Ankle

The article below was conceived and written entirely by a past patient of York Rehab. We did not solicit the article nor has the patient received any compensation or special privilege for the submission of this piece. His motivation to write this article was because his treatment outcome has been life-changing and he wants to share his story so that others suffering a similar fate are aware of the possibilities for healing. We are immensely grateful for this individual’s thoughtfulness and his time spent to produce this article, especially without the need for recognition or reward.

I’ve wanted to share my experience for a while but had not discovered an outlet until now – thank you York Rehab for allowing me a platform! Here goes: A friend (and soccer teammate) of mine recently turned the corner on a year of suffering from an injury. Feeling unqualified to share my opinion while I observed his situation, I bit my tongue only gently offering suggestions on what he might consider re-evaluating with his treatment approach. My advice was usually politely dismissed, and understandably so given my untrained perspective was different from his surgeon’s. When his lack of recovery reached a point where he was getting ready to give up playing soccer (a game he loves so much), he was then willing to listen and try anything. I won’t provide any specifics of his injury and experience, that’s his story to share. But I told him about McKenzie Therapy, which he had never heard of (as is the case with most people). The short story was that after a year of debilitating pain, one visit to a trained McKenzie physiotherapist reduced his pain by almost 70%, allowed him to return to play within a week and restored hope that recovery was possible. Helping my friend led me to want to help others by sharing my own story. Although not related to McKenzie Therapy (a treatment approach I’ve significantly benefited from many times), it’s another type of treatment that changed my life in an unimaginable way. I want my story out there to let people know about the possibilities of healing from long-term and chronic ailments.

Now my story. I’ll start with some background information. First off, I should quantify my reference to “soccer career”. I’m not a professional, I don’t make a living playing soccer, I play the game for its pure enjoyment (for over 4 decades). It has been and will continue to be an important part of my life until my very end. Let me add that although I may watch the occasional game on TV, my interest and love for the sport lies in my ability to get on a field and play. If I never see another professional league game for the rest of my life, no sweat…if something happens that prevents me from playing soccer, my life would feel like it’s over. And that’s the direction things were heading about 4 years ago, leading up to my visit to Glenn Woodland (a chiropodist at York Rehab).

My problems started about 2 years prior to my first meeting with Glenn (Chiropodist at York Rehab). I had been really struggling with recovery after my weekly soccer game. The typical minor muscle and joint pain from my once-a-week calling on underused body parts like knees, ankles, and quads had been manageable in the past, but a new problem was surfacing…Achilles pain and it was escalating. Initially, I assumed the cause was from the ankle braces that I had been wearing for the past 15 years to protect me from chronically rolling my ankle during play. A result of loose ligaments from repeatedly spraining my ankles when I was younger. I figured the brace was the culprit because it was rubbing on my Achilles in the area the pain was originating. I began to become more concerned when the pain began to limit my ability to play and the post-game recovery process which consisted of 2 days of waddling around like a penguin to minimize the pain coming from my throbbing Achilles. My self-imposed number of days between games which I set to 3 days to allow for the usual recovery was becoming insufficient.

As my pain continued, my thinking changed from the ankle bracing being the culprit. Maybe the progressing pain and discomfort was something that simply came with age. The pain was starting to become more intense and drag on for days and the thought of taking some time away from the game started to surface. That became a very depressing thought! My wife sensing my panic with the thought of having to stop playing the game I love suggested I go see a chiropodist. Maybe orthotics could help she said. I then remembered a teammate of mine from 15 years ago had Achilles issues, got orthotics and his problems went away. I knew of orthotics but always figured it was for someone who had inherently bad foot design issues. I always considered myself more of an athlete (all in my head) with a perfectly aligned body and would never need to rely on devices like orthotics to correct my movement.

So, my wife’s suggestion brought me to Glenn’s clinic for an appointment. His assessment began with observation and minor contact of the affected area…he noticed how swollen my Achilles was, how sensitive they were to mild contact (as they had been for 15 plus years), and how bumpy (scaring) they felt below the skin from the recurring trauma due to the demands of playing soccer. He then started to focus intensely on the design and movement of my legs and feet and measuring parts of them with instruments I’d never seen before. He took stock of:

• How I stood up still.
• How I walked on the treadmill.
• How my feet moved as I tiptoed.
• He looked at the soles of my shoes.
• And finally, he moved my feet and toes a few different ways

This data gathering process led him to a few conclusions all of which he shared with me in detail to ensure I understood his reasoning.

• First, he noted that I have a slight bow to my legs, i.e. when I stand up straight with my feet together, my knees don’t touch – this by itself wasn’t news to me I’d always known this but never thought anything of it. He explained that the bow was likely causing me to wear the soles of my shoes on the outside edge – something I’d also observed all my life but never knew why it happened – I was now really listening. Glenn suggested that shoe inserts (Orthotics) would help – they’d correct how my feet make contact with the ground.
• Because of my slight bow, my feet hit the ground on the outside edge which is part of the reason why I would roll my ankle so easily when playing soccer. According to Glenn orthotics would help to correct my chronic ankle rolling too. I was hopeful but skeptical, after all, I’d needed ankle supports for the last 15 years of playing soccer. And I didn’t wear them for a game, without fail – I would roll my ankle. I was super dependent on them.
• Lastly, because I was so dependent on ankle supports, my ankles were very weak and unstable – which was partly leading to more strain on my Achilles. Orthotics would help to reduce the strain on my Achilles which would reduce the inflammation.

Although Glenn felt that orthotics would help, he wanted to test how I would respond to some adjustments to my current footwear. So, he hand-crafted some temporary inserts on the spot for me to use in my shoes for the next two weeks (he had me bring in the 2 pairs of shoes that I’d wear the most during that time: running and soccer). I left Glenn’s Chiropody clinic with my inserts, slightly hopeful of pain relief but still full of skepticism that a solution to my pain and injury rested in a couple small pieces of cork (the material the inserts were made of). What happened over the next several days was pretty miraculous.

• I played my first soccer game two days later with the inserts and without my ankle supports. I started the game very timidly because I anticipated I’d roll an ankle (or two). Halfway through the game, I was going full tilt and had forgotten I didn’t have on my ankle supports…I finished the game without any ankle injury (I was amazed but thought it must be luck) and minimal Achilles pain.
• I had another soccer game 3 days later and again I played without ankle braces but this time with less in trepidation and more intensity…and again no injury. I didn’t even notice my Achilles weren’t hurting. It’s strange how quickly you forget you had pain once the healing process begins. It wasn’t until the next morning when I instinctively stepped down from my bed slowly anticipating pain…but there was none…that’s right, none!

Fast forward to 3 months later and regularly using my actual pair of orthotics. I was able to jog and play soccer twice a week with no issue and no pain whatsoever. Playing without my ankle supports has allowed me to play like I’m 15 years younger – my mobility, agility and speed have both improved immensely. And no longer does it take me 15 minutes to suit up to play – lacing up my ankle braces was always a hassle. I’m ready for play in 2 minutes…it’s a new lease on life. And the Achilles pain is gone…so is the swelling and tenderness. I haven’t been able to touch my Achilles for decades because they were so tender.

It’s been two years and my ankle and Achilles situation has permanently changed for the better. After a lifetime of wearing out my soles on the outside edge (since I was a kid!) it no longer happens! I thought I’d be playing soccer with ankle braces for the rest of my life, but I don’t need them anymore. I don’t even carry any in my gear bag just in case. Ankle exercises and the mere fact that I’m not restricting my ankle’s mobility has allowed my ankles to strengthen nicely. There are other small changes that are actually big things to me. Like the fact that I can put up my legs on a table or ottoman and cross them so that my Achilles rests on the front part of my ankle without me wincing in pain. I’m also playing soccer as I did 20 years ago because my ankles are no longer restricted, the mobility and agility that I once knew are back – things I thought were lost as I age. I also wake up the next morning after a game and can simply walk (no more wobbling to avoid pain). I never imagined that a small shoe device could do so much for me – they have made the inconceivable possible. By sharing my little story, I hope others who are suffering from chronic pain take a small step forward and visit a chiropodist (or physiotherapist if the pain is elsewhere). I must include “physiotherapist” because I’ve had a couple of life-changing recovery experiences with one as well. I am motivated to share my story because like many people I assumed your body slows down and falls apart with age – but I’ve learned that it’s the other way around. Your body falls apart because you slow down as you age – simply put, don’t slow down. Walk, run, and play forever because if you stop using it you will lose it.

Thank you, Glenn!

A common injury for people involved in sports such as soccer, tennis, squash, or running is an ankle sprain. Many athletes and weekend warriors alike have experienced this injury, often multiple times, and may rely on using a brace for support to prevent re-injury or be forced to cut back on their participation due to recurring injury. It is possible to minimize the recurrence rate of this injury by seeing a qualified physiotherapist who can assess for and address the following limitations that are common in people with repetitive ankle injuries.

Some people who have had a long history of ankle injury have range of motion limitations. What can happen is the ankle swells following the sprain, and it gradually recovers, but the scar tissue that forms to rebuild the injured tissue does not get adequately stretched. This is how a stiff ankle can develop, and playing sports with this movement loss can lead to another injury quickly. A physiotherapist can identify these limitations and prescribe the proper stretches to recover as much mobility as possible.

Secondly, following the recovery from an acute (within 6 weeks of injury) ankle sprain there might not be any residual pain, but often there is a lingering weakness. Because the ankle feels free of pain the athlete is compelled to return to their sport, neglecting the strength deficits that are present. Depending on the sport, this might manifest as decreased endurance, overall strength, or explosive power such as in jumping sports. This can be remedied by regularly performing the appropriate exercises specific to your sport, exercises which can be determined by a physiotherapist.

A hidden impairment that an athlete may not notice after an ankle injury is decreased proprioception. This refers to the “position sense” of your joints and ligaments, similar in a way to other senses such as vision and smell. There are sensors embedded in these tissues that give the body feedback about where it is in physical space, and we rely on this sense to maintain good balance and stability during weight-bearing activity. After an ankle sprain, we often lose some of this sense, but it can be readily retrained much like muscle strength can. Specific balance exercises can be done to regain this sense, with progressions to sport-specific activity.

Building on that last point, before returning to your activity is considered, an athlete should be able to perform the necessary tasks involved in the activity. For example, a soccer player should be able to sprint, change directions quickly, kick, and dribble a ball. Often the speed at which these activities can be done following an ankle injury is much less than in normal conditions. Agility exercises and plyometrics, which are a type of exercise involving explosive movements such as jumps and sprints, are essential here. Regaining these skills is crucial to minimize the risk of long-term ankle injury recurrences.

To summarize, if you have had trouble with repetitive ankle injuries, you should consider seeing a physiotherapist who will assess to see if any impairments discussed above are present and design the optimal program for you to address them. Frequently the solution to the problem is relatively simple; it just takes some diligence to stick with the program to see results. Instead of worrying about your ankle every time you return to activity, wouldn’t it be nice to pivot, jump, sprint or whatever you do with confidence? You can make that a reality following an individualized physiotherapy regimen to help with your recovery, so you can get you back in the game as quickly and safely as possible.