Ankle pain can be commonly related to back issues due to our bodies compensatory mechanisms, it also of course may be a result of injury. A common diagnosis of ankle pain is Achilles’ tendinopathy which is located at the back of your foot. The Achilles tendon is the largest and strongest tendon in the body, and serves as the conjoined tendon for the calve muscles consisting of the gastrocnemius and soleus muscles.(1)
Causes are multi-factorial, with both extrinsic and intrinsic risk factors likely contributing. Extrinsic risk factors include training errors, increased training volume or physical activity, environmental variables or improper footwear. Intrinsic risk factors to consider include abnormal ankle dorsiflexion range of motion, abnormal subtalar joint range of motion, decreased ankle plantar flexion strength, increased foot pronation, increasing age, and genetic factors. Co-morbidities of obesity, hypertension, hypercholesteremia, and diabetes can also contribute, and the presence of systemic inflammatory disease.(2)
In a recent study completed this year, the application of lumbar spine manipulation may help manage improvements in Achilles’ tendinopathy. Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation.(3)
Beyond strictly manipulating a location of dysfunction, it was believed that improving lumbar mobility would improve gait mechanics by decreasing proximal compensation. The patient was able to perform more heel raises with less pain reported, and with improved pain values noted at the Achilles tendon.
Joint mobilization and manipulation were utilized in addition to eccentric exercise, with immediate improvements in symptoms and function noted, which were maintained at discharge (12 weeks) and follow-up (nine months). Healing may take several months in chronic conditions and may partially be due to the lack of vascularity to the tendon. Initial conservative treatment measures should begin with relative rest and activity modification to provide pain relief and time for the tendon to heal.(2)
According to recent literature Chiropractic mamangement appears to be a safe and effective intervention in the rehabilitation of chronic tendinopathic dysfunction.(1)
1. Jayaseelan DJ, Kecman M, Alcorn D, Sault JD. Manual therapy and eccentric exercise in the management of Achilles tendinopathy. J Man Manip Ther. 2017;25(2):106-14.
2. Papa JA. Conservative management of Achilles Tendinopathy: a case report. J Can Chiropr Assoc. 2012;56(3):216-24.
3. Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. Journal of bodywork and movement therapies. 2021;26:214-9.
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