quadriceps, which will help stabilize your knees and ankles
• To do this, sit in a chair, keeping your back straight
• Focus your eyes on a point directly in front of you, and slowly rise to a standing position, taking at least five seconds to do so
• While you rise, do not round your back, but keep it straight, and do not hold onto the chair for support
• Be sure to keep your knees pointing forward
• Once you have reached a standing position, slowly lower yourself back to the seated position in the same way, keeping your back straight, and taking your time
Try for 30 repetitions, 2-3 times daily.
• Loop a resistance band around the forefoot and hold onto the ends
• Point the foot away slowly allowing it to return to a resting position
• Once this exercise feels easy, you can increase the strength of the resistance band or progress on to full calf raise exercises
Try for 10-20 reps and 3 sets, twice daily.
• Using a rehabilitation band pull the foot and toes up against resistance and then down again
• This is an important strengthening exercise, however it is important not to over do it
• Remember you will still have to walk on the ankle after the strengthen session so do not take the ankle to fatigue
• Over time this may also lead to pain in the front of the shin - less is probably more with this exerciseAim for 10 to 20 repetitions and 3 sets with a short rest in between, twice daily
4. Calf Raise
• Begin by standing in front of a step or riser with feet shoulder width apart, facing forward
• Step up onto the step with both feet, holding on a rail or chair, and letting heels hang off the edge
• Rise up onto your toes as high as possible in one smooth motion. Hold for a couple seconds
• Slowly lower heels as far as possible, below the level of the step to complete one rep
Note: You can extend your arms out to your sides or lightly rest your fingertips on a wall or chair to help with balance
Make it harder: Try one-leg calf raises following the same instructions. Alternate feet after completing one set on each side
Try for 10 x 3 reps each/both leg(s). Twice daily
• Although mainly a knee exercise, lunges can be used to improve the balance and strength at the ankle joint• Stand with the injured foot in front of the other, toes facing forwards
• Bend the back knee down towards the floor, keeping the back upright
• Stop just before the knee touches the ground and push yourself back up again
• Start with a low number of reps, such as 3 sets of 10
About NAT Courses
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Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.
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There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.
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Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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