Some Magic: Healing the results of a sprained ankle2 Comments June 25, 2007 / Posted in Mindful Running, Running Injury Prevention
Some Magic to Rehab Strained Ankles
Over the years at Rec.Running the issue of sprained ankles continually arises. Sometime, years after a serious sprain the pain around the outside ankle continues. Some feel it as an impingement, a pinching or tightness around the outside of the ankle. Something to be put up with.
That bump sticking out on the outside ankle is the end of the fibula called the malleolous. When one sprains their ankle by rolling to the outside of the foot, the peroneus longus and peroneus brevis attached to the outside of the fibula get strained or overstretched. To protect themselves they contract and the connective tissue around them may shorten and thicken to help in the healing process. That connective tissue is called fascia.
Fascia plays an important role in causing an ankle pain to remain, long after the healing has taken place. Think of fascia as the stocking or sausage skin around a muscle.
Once the healing has taken place with the ligaments and swelling is gone, people often notice the discomfort around the ankle. They feel it around the outside of the ankle where that bump is.
Ida Rolf talking about the impact of an injury or surgery on fascia says:
The fascial tissue tends to become tenser and shorter as it heals, as all of us can verify from old or new scars. …This fascial web connects and communicates throughout the body; thickened areas transmit strain in many directions and make their influence felt at distant points, much as a snag in a sweater distorts the entire sweater.
To protect the strain or injury to the peroneus muscles, the fascia aids in the splinting of the muscle so it won’t be damaged further. Remember that fascia has a tendency to contract due to injury, age, poor posture and muscle imbalance. So the fascia around the peroneus remains shortened and unnoticed. What is noticed is the tightness or sense of pinching aroung the ankle.
As the person makes a circle with their foot,why do they feel the tightness in the ankle?
What is happening is the peroneus longus and peroneus brevis tendons which go around the malleolous and attach at the first and fifth metatarsals, respectively are being strained.
This strain is due to the peroneus muscles not being able to stretch fully since their sausage skin (fascia) is shortened due to the injury a month or 10 years ago.
So often the sprain is gone but those muscles and fascia which splinted to protect the pulled muscles and strained ligaments don’t let go. Those muscles that hold on are unknown by most people. They keep thinking ankle and forget the ankle residue of tightness and/or clicking may be a symptom.
Those muscles and their fascia (the thin transparent film you see between the skin and the meat on a chicken breast) must be worked on through transverse friction, deep tissue massage or fascia release. Once that muscle group on the outside of the leg is freed up the ankle joint is freed up and it’s ease of movement almost feels like a miracle has happened. There’s no clicking and the person feels immediately a fuller range of ankle motion.
I continue to maintain that the problem of the continual re-spraining of one’s ankle is more a function of the peroneus remaining shortened by the original sprain and the fascia holding the muscle in that shortened state.
Back to my soapbox about my reason for having people train on unpaved roads, grassy or uncompacted dirt is to train their stirrup muscles which are postural muscles (peroneus and posterior tibialis) that respectively evert and invert the ankles.
If people keep running on flat, level surfaces that are concrete or asphalt the level, flat surfaces create an overuse syndrome which never let the ankle act as the semi swivel (not anatomically correct) it is. My reason for having people run on grass and unpaved surfaces is to allow the ankle to do what it was make to do…adjust to the terrain.
Paved roads create an overuse syndrome because those muscles never get taken through a wider range of motion and therefore shorten and the fascia then locks them in that position.
I think that the solution is counter intuitive. It’s not the unpaved and uneven surfaces which are the problem. It’s the paved even surfaces which never allow for the variability which the ankle needs to experience to maintain its range of motion and muscle flexibility.
What To Do About The Tight Or Clicking Ankle
Using A Partner
Have your partner start about 3 inches above the ankle bone on the outside. Hold as if they are going to strangle the outside of your lower leg- fingers wrap around the lower leg thumbs pointing toward each other or one thumb rests on the other thumb (if more pressure is desired) on the fibula and therefore on the peroneus. The thumbs are pushing in and upward to make the skin taut.
Have your partner use light pressure by pushing in with thumbs as you make a small (emphasis on small), smooth (emphasis on smooth) circle. As you make small smooth circles with the foot they slowly start to slide their thumbs up the peroneus muscle. The feeling is that your skin is being pulled where the thumbs are holding the skin taught.
As you make the small circles, your partner is slowly sliding their thumbs up the peroneus as you feel the pull of your skin sliding under their thumbs.
The idea is that you loosen any adhesions where the shortened fascia was holding the peroneus from going through it full range of motion.
Stop after 3 or 4 times of small circles and they holding and sliding up the peroneus.
Walk a few steps. More often than not, you’ll feel less pressure around the ankle as it can move more freely due to the freeing of the peroneus higher up the leg.which takes the tightness off the ankle area. Now the tendons of the peroneus are not being strained since the peroneus has an increased range of motion.
The peroneus and posterior tibialis are often called stirrup muscles as they evert and invert the foot, respectively. They are also postural muscles and therefore slow twitch, in that they help maintain correct posture when functioning properly.
Doing The Loosening On Your Own
To loosen the peroneus on your own, face a railing with a middle railing. See the picture. Turn your body 45 degrees and place the peroneus side of the leg on the bar, usually the middle bar is better unless you’re very tall.
Do the same foot movement as mentioned above to loosen the peroneus and the fascia that may be constricting the ankle for its full range of motion. As you make the small circular movements slide the outside of the leg slowly down the railing. Start about 3 inches above the ankle bone and go to about the middle of the lower leg.
If the circle made by the ankle is to big, it will be a jerky circle and you’ll just be straining tendon since the muscles won’t be letting go. So small circles, start penny size. The circle is not made with just the front of the foot. The bottom of the heel is scribing a circle also. Imagine your foot is the bottom of an unside down pie plate and you get the idea how both the front of the foot and bottom of the heel are circling.
As the foot makes the small circles at first imagine you’re screwing out the foot so there’s more space in the ankle. When the peroneus loosens up there is a better range of motion in the ankle.
Remember to do this lovingly. If you make big circles, or do it too hard or too fast, your body will remember the feeling when it was originally hurt, and tighten up even more to protect itself.