Since the ankle supports the entire weight of the body, it’s very prone to injury. According to The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), over one million Americans suffer from an ankle injury each year, eighty-five percent of which are ankle sprains. In order to have a normal, smooth, and effortless gait, the ankle must function properly.
Ankle Injures- Ankle Pain
The muscles, joints, bones, tendons, and ligaments of the ankle all work together to propel the human body through gross motion.
The ankle joint, also called the talocrural joint, functions like a hinge to allow the foot to move up (dorsiflexion) and down (plantarflexion). However, unlike typical hinge joints, the ankle joint also allows for a slight degree of side-to-side motion. The ankle joint is the meeting point for the distal ends of the fibula and tibia bones of the lower leg and the proximal end of the talus bone in the foot. Within the joint, the ends of the three bones are covered in articular cartilage. This smooth and slick material is what prevents bone-to-bone friction.
Ligaments are strong bands of connective tissue that attach bone to bone. In the ankle, there are ligaments on both the lateral ankle (outside area of the ankle that‘s farthest away from the mid-line of the body) and medial ankle (the inside area of the ankle that’s closest to the mid-line of the body). The deltoid ligament is the thick ligament that supports the medial ankle. The three lateral ligaments are the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The anterior talofibular ligament is the main stabilizer of the ankle joint and the most often injured. There are also three main ligaments supporting the ankle syndesmosis (the area where the fibula meets the tibia). The anterior inferior tibiofibular ligament crosses above the front of the ankle. The posterior inferior tibiofibular ligament and the transverse ligament cross at the back of the tibia and fibula bones.
Tendons are much like ligaments, but tendons connect muscle to bone. Of the ankle tendons, the Achilles tendon is the most infamously injured. It’s vital for rising on the toes, jumping, running, and walking. It attaches the calf muscles with the calcaneus heel bone. The peroneus longus and the peroneus brevis are the tendons running behind end of the fibula (an area termed the lateral malleolus). These two tendons allow the foot to turn down and outwardly. The posterior tibial tendon runs from the calf to the bottom of the foot, passing behind the inside bump (medial malleolus) along the way. This tendon is what allows for the slight inward motion of the ankle. It’s counterpart, the anterior tibial tendon, is the tendon that allows for the foot to turn up.
Motion in the ankle is mainly powered by the strong muscles in the lower leg. Some intrinsic ankle muscles also provide ankle movement. When a muscle contracts, it simultaneously pulls its end of the tendon, thereby making the bone attached to the other end of the tendon move. The main muscles involved in ankle movement are the: gastrocnemius and soleus calf muscles, peroneus longus and peroneus brevis muscles in the outer edge of the ankle, and posterior and anterior tibialis muscles.
There is also an extensive nerve and blood supply passing the ankle on the way to the foot.
What Causes Ankle Pain?
When any of the above structures are injured or otherwise not functioning as they should, it can result in ankle pain. Ankle injuries can affect anyone of any age, from the most well-conditioned and fit person to those with sedentary lifestyles. The average person can suffer a painful ankle injury from something as simple as misstep off a curb. Ankle injuries are common to running, jumping, sliding, and contact sports. A workplace slip or fall can produce an ankle injury.
What Are Some Common Ankle Injuries?
Sprains
As mentioned above, sprains are the most common ankle injury. A sprain is an injury to one or more the ligaments in the ankle. The ligament is abnormally stretched or torn. Sprains commonly happen when the foot is twisted or turns or rolls beyond its normal range of motion. This can happen during a forceful landing from a jump, when the foot is planted on an uneven surface, or when an imbalance causes the foot to roll or turn after being planted. Sprains are graded by the amount of damage to the ligament. A grade one sprain involves stretching and some possible microscopic tearing of the ligament fibers. A grade two sprain involves the ankle joint being loose from the partial tearing of the ligament. A grade three sprain is the most severe and involves extensive to complete tearing of the ligament fibers and a highly unstable joint.
Achilles Tendinitis, Tendonosis, And Rupture
Achilles tendinitis is inflammation of the Achilles tendon. Tendonosis is the term used to describe the degenerative affects (tiny tears) of the tendon, which may be the result of chronic tendinitis. An Achilles tendon rupture is an injury in which the tendon partially or completely tears. These tendon injuries are most often associated with overuse, repetitive stress, and direct trauma.
Ankle Fracture
Ankle fractures occur when one or more of the bones mentioned looses continuity due to a direct blow, hyperextension, hyperflexion, or rolling or twisting motion. Ankle fractures are generally classified as displaced (the affected bone has moved out of normal alignment and position) and non-displaced (the affected bone stays in normal alignment and position).
Equinus
This is condition where the ankle joint is limited in bending the foot upward to toward the front of the leg. There are several causes for this limited range of motion. However, the condition is most often associated with a congenital condition, a tightened calf muscle or Achilles tendon or a displaced fracture restricting or blocking the joint from completing ankle motions. As the individual with equinus tries to compensate for the lack in range of motion, such as by toe walking, the surrounding structures are placed under a great deal of stress. This can lead to ankle and foot pain, tendinopathies, sprains, and strains.
Strengthening Exercises
These Ankle Exercises are ideal to build strength and flexibility.
Massage Treatment
These Ankle Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.
ACUTE STAGE SYMPTOMS AND TREATMENT
This stage is characterized by swelling, redness, pain, and possibly a local sensation of heat, indicating inflammation. If coolness makes your pain feel better, then the Acute Stage Treatment is recommended.
ACUTE STAGE SYMPTOMS:
The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the ankle because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured ankle, causing pain, inflammation, lumps and swelling.
The sensation of heat is due to the warming action of the blood and fluids overheating in the injured ankle as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
During the acute stage it is very important to restore normal circulation to the ankle, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the ankle, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the ankle can strengthen and regain it's mobility.
ACUTE STAGE TREATMENT:
1. Apply the Sinew Herbal Ice on your ankle to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the ankle. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.
Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that don't heal well.
2. Massage your ankle with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
CHRONIC STAGE SYMPTOMS AND TREATMENT
This stage begins once the swelling and inflammation are gone, but you still feel pain, stiffness, weakness, and/or sensitivity in cold and damp weather. If heat makes your pain feel better, then the Chronic Stage Treatment is recommended.
CHRONIC STAGE SYMPTOMS:
The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your ankle that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.
Your ankle may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your ankle you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.
During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the ankle, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.
CHRONIC STAGE TREATMENT:
1. Massage your ankle with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. The Sinew Relaxing Soak can be used in-between applications.
2. Soak your ankle with the Sinew Relaxing Soak to relax muscles and tendons that are in spasm, ease joint pain and stiffness, and improve range of motion. The Sinew Relaxing Soak is particularly useful if you feel restricted mobility in your ankle. Chronic Sinew Liniment can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
