Neurokinetic Therapy® Blog

Ankle Sprains and the Kinetic Chain

An ankle sprain can be a fairly serious injury. Estimates for recovery range from three months to a year. We know that ligaments heal slowly and the tissue surrounding them must be strengthened in order to regain complete functionality. But what is often ignored is the effect of the unstable ankle on the rest of the body. Understanding how kinetic chains work is essential in unwinding complicated compensation patterns from acute or chronic injuries. The motor control center in the cerebellum will create a dysfunctional coordination pattern based on the information it is getting from the ankle and the rest of the body. This pattern will persist until it is reprogrammed with a new functional one. Long-standing aggravations to the knees, hips, lower back, and neck can be traced to dysfunctional movement patterns created by an ankle sprain.

Almost all ankle sprains are caused by a twisting of the foot which overstretches and tears the ligaments around the lateral malleolus (inversion sprain). What happens next is very interesting. It becomes very difficult to put weight on the outside of the foot because that causes pain. The foot then tends to be more comfortable in eversion, placing more weight on the inside of the foot. This causes the lower body to lean to the opposite side. What muscles must engage to make that happen? The evertors of the foot, adductors of the ipsilateral hip, abductors of the contralateral hip, the contralateral quadratus lumborum, the contralateral obliques, and the ipsilateral lateral neck flexors(upper body leaning ipsilaterally to counterbalance lower body). This will cause strain to the medial portion of the ipsilateral knee (medial meniscus strain), to the lateral portion of the contralateral knee (ITB syndrome), tightening of the contralateral quadratus lumborum and obliques (hip and shoulder level differences and leg length discrepancy), and tightening of the ipsilateral upper trapezius (neck problems such as persistent subluxations).

Clearly the dysfunctions along the kinetic chain must be addressed. I have seen neck problems of many years traced back to an ankle sprain. Changes in gait resulting from such a sprain can cause knee, hip, and lower back injuries. How would you treat this? I use the NeuroKinetic Therapy protocol to assess and treat such conditions. First I would manual muscle test the strength of the ankle and find what muscles/functions are compensating for that weakness. Then I would release the compensating muscles and retest the weak/inhibited ankle function. The same process can be applied to the knee, hip, lower back, and neck. I often find that when I asked my client to laterally flex their neck to the opposite side as the sprained ankle, it will inhibit many functions along that kinetic chain. Conversely, because the lateral neck flexors are bracing for those weak functions they can never relax. Each client will present a different combination of the above, so proceed slowly and investigate with great detail all the possibilities.

Having a global approach to injury is a very crucial aspect of successful rehabilitation. Treating injuries myopically can only lead to further dysfunction. Understanding how an injury can affect an entire kinetic chain is the key to unraveling the mysteries of chronic pain.

11 Responses

  1. Sly

    This is what I discovered recently when I picked up running. My left knee hurts because there has been an imbalance due to a right ankle sprain a couple years back. This article has been really helpful to let me know what’s going on. I am doing some yoga to train my muscles, but what other kinds of therapy might help? Thanks.

  2. Sam

    I have this been dealing with it for years had a sprain in high-school 8 years ago and to this day my ankle is outta walk. Still dealing with issues always trying to do mobilization Kelly Starrett style. But have shoulder problems on that side and hip problems all because of that sprain years ago.. Never had problems before that. What other ideas do you for people who have it ml

    • neurokinetictherapy

      Don’t assess without seeing you

  3. Nicole

    This is what I have been dealing with. I sprained my right ankle which caused me pain in my inner left knee, QL pain and pain in the right side of my neck. Amazing that it can be traced back to my ankle.

  4. Glenn

    I have had this problem since 1992, when I fractured my ankle in a motorbike accident. Of the hundreds of visits & thousands of dollars paid to supposed experts of all descriptions (including specialists, who removed my coccyx in 2003), not one of them understood this. I even mentioned the above to the last person I saw & they basically said that I was fooling myself. The real worry is that they were treating A grade football players, no wonder why there are so many injuries in football: incompetent practioners seem to be the norm these days. I have nearly fixed the problem by training the calcaneus to rotate inwards when walking & weight training & re-aligning my centre of gravity. Interestingly the contralateral side is the exact opposite: it’s taken a long while & really started to turn around when I retired & stopped standing all day.

  5. Jay lee

    Will someone with previous ankle sprain over pronate in the single leg stance?

    • neurokinetictherapy


  6. Jovanni

    I have been wandering what has been going wrong with me and this hts the nail right on the head. I have been having really bad lower back and hip pain, inner knee pain, and shoulder pain all on my right side from spraining my ankle about a year ago. I never really healed it because I wanted to go back to playing football. I was placing wieght on the inside of my foot instead of the outside and my hip would crackle everytime I walk or rotate my leg. Should I go back and pay for physical thearpy and see a doctor? Or should I look up youtube videos and do at home thearpy? What is the best way to realign and strengthen everything? Thanks

    • neurokinetictherapy

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