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.