Just got off of the phone with someone who has a history of ankle issues after a bad sprain years ago. Damage was done primarily to the ATFL ligament, whos main role is to prevent excessive inversion of the ankle. This is the classic rolling over on the ankle injury. Rehabilitive exercises were performed to regain mobility and then when it was ready they started to work on building the strength back up in the surrounding muscles. This process does need to happen, but we shouldnt just leave it there. There are 2 major factors that come to mind with this kind of issue: 1: Ligaments also have another major role that rarely gets mentioned in rehabilitation. They are highly proprioceptive. This means that they help to supply the brain with information about the position of joints. When ligaments are damaged, so can be the proprioceptive feedback mechanism. In reality all that happens when this stage of rehabilitation is missed out is the feedback becomes slow. We are much more likely to go over on the same ankle again because by the time the signal gets to the brain telling it that we have gone too far, its too late! Remember proprioceptive training can be highly beneficial. A simple example for the ankle is a single leg balance. This can be progressed by challenging the stability of the surface that you are stood on, or using drivers of force from other parts of the body to try and put yourself off balance. The proprioceptive feedback becomes challenged and therefore adapts for next time the body is in this situation. 2. Looking at how the body has compensated and changed its movement and recruitment patterns due to the injury. The first thing we generally do when something is injured is shift our weight away from it. The body will always choose the path of least resistance, and so it will recruit different muscles in different ways to create these new pain free patterns. This is an amazing process that does need to happen in order for damage to repair. The issue comes when we then forget about these changes once the tissues have repaired. We now find ourselves stuck in these new sub-optimal patterns which can then eventually lead to over use injuries in other sometimes seemingly unrelated parts of the body. An intrinsic biomechanics screen helps to identify these changes and correct them to restore optimal function of the joints, tissues, ligaments, and nerves and the integration between them. So there you have just a couple of points on what might potentially be missing from a rehabilitative point of view, and this is just the beginning. Research is ever changing and ever moving. If we just stay still and accept what we are told without challenging the systems and current processes, then how can we ever progress? If we learn to work with the bodys own processes and facilitate healing then we can once again regain proper function as a whole :-)
Posted on: Mon, 17 Mar 2014 17:15:49 +0000
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