“Smile strengthen, smile care, for your ankles' welfare!” :-)
Why Do We Want to Love Our Ankles?
The following are some findings that I have come across on ankle injuries, which shed some light on ankle injuries and causes.
Web MD's article “Ankle Injuries: Causes and Treatments” gives us a lot of great information for gaining a perspective on
- just how big an issue ankles injuries,
- everyday 25,000 people in the US sprain their ankle
- 1 million will visit the emergency room because of ankle related injuries
- ankle injuries happen at any age
- men from 15-24 have particularly high rates of ankle strain
- once women reach 30, they have higher rates then men
- what those injuries are,
- common injuries
- fractures- a break in one or more of the ankle bones
- sprains- damage to muscles and tendons that have been pulled or stretched too far
- other injuries
- tendon ruptures
- subluxation- tendons that slip out of place
- tendinitis- acute tears in the peroneal tendon (may take several years to develop)
- common injuries
- common causes
- during sports activities
- while walking on uneven surfaces, which cause the ankle to be forced into an unnatural position
- wearing high heals, loose fitting clogs or saddles, and/or faulty footwear
- tripping
- falling
- landing awkwardly from a jump
- sudden impacts like car wrecks
- twisting or rotating the ankle beyond its natural limit
- rolling the ankle
- signs of injury
- pain, usually sudden and severe
- swelling
- bruising
- difficulty or inability to bear weight on injured joint
- in tendinitis
- the ankle feels warm to the touch
- weakness or instability in the foot or ankle
- sporadic pain outside the ankle
- increased height in foot arch
- in subluxation
- instability or weakness
- sporadic pain behind the outside of the ankle bone
- a “snapping” feeling around the ankle bone
Dr Nabil Ebraheim offers us a very through explanation of different kinds of ankle injuries in different areas, and their symptoms in “Ankle Pain Complete Overview.” It is very important to pin point the pain you are experiencing in order to get an indication of which one of the many types of ankle injuries there are. There are 19 listed here.
- Anterior Ankle
- Anterolateral Impingement- painful limitation of full range of movement because of a (bony) pathology
- common to athletes with prior ankle injury
- can become chronic source of main and limitation of movement
- Arthritis of the Ankle
- common cause- prior injury and inflammation of the ankle
- Osteochondritis Dissencans of the Talus- chip-type fracture that usually occurs during sprained ankles
- symptoms- pain, swelling, and stiffness of the ankle joint
- Tibialis Anterior Tendonitis
- causes- overuse
- usually accompanied by anterior shin splints
- common to runners
- symptoms- pain and tenderness as tendon is strained in dorsi-flexion or when tendon is touched
- causes- overuse
- Anterolateral Impingement- painful limitation of full range of movement because of a (bony) pathology
- Medial Ankle
- Posterior Tibial Tendonitis or Rupture
- causes -overuse, degeneration, trauma
- symptoms -sagging arch or flat foot deformity, a tight Achilles tendon, painful swelling on the posteromedial aspect of the ankle, unable to perform leg toe raise
- Tarsal Tunnel Syndrome- compression of the tibial nerve in the tarsal tunnel
- causes -ganglia, accessory muscles, soft tissue mass
- symptoms -pain on the medial side of the foot, pain worsens with dorsiflexion, paresthesia and numbness of the foot, positive tinel's sign behind the medial malleolus
- Fexor Hallucis Tendonitis
- symptoms -pain, swelling, and weakness posterior to the medial malleolus
- dosiflexion of the big toe may be reduced when the ankle is in dosiflexion
- pain may be triggered in the tendon sheath with toe flexion
- often occurs in ballet dancing where plantar flexion often occurs
- symptoms -pain, swelling, and weakness posterior to the medial malleolus
- Rupture of the Deltoid Ligament
- prevents the foot from averting
- this is a rare injury
- Posterior Tibial Tendonitis or Rupture
- Posterior Ankle
- Posterior Ankle Impingement (os trigonum)
- common to athletes such as ballet dancers
- symptoms -tenderness in the posterolateral aspect of the posterior ankle to the peroneal tendon especially with passive pantar flexion
- Flexor Hallucis Longus Tenosynovitis
- often occurs in ballet dancing where plantar flexion often occurs
- symptoms -swelling and pain posterior to the medial malleolus
- triggered with toe flexion
- dosiflexion of the big toe may be reduced when the ankle is in dosiflexion
- Achilles Tendonitis -irritation and inflammation due to overuse
- symptoms – pain and swelling
- Achilles Tendon Rupture
- causes -because of age, lack of use, or aggressive exercise
- Posterior Ankle Impingement (os trigonum)
- Lateral Ankle
- Ankle Sprain
- Symptom -pain on the outside of the ankle near the joint
- High Ankle Sprain
- Symptom -pain on the outside of the ankle above the joint
- Peroneal Tendon Subluxation
- Rupture of the Peroneus Longus Tendon
- Symptom -pain on the outside of the ankle near the arch of the foot
- Peroneal Tendonitis
- Symptom -pain on the outside of the ankle, running along the protruding part of the Fibula bone
- Anterior Process of the Calcaneus Fracture
- Symptom -pain on the outside of the ankle just below the joint
- Lateral Process of the Talus Fracture
- Symptom -pain on the outside of the ankle near end of the Fibula
- Ankle Sprain
“Simple Yoga Exercises to Strengthen Your Feet, Ankles, & Toes” from the PA Foot & Ankle associates tells us that because most of the world wears shoes for most of the day the muscles in our feet do not get the exercise they need to prevent many maladies that come with age including:
- bunions
- hammer toes
- aching arches
- aching toes
- poor balance
- and many others
As the feet are the base for the ankles, anything that effects the feet negatively will cause an increase risk of injury in the ankle.
They go on to tell us that strong feet and ankles are very import for everyone, especially as we age to remain balanced as we move through the day. Athletic activities are great, but they do tend to develop the body in a lopsided manner because by nature we tend to have a dominate side. Yoga is perfect for countering this tenancy by focus on equaling out or balancing the strength and flexibility in both the left and the right halves of the body.
Now let's learn how to help our ankles support us any time, any where!
“Smile strengthen, smile care, for your ankles' welfare!” :-)
How to Love Our Ankles
When an ankle injury does occur, Web MD's article “Ankle Injuries: Causes and Treatments” recommends that we take the R.I.C.E or
- Rest -a preventative measure
- Ice -to reduce swelling and ease pain
- CAUTION: frostbite may occur if you leave the ice on more than 15 to 20 minutes
- CAUTION: frostbite may occur if you leave the ice on more than 15 to 20 minutes
- Compression -wrap the ankle in an elastic bandage to help with immobilization and support
- CAUTION: blue toes, loose of sensation in the toes, and or a cold sensation in the toes means that you have tightened the wrap too much
- CAUTION: blue toes, loose of sensation in the toes, and or a cold sensation in the toes means that you have tightened the wrap too much
- Elevate -make the injure at least level to the height of the heart to help reduce swelling and pain
- ask how the injury occurred
- note the amount of swelling and bruising
- move the ankle in order to evaluate the pain and make a diagnosis
- possibly order an X-ray to see if there are any broken bones
Treatment for fractures
- usually a brace or splints
- unstable ankles are treated surgically
- once the doctor has determined it safe to move your ankle you may need physical therapy
- this means periodic visits to the therapist
- the therapist will develop a home practice for you in between visits
- exercises include
- gait training
- balance
- strengthening
- mobility
- gait training
- you will continue exercising until there is a normal walking pattern without limping
- this means periodic visits to the therapist
Treatment of sprains -depends on severity (mild, moderate, or severe)
- surgery is usually only needed when there is extensive damage, which involves more than just ligaments, or when other treatments fail
- mild sprain treatments
- use of the RICE method for several day until pain and swelling improve
- as soon as you can handle weight on the joint, the doctor will prescribe range of motion, stretching and strengthening exercises
- use of the RICE method for several day until pain and swelling improve
- moderate sprain treatment
- use of the RICE method for a longer period of time
- a boot, splint, or other device for immobilization may be prescribed
- physical therapy
- range of motion
- stretching
- strengthening
- range of motion
- use of the RICE method for a longer period of time
- severe sprains -complete tear or rupture of a ligament
- immobilization
- then a long period of physical therapy
- range of motion
- stretching
- strengthening
- range of motion
- surgery may be prescribed if the injury is taking too long to heal
- immobilization
Treatment of tendon injuries
- similar to treating sprains
The National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends the following for ankle injury prevention:
- avoid sports and exercises when you are tired or in pain
- eat a well balanced diet
- keep a healthy weight
- avoid falling
- wear appropriate shoes
- don't wear heels that are imbalanced from wear
- exercise daily
- condition properly for any sport you are practicing
- warm up and stretch before sports activities
- wear proper sports equipment
- run on flat surfaces
“Ankle Exercises – A Complete Guide” by Dr. Laura Inverarity gives us 6 different categories of exercises to use when we are recovering from an ankle injury. These exercises include:
- Range of motion with no weight bearing
- Dorsiflexion -point your foot toward your nose, hold, then return to a neutral position
- Plantar flexion -point your foot forward, holding, then return to a neutral position
- Inversion -with toes pointed up, turn the foot inward, hold, return to a neutral position
- Eversion -with toes pointed up, turn you foot outward, hold, return to a neutral position
- The Alphabet -point you foot and toes forward and draw the alphabet in the air
- Dorsiflexion -point your foot toward your nose, hold, then return to a neutral position
- Isometric strengthening exercises -by strengthening the muscles around the ankle, the joint is better supported
- Eversion isometrics -while seated, lift the foot, place it on a flat surface, push outward, hold, relax, repeat
- Iversion isometrics -while seated, lift the foot, place it on a flat surface, push inward, hold, relax, repeat
- Eversion isometrics -while seated, lift the foot, place it on a flat surface, push outward, hold, relax, repeat
- Resisted strengthening exercises – CAUTION: never tie bands so tight they cut off circulation
- Dorsiflexion, Plantar flexion, Inversion, Eversion -same as in range of motion exercises with the addition of a resistance band
- Dorsiflexion, Plantar flexion, Inversion, Eversion -same as in range of motion exercises with the addition of a resistance band
- Partial weight-bearing exercises
- Seated calf raise -seated in a chair, lift the heal as far from the floor as possible while keeping the toes on the floor, return heel to the floor, repeat
- Single leg stand -stand up straight holding an object, shift weight to the injured foot, hold, relax and shift your weight back on the other foot
- Seated calf raise -seated in a chair, lift the heal as far from the floor as possible while keeping the toes on the floor, return heel to the floor, repeat
- Full weight-bearing exercises
- Single leg stance -stand on the injured foot while the other foot is lifted off the ground, hold, relax and put your weight back on your other foot
- Standing calf raise -stand on the injured foot while the other foot is lifted off the ground, raise up on the ball of the injured foot, lifting you heel off the ground, hold, relax, lower your feet, and put the weight back on the other foot
- Lateral Stepping -place a rolled towel or something similar on the ground beside your injured foot, step over the object, remain on the foot, bring your uninjured foot over the object, stand on both feet, step the uninjured foot back over, remain on that foot, step the injured foot back over, stand on both feet
- Lateral jump- place a rolled towel or something similar on the ground beside your injured foot, hop over the object, land on the injured foot, hop back, land on the uninjured foot
- Single leg stance -stand on the injured foot while the other foot is lifted off the ground, hold, relax and put your weight back on your other foot
- Balance activities -done toward the end of rehabilitation to prevent future injury
- Single leg stance on a towel -place a towel that has been folded into a small rectangle on the ground, stand on the towel with the injured foot, lift the uninjured leg off the ground, hold the balance, return the uninjured foot to the floor
- Single leg stance on a towel -place a towel that has been folded into a small rectangle on the ground, stand on the towel with the injured foot, lift the uninjured leg off the ground, hold the balance, return the uninjured foot to the floor
The PA Foot & Ankle associates' give us a good variety of “Simple Yoga Exercises to Strengthen Your Feet, Ankles, & Toes” in their article. These include:
- Tadasana or mountain pose
- strengthens feet, especially arches
- teaches us to carry our body weight evenly
- strengthens feet, especially arches
- Adho Mukha Svanasana or downward dog pose
- stretches the soles of the feet
- strengthens the arches
- stretches the soles of the feet
- Modified Virasana or hero pose
- stretches the tops of the feet
- strengthens the ankles
- stretches the tops of the feet
- Toe lift exercise
- teaches us to walk in a balanced way
- teaches us to walk in a balanced way
- Bent knee standing pose
- teaches us to balance weight across our feet
- strengthens muscles in the toes and soles of the feet
- teaches us to balance weight across our feet
“Smile strengthen, smile care, for your ankles' welfare!” :-)
How Adho Mukha Svanasana can Help Us Love our Ankles
In “Light on Yoga,” BKS Iyengar goes on to say this about Adho Mukha Svanasana.
“When one is exhausted, a longer stay in this pose removes fatigue and brings back the lost energy. The pose is especially good for runners who get tired after a hard race. Sprinters will develop speed and lightness in the legs. The pose relieves pain and stiffness in the heels and helps to soften calcaneal spurs. It strengthens the ankles and makes the legs shapely. The practice of this asana helps to eradicate stiffness in the region of the shoulder-blades, and arthritis of the shoulder joints is relieved. The abdominal muscles are drawn towards the spine and strengthened. As the diaphragm is lifted to the chest cavity the rate of the heart beat is slowed down. This is an exhilarating pose.
Those who are afraid to do Sirsasana (the father of all asanas) can conveniently practice this position. As the trunk is lowered in this asana it is fully stretched and healthy blood is brought to this region without any strain on the heart. It rejuvenates the brain cells and invigorates the brain by relieving fatigue.
Persons suffering from high blood pressure can do this pose. (p.101-102)”
Here are the benefits in list form:
- removes fatigue
- brings back lost energy
- develops the legs
- speed
- lightness
- to be shapely
- relieves pain and stiffness in the heels
- softens calcaneal spurs
- strengthens ankles
- helps to eradicate stiffness in shoulder-blades
- relieves shoulder arthritis
- strengthens abdominal muscles
- slows the heart beat
- creates exhilaration
- has many of the same benefits as Sirsana (the father of all asanas)
- the trunk is fully stretched
- healthy blood is brought to the trunk and head without strain to the heart
- rejuvenates brain cells
- removes fatigue from the brain
- creates an appreciation for seeing a dog stretching :-)
Let's Practice Adho Mukha Svanasana! :-)
CAUTION: Those suffering from
- carpal tunnel syndrome
- diarrhea
- high blood pressure or headache
- support your head with a block or bolster to make you ears level between your arms
Technique
- Come onto the floor with your palms facing down about shoulder length apart, slightly forward from your shoulders, and your knees about hips length apart, directly below your hips.
- Spread your fingers wide, feel the strength running along the outside of your hands and arms supporting you. This is where martial artists get their strengthen to break wood and other material with a swift chop.
- Turn your toes under.
- Exhale and lift your bottom toward the ceiling. You can keep your knees bent initially, and then lower your heels to the floor if comfortable.
- Lengthen your tailbone toward the ceiling, so that your back has a slight arch backwards.
- Contract the leg muscles, so that they spiral inwards.
- Remember to relax and breathe while in this pose. Enjoy the stretch. Hold this pose for as many breathes as you would like or are able to.
- Recommended feel good practice: First, only follow these suggestions if they help you relax more. Remember the goal is relaxation. Simply breathing is enough in many cases, but these might deepen your experience.
- As you breathe try thinking to yourself the following sentence with each breath. “Smile strengthen!” inhale. “1” exhale. “Smile care!” inhale. “2” exhale. “For your... “3” exhale. “ankles' welfare!” inhale. “4” exhale. Continue this as long as you would like.
- Smiling will help you relax even more.
- Sink into this pose, and enjoy the stretch! You might even try wiggling your bottom like a happy dog! It is loads of fun! Another good variation to build up a little more energy is when you pump your heels up and down like you are riding a bicycle. This pose is a foundational yoga asana, and will serve you well as a relaxing and re energizing pose. Whenever life gets tough think of a happy relaxing dog ready to play and enjoy the simplicity of the day! :-) “Smile strengthen, smile care, for your ankles' welfare! :-)”
- When you feel that you have held this asana long enough relax the effort, and come back to your knees. It might feel good to put your big toes together, and lean back so that you are sitting on your feat and your arms are stretched out forward, this is called Balasana or child's pose. Thank your body for carrying you through a great strengthening, caring, re energizing practice today! Remember to “Smile strengthen, smile care, for your ankles' welfare! :-)” as you move on to whatever is next for you feel the happiness in your body as ready to meet the day with a playful spirit of a wagging downward dog! :-)
If you want to read more about Adho Mukha Svanasana, Yoga Journal offers a great article full of information including modifications, deepening the pose, etc. http://www.yogajournal.com/pose/downward-facing-dog/
“Smile strengthen, smile care, for your ankles' welfare!” :-)
I hope that you enjoyed the article this week! May goal is to offer you something that will help improve your lives through self knowledge in some way. If there is ever anything that you would like to hear about please let me know in the comments area here or on the Facebook group “For the Love of Self.” I am always happy to hear comments on how to improve or to hear what you enjoyed about the current article. May your ankles stay healthier now that you have read “How to Love Yourself by Loving Your Ankles! :-)” Have a wonderful rest of your week! Remember the happy wagging dog's joy for life and live to the fullest! Aaron Szczurek <3 :-)