Laurie's Blogs.

I believe that when we are given challenges, we are meant to learn from them.  Another way of putting this, is ‘when life gives you lemons, make lemonade’.  Blah, blah, blah… but seriously my ankle is still bothering me, and by the time I publish this blog it will be 2.5 months since I injured it (presumed cranial subluxation of the talus when I was getting up from the floor at work one day).  Where am I at now?  Well, the ankle is slowly improving (much slower than makes sense) but I am now ‘feeling’ all of the compensatory / secondary issues from favouring my ankle for the last 12 weeks!  So, that is what has me thinking of this topic!

Let’s start with me.  I think there are lessons to learn in my story, or maybe it’s therapeutic for me to share my ‘woes’…  

The ankle has hurt to take a full-ish stride on it.  It has been difficult to walk very much.  I am sitting more and in general, exercising much less.  It hurts at night for the foot to be under the covers and the pressure of the sheets ‘pushing’ it into a plantarflexed (pointed) position hurt.  It ‘catches’ and pains when I go to dorsiflex (flex) the ankle, especially against the resistance of the bed sheets, or if the ankle has been in a pointed position for a prolonged period of time.  So, what has that done to the rest of me?

•  Sitting more has led to tight hip flexors and external rotators of the hips

•  The pain at the ankle and the off-loading of that leg has resulted in decreased bulk and tone in my calf muscle.

•  Abnormal / asymmetric gait patterns have caused pain at the knee and sacroiliac joints when I walk.

•  Protecting the ankle as well as the gait alternations have resulted in myofascial triggerpoints detectible throughout the lateral calf musculature.

•  Less exercise and movement in general has mean more time in front of the computer along with a head-forward posture, rounded shoulders and overall deconditioning.

It’s been hard to bounce back!  Although I’ll share a secret with you all.  I can now put on my underwear without having to sit down or lean against the dresser, because I’ve been practicing my one leg stands!  Win!!!  I am still unable to do this with pants however, but I'm working on it!

Okay,  so what’s my point… other than ‘psycho-therapy’ for me by getting to telling my story?  

The point is, that sometimes treating the compensations is what you can do and what will make a difference while the underlying injury is undergoing it’s healing.  

Picture the dog with hip arthritis who comes to you ‘tucked in the rear’, atrophied in the gluteals and rear legs in general, and resistant to exercise in its current condition.  Your GOALS might be to strengthen the rear legs, and improve hip range of motion, but you’re not going to get there quickly.  What CAN you do in the beginning?

1.  Start with pain management (pharmaceutical and modalities).

2.  Start small – Easy walking, 3-leg standing, weight shifting, front feet up on a stair step.

3.  Work on the compensatory issues:

     *     Check for back pain and mobilize

     *     Check for soft tissue pain and massage, stretch, or dry needle

Addressing the compensatory issues can provide enough relief that the patient can then tolerate the discomfort associated with the primary injury and beginning to build from there.  So, I think that you always need to check for the compensations throughout rehab, but that working with them in the early phase might yield your greatest ‘return on investment’.

So, on that note, I’m off to needle my calf muscles!!  Thanks for reading folks!

Until next time,

Cheers!  Laurie