Ankle Problems (Dr has mentioned possible CRPS)

[physiomitch]

Hi Callum

Amkle sprains unfortuantely can result in many different permutations, some last longer than others. One thing you need to be aware of is the secondary accommodative changes that can take place and that I find commonly with ankle sprains. These include sympathetic nerve dysfunction, either due to a prior dysfunction(common if you are involved in sport), or due to the reaction to the injury, and biomechanical dysfunction often in the hip of the injured leg, ie weakness developing in the muscles of the hip due to altered accommodative mechanics to support the injured ankle.

Both are essential to correct before the ankle can recover correctly. It is possible that your discolouration and swelling continue because the sympathetic nerve control of the blood flow to that area is sluggish, thus resulting in a poorer blood flow rate, thus sluggish return of blood flow and fluids to the heart. Swelling can often remain for months if untreated. Swelling also occupies a space not normally occupied thus resulting in tender irritable local tissues.

Hip weakness means the muscles may be starved of a good blood flow, and/or they are being trapped in their own (fascial) sheath often due to overuse in adapting to the injury. Walking with a limp or carrying an ankle with POP on it can put unnecessary strain on the leg and hip and weakness resulting from this means the support for the ankle is missing, causing the calf muscles to work too hard, thus a viscious cycle is set up. I would think if I did a study on all the ankle sprains I have treated in the past 16 years, I would probably find >90% of them had hip weakness, which if not treated, results in the ankle not being supported by the higher mechanical centres. So the ankle injury cannot repair fully.

Excuse the long-winded view, but it is not as simple as exercise and mobility, there is often a bigger picture involved. You would benefit from a manual muscle test from the hips down, find the weaknesses and restore these through some form of work on the T10 to L2 sympathetic area of the spine, and soft tissue release (myofascial) over the weak muscles and tight areas of the calf. It would not be unusual to find resisted weakness in the ankle dorsi and plantar (with inversion) flexion, as well as hip weakness. The fascia of the calf reacts to the injury by tightening up in the posterior tibial areas (behind the shin bone), and the anterior tibial muscles become weak from the sudden overstretch and reciprocol inhibition to the tightness of the posterior tibial group.

All these need work to restore flexibility, circulation and thus strength. Only when these have been restored should you think about exercise. Exercise when there is still weakness of this type and stiffness and the problem expands.

Hope this helps

[Callum]

Thank you all for your replies, I shall certainly mention to my physio (next appointment this Wednesday) about the muscle test. I have been performing the exercises given to me by her, no improvement yet but it is early days. I shall post any devolpments.

Thanks again
Callum