Balance and Ankle Injuries
In the last newsletter, we covered the topic of BALANCE and the beginning approach to managing balance issues. I would like to take the discussion further and look at the importance of maintaining adequate ankle mobility to enhance our ability to maintain balance.
We want our bodies to be able to make compensations. A compensation, can help us initially by avoiding an injury, however, in the long run, it may cause harm. An example I like to give is stepping on a pebble while running. If someone steps on a small pebble on the lateral side of their foot, the knee may cave in, the hip will internally rotate and there may also be some rotation through the spine. The fact that our bodies can make this compensation is a great thing. However, energy may have been lost doing this extra knee and hip internal rotation. What would have been the preferred reaction is simply the ankle everting as it stepped on the pebble, with no compensation up the chain (leg, hip and spine). If adequate ankle mobility, in this case, eversion, is present, there doesn’t have to be any compensation and no energy leak. Energy leaks over time can lead to injury (which can be far away from the source of the problem). In the short term, energy leaks decrease performance (speed, acccuracy, targets, and other outcome measures).
With an ankle injury, not only are there injuries to the ligaments, tendons and muscles, but there are injuries to the nerve endings that go to all of these structures. These nerve endings tell the brain where the body part is positioned in space, called proprioception. With an ankle sprain, this sensory information coming from the ankle becomes distorted and the brain “can’t read the message” and balance becomes an issue. We want the brain to receive the most accurate information possible.
Ankle sprains aren’t the only thing that may cause this “lack of information”. Bone fractures around the ankle joint, periods of immobilization, arthritic conditions, muscle injuries and other ankle injuries can also throw off proprioception and cause some balance issues.
Following an ankle injury, rehabilitation must focus on restoring mobility first followed by stabilization and then functional movements. In some cases, using custom orthotics can also help improve alignment and reduce compensations during recovery. One of my favourite more advanced range of motion exercises can be seen below:
Stabilization involves strengthening the muscles that cross a joint. Banded resistance strengthening, resistance with weight (dumbbells or kettlebells) are a great way to increase the muscle mass and tolerance to the tendons.
Functional training is typically done specific to the sport. Basketball and volleyball players need to work on push off and landing from jumps. Tennis and soccer may need more pivoting motions added to their workout. Functional training should focus on the motions that are used during the sport while incorporating range of motion and strength.
To summarize, ankle injuries can lead to decreased range of motion and faulty proprioception which can alter the information being put back out by the brain, and resulting in a balance issue. If you need help with exercises recommendations after your ankle injury or are experiencing some balance issues, book in for an initial assessment or a reassessment for existing patients, and let us help you.