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.
Do you feel weak in your lower limbs?
People with musculoskeletal pain, whether its knee, hip or low back pain can present with weakness in the muscles. Muscles that are weak may fatigue faster which could be problematic if you spend most of your day standing. There is growing evidence that spinal manipulation may increase muscle strength in healthy people and people with musculoskeletal and neurological disorders (1).
A recent study had shown that spinal manipulation helped improve voluntary force and limb joint position sense that reflects improved sensorimotor integration and processing (2). It reported that participants of the study who were receiving a single session of spinal manipulation or 12 weeks of chiropractic care showed an improvement in their ankle and elbow joint position sense (2). This suggests that manipulation may have an impact on the integration and processing of somatosensory information from the limbs (2) which can improve one’s balance and muscle strength & control.
Another study where an early randomized controlled trial found that quadricep strength was increased after spinal manipulation to the L3-L4 lumbar segments (3). However, this study did exclude people with previously diagnosed pathology which limited the clinical applicability.
Two studies looked at a specific muscle, the Tibialis Anterior (the muscle in front of your calf), and whether there was an increase in strength and motor control after a single session of spinal manipulation. It showed that the maximum voluntary control force increased in muscle strength suggesting that motor control was altered (1).d
The basic science does allow a better understanding of the mechanism behind the effects of spinal manipulation. However, there still needs to be further research on the longer term and potential functional effects on patients who exhibit increased muscle strength and function after spinal manipulation (1,2). Manipulation may be the starting point for a strengthening program that would be best integrated with other therapies for functional and strengthening improvements (3).
If you feel weak in your lower limbs or anywhere in your body, come down to Sprouting Health, we are here to help you!
Whiplash is a well known mechanism of neck injury. Characterised by an acceleration followed by a sharp deceleration, which forces the cervical spine into hyperflexion and hyperextension, most commonly resulting in soft tissue injuries, neck pain, headache, dizziness and fractures.(1, 2)Whiplash was once the most common emergency room treated motor vehicle injury in the USA.(3) Despite the fact that patients with whiplash injury very often suffer from short term neck pain(up to 10 days), a recent study has found 40-50% of whiplash patients develop chronic symptoms.(2)
Whiplash can happen easier than you might think! A simulation using vitro cervical spine revealed 3.5 G-force is considered to be the threshold for neck injuries.(4) “Traffic accident data compiled in Germany reveals that over 90% of whiplash injuries result from rear impacts at speeds of less than 25 km/h”.(4)
Fun fact: Backdated to 1995, the reported incidence of whiplash injuries in the Netherlands has a sharp increase in relation to the rise of seat belt use.(3)
Whiplash symptoms including neck pain exacerbated with movement, headaches, loss of range of motion, pinpoint tenderness at the base of occiput and more..(2, 5) In more significant impacts, whiplash patients may experience neurological symptoms in their peripherals such as weakness in the arm and grip strength.(5) Accidents in sport can also cause whiplash injury, especially with reported higher rates of occurrence in football and indoor soccer players, along with the potential of a concussion.(6)
Most occupants in major car accidents would have undergone a medical assessment to exclude spinal injuries. However, occupants in minor car accidents can often be left alone with neck injuries hoping it will get better over time. A Chiropractor can help manage chronic musculoskeletal pain, including neck pain, for the best possible outcome as mentioned in our blog from last week. Chiropractors are a primary health care provider in Australia which means you do not need a referral to see one of us for an assessment. If you are experiencing pain, give our practice a call and see whether we can help manage your concerns.
1. Chen H-b, Yang KH, Wang Z-g. Biomechanics of whiplash injury. Chinese Journal of Traumatology (English Edition). 2009;12(5):305-14.
2. Al-Khazali HM, Ashina H, Iljazi A, Lipton RB, Ashina M, Ashina S, et al. Neck pain and headache after whiplash injury: a systematic review and meta-analysis. Pain. 2020;161(5):880-8.
3. Ioppolo F, Rizzo R. Epidemiology of whiplash-associated disorders. Whiplash Injuries: Springer; 2014. p. 13-6.
4. Li F, Liu N-s, Li H-g, Zhang B, Tian S-w, Tan M-g, et al. A review of neck injury and protection in vehicle accidents. Transportation Safety and Environment. 2019;1(2):89-105.
5. Seroussi R, Singh V, Fry A. Chronic whiplash pain. Physical Medicine and Rehabilitation Clinics. 2015;26(2):359-73.
6. Albano M, Alpini DC, Carbone G. Whiplash and Sport. Whiplash Injuries: Springer; 2014. p. 127-37.
Blogs by the team at Sprouting Health