Back to my brother in law and his iffy ankle. So why the ongoing problem and why doesn’t just resting it for a week or so, which he often does between ski weekends and for longer periods in the summer, make it better?
It comes down to the difference between letting something heal, or at least waiting for the acute symptoms to go away, and actually rehabilitating the area.
The events that happen when we sprain our ankle, or knee or shoulder can include tearing a ligament, straining or tearing a muscle or tendon and in some cases fracturing a bone. More important to our future function however, is that we tear or at least disrupt the nerve endings that connect to that injured part.
Why does that matter?
What those disrupted nerve endings do when they are working properly is to quickly send messages back and forth from our muscles, tendons, ligaments and joints to our spinal cord and brain. These messages tell how quickly to move, which muscles to contract and how fast and hard, and which muscles to relax and when. They determine what position our joint should be in so that we can achieve our goal while still protecting that joint from injury. These nerve endings get information from the ground under our feet, what our eyes see, what our inner ear and it’s balance system indicate about our position in space. They can react to how heavy something is, or how hot, and they can cause us to move rapidly away from something painful. They give feedback when our tissues are being pushed too far and they work to protect us.
It’s a pretty amazing system and it’s called proprioception. These messages aren’t conscious. Proprioception works much faster than that. If we had to think about each element needed to respond to changing terrain under our feet when running, or how to hit a tennis ball, or catch a falling glass or child we would be too slow to react, and it would take so much thought that we’d be unable to think or do anything else. In fact we can’t really make our proprioceptive system conscious because the systems involved don’t come under our active control.
The problem comes in when we disrupt this system with an injury, surgery or even a period of being immobilized. Just because the pain is gone, the swelling has subsided and you feel ready to go doesn’t mean that your injured joint or muscle is. Even worse, while you were resting that ankle, your knee and hip and back and even shoulder on that side got lazy, and you may have overworked your other side to compensate.
Now although you may be eager to get back on the basketball or tennis court, start running again or even do something as simple as pushing your lawn mower around the yard or going down a flight of stairs, unless you do something to turn your proprioceptive system back on, it’s not going help you out.
So what, you ask?
Well what that means is your ankle is now likely to roll and sprain very easily. Even worse, the knee on that side may be taking extra stress because your body doesn’t trust your ankle. In addition, your hip is likely tight and weak, which is a frequent occurrence following an ankle sprain, and to make up for this limitation your low back will work harder than it should to make up the difference. I’m going to stop there because I think I made my point, but the upper back, neck and shoulder aren’t immune to a problem too, and we haven’t even looked at the other side yet.
All because you sprained your ankle and you didn’t get your proprioceptive nerve fibers back on the job.
Ok so maybe you did a few stretches and you went back to the gym and did some strength exercises. Good. Those will help if you did things that challenged your balance in a progressive way. If you did things that loosened up that hip, that showed reminded your body how to react to the speed, load and flexibility needed to run or go down stairs. That reminded your hip and not your back to rotate, contract and push off to chase a tennis ball.
It sounds a little complicated, and it is and it isn’t. Your body will almost always find a way to get the job done. If you remind it how to do something correctly, it will very often reset itself and start acting properly again with even some simple, but appropriate exercises or interventions.
The problem comes when you try to do something and you haven’t reset the system. Your body will still do it’s best to get the job done, but now it’s forcing joints, muscles, tendons and ligaments to work in ways that they weren’t made to. Several things might now happen. Those parts are now more likely to wear out and break down. You won’t move as well as you could, which matters a lot if you are an athlete or do heavy work. You may experience pain on a regular basis, and you will probably get injured more often. And, there may come a point where you just decide “I can’t move very well any more” and so you stop.
This may seem dramatic or even a little far fetched but it’s not. I’ve seen it (again and again) in myself after an injury, however small. I’ve seen it in competitive high school runners, elite age group athletes, weekend warriors, bowlers, gardeners and even avid knitters.
There are so many instances where a patient will come to me for one problem and as we work our way back through their history they remember an old injury, fall or repetitive activity and now a pattern emerges. Sometimes it was a significant problem and sometimes something they paid little attention to, but as we go over their activity, or lack of, from then until now, often the connection becomes clear. Now we have something to work with. We can address the current problem and we can reset the proprioceptive system disrupted by the old injury. Success most often requires both parts.
So some food for thought. Maybe the reason you can’t move without pain, can’t get up from weeding the garden, wish you could be more active but don’t seem to successfully be able to, or even just find it hard climb a flight of stairs isn’t because of your age, but because you’re still limited by an old injury.
Even if it’s been a while, and you don’t think you can move any better, you’d be surprised at what the body can do if you remind it and reset that proprioceptive system.
Maybe it’s time to check in with a physical therapist and get an assessment of your ability to move. You might surprise yourself.