How to fix ankles – Osteopathy and Pilates: sprains, stiffness, and instability. TWD Osteopathy and Clinical Pilates, Footscray. By Dr. Jim Pattinson (Osteopath).
Simple ankle sprains require straightforward management, the usual rest and ice and so forth. I find that they recover much faster, however, with the right sort of muscle work. That is, specifically to free up the tendons in and around the joint – this has to be done in a way that does not aggravate a recent sprain. When this work is done, the swelling will reduce rapidly and the patient will be able to place weight onto the ankle much sooner, if not straight away after treatment.
The following treatment is for the most common types of chronic ankle injury, especially when they have not responded to standard treatment/rehab. Chronic ankle problems require an understanding of the commonly overlooked restrictions in the muscles and joints of the ankle/foot.
The main thing to understand is that the ankle mainly requires two movements for normal gait – they are, dorsiflexion and eversion. Flexion is less often an issue in normal gait, and has to be very restricted before it is much of a problem. Dorsiflexion and eversion, however, can cause problems with only a relatively minor degree of restriction.
The specific osteopathic techniques are:
(a.) muscle release: a relatively gentle,cross-fibre, repetitive stretching motion of the tendons around the ankle, especially the lateral malleolus (i.e. peroneus longus and peroneus brevis muscles). This technique will rapidly free up the motion at the joint, facilitate drainage of any swelling – and it is not terribly painful. The peroneus muscles are the most commonly overlooked, or are just poorly treated.
(b.) articulation/mobilisation of the ankle. As the fibula is more or less a “floating” bone, it is the one that is most likely to be adversely affected by any tension in the associated muscles. Therefore it seems to be the one that yields the best/fastest results when it comes to treatment. The two most common directions of restriction are superior glide, which is needed to allow eversion movement; and posterior glide which is necessary for dorsiflexion. To treat, simply take the ankle into the restricted range and apply over pressure on the distal fibula in the desired direction – superior glide coupled with eversion; posterior glide coupled with dorsiflexion. A straight anterior to posterior thrust of the fibula/tibia on the talus is also very useful, but not in the acute phase of the injury. I should probably also mention articulation with the ankle in traction – a great way to get rid of those clicking, crunching, grinding noises patients sometimes get on circumduction movements. Again, start off with dorsiflexion and eversion in traction, and gradually add in other directions as required.
And that’s all there is to it. There are less common presentations that require some modification of this approach, but once you understand this simple method it is fairly simple to adapt to any other presentation. I generally will begin with this approach because it gets the fastest results, and then any other restrictions in the ankle are more or less a bit of fine tuning.
Dr. Jim Pattinson (osteopath) is Clinical Director at TWD Osteopathy and Clinical Pilates, Footscray.