Ankle update: Focus on function

Its been 3 months since I broke my ankle and I’m at that stage where I feel pretty much 100% back to normal. The pain of falling over crutches and hopping up steps is a distant memory & I can go about my day to day business without really thinking about it. I can even head off on walks of 4 or 5 miles into the hills without it complaining, and I can see how tempting it is at this point to stop with the rehab faff and just enjoy being pain free!

But here is where its important to look a little beyond simply how things ‘feel’, and focus on how things ‘function’ instead. For example, when I’m walking, the push off phase causes me a bit of discomfort due to lack of flexibility in my ankle; when I try to match my uninjured side stride for stride, it causes pain. By pushing off less forcefully on the injured side I can avoid the pain and walk comfortably. Win!

But when it comes to function its important to understand that while walking, specifically in this push off phase, the ankle produces the highest mechanical power among all joints involved. It was designed to be used in this way. If we limit the movement and subsequent power of the ankle, we have to compensate elsewhere further up the chain, with the knee bearing the brunt in this particular ankle movement (ref). The hip is also helping out a bit more than usual and our energy use becomes less efficient – all because we’re avoiding pain – anything for a simple life!

What I’m trying to point out here is that the ‘simple’ option that saves us time and effort right now can often be the decision that creates life long compensatory patterns that can affect us later on down the line. But for most of us, when the temporary pain is gone we don’t have that connection with our body anymore. It’s easy to switch off and carry on as usual.

I’m looking at starting my Couch 2 5K (again!) in the next few weeks and don’t want to be loading up an already complicated situation. So I thought I’d share with you a few things that I’ve found really useful to do on a fairly regular basis as part of my rehab journey – bear in mind these are post-injury tips relating to me – they are not ‘things you must absolutely always do to be any good at stuff’, as you know I’d never tell you that. But if you feel like you could do with some lower limb advice read on (and as always feel free to get in touch with your own issues you’d like help with!).

(And for any of you that might have suspected I’d be my own worst customer I’m happy to report that I’m a right little nerd whos even being doing lunges – the devil’s own exercise – cos the physio said I should. So there.)

1. Flexibility:

Here’s a photo of my before and after flexibility in that left ankle, so you can see the difference!

inCollage_20200707_173611220The results of 6 weeks in a boot. And I used to think my ankles weren’t very flexible…

Dorsiflexion is the movement that allows the shin to lean forwards over the foot. Its the foundation for all body movement that happens above it during walking or running. Without sufficient dorsiflexion I can only squat down to a certain point where my ankle stops flexing. This in turn means I can only bring my bum down so far before balance goes and I have to lean my upper body forwards to compensate – which simply put means when I try to squat down to pick something up I fall on my arse!

Improving flexibility can involve all sorts of exercises – obviously your traditional static stretches are handy but I have found a whole heap of far more interesting ideas from the Prehab Guys here

Also due to all the new movement going on I’ve been using a golf ball to roll out the sore bits on the sole of my foot pretty much every day, plus massage from my lockdown buddy who just happen to be a sports therapist too. Handy!

(And as you can see I love to take photos of my progress so I can see where I started and where I am right now, and then plan where I want to be.)

2. Strength:

Its only been in the last few days that I’ve been able to do a single leg heel raise on my left side, and this was the result:

inCollage_20200707_173438256

It hurt. Plus you can see how I’ve moved my knee further forwards to try and help somehow lever my ankle up a bit more? Didn’t know I was doing that!

In 2017 a study was published by Hébert-Losier et al, with the average amount of single leg calf raises you should be able to do for your age and sex. A woman of my age should be able to do roughly 24 each side. Let me tell you, this is not the case right now – I’m currently a 70 year old woman as far as my calfs go! And as you can also see I’ve a way to go with the height of my left raise too.

And quite simply the exercise to remedy this is to do calf raises – good quality calf raises, 1 second up, 1 second down, full height, rolling up onto the big toe. And if that’s all a bit too easy for you add in jumping or a hopping and work on those plyometric movements – but for now, this is where I’m at.

I’d also add that I’ve got a routine of many other exercises that I do regularly, all working on strength and movement of the hips, thighs, core and lower legs – its important not to get too obsessed with 1 muscle group as your body is a whole system of pulleys and levers that rely on each other.

3. Balance:

Balance is super duper important for all of us – whatever age, whatever level of activity. Being able to react to sudden changes and movements is part of our day to day life and tuning into our senses and engaging with our bodies helps us do it better. There are countless studies out there that point to good balance = less injury.

In our pre-rugby warm ups I have the players hopping about and I’m sure they think I’m just having a laugh at them (maybe a little bit) but its all about helping to prevent ankle and knee injuries. In our older population its important for preventing those slips, trips and falls we’re always warned about. And sadly our super modern sedentary lifestyles see us primarily balancing on our bums, which isn’t a great deal of help.

Plus the best IMG_20200707_131431thing about balance exercises is that they are FUN. Whenever we put on a Strength and Conditioning for Runners course the most hilarious part of the whole thing is where we’ve got them balance training and trying to push each other in mid-air. You’ll find tonnes of different ways to train balance online, but simply standing on one leg while you brush your teeth is a decent place to begin. Single leg dips, hops and squats are easy to do anywhere & single leg Romanian deadlifts are ace.

One of my favourites is in the photo to the left, where I set out 3 cones or rollers or whatever you have to hand (the lower to the floor the harder it will be). Stand on one leg in front of them and slowly bend over to touch them one at a time – always controlled, and hinging at the hips. You can add a couple behind you if you fancy making it a bit harder.

As with checking strength, you can assess balance from side to side to see where to give more attention – try balancing on 1 leg for 30 seconds with your eyes shut and compare to the other side! Or just pay attention during single leg exercise and see if there’s anywhere that feels a bit more wobbly.

Anyway, the aim of writing this all down is partly as a diary for me to look back on, but also to help anyone else that’s coming back from lower limb injury. Our bodies will do a great job of automatically fixing things up so we can almost forget about the pain, but it takes active effort on our part to create resilience and restore balance. And what you need to do is work out whether you believe that’s worth doing for yourself…or not.

I see so many people who look outwards at their sporting idols or inspirations and try to follow someone else’s training plan to be able to achieve what they’ve achieved. And inspiration is SO important, but the fact is (and I feel like I end every blog saying this) everyone is different. I’d recommend that anyone who wants to strengthen up for their sport – whether you’re a weekend yogi, a gnarly ultra runner or a mountain wanderer (like me) – should have a go at checking out their balance side to side, assess strength on each side, see how flexible you are on both sides. What is important to you? What do you need to be able to enjoy or perform your sport to the best of your abilities? How bothered are you, and how much effort are you happy to put into this?

And failing that…give me a bell x

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