Vail health column: Muscle imbalances created by ankle injuries can persist for decades |

Vail health column: Muscle imbalances created by ankle injuries can persist for decades

Julie Peterson, MPT
Health Insights

Is it a coincidence if you have hip pain on the same side as an old ankle sprain? Far from it. Anything from a tight iliotibial band (the ligament that runs down the outside of the thigh from the hip to the shin) to an arthritic hip can be traced back to the sprained ankle. It may have been last week or 30 years ago; regardless of time, the brain holds onto the injury. Think of it in the same way as visiting a website that leaves cookies on your computer.

More than 80 percent of ankle sprains are a result of inversion, or inward rolling, of the ankle. When this happens, the muscles on the outer side of the calf shut down, a response called painful inhibition. To prevent further damage or movement, the muscles on the inside of the calf go into overdrive, a response called protective spasm. Simply put, the inner calf muscles are locked on and short, while the outer muscles are locked off and long. This pairing can last for decades.

The muscle imbalance actually changes the resting position of your foot. If you've had an ankle sprain, take your shoes and socks off and look at your feet. On the sprained side, is that foot more rolled in? If so, your neutral is actually a "sprained" position. This explains a recurrence rate of nearly 75 percent in ankle sprains, according to an article published in the British Journal of Sports Medicine.

This foot position sets off a chain reaction as we walk. For stability, we need to land/load the foot on a tripod (base of big toe, base of pinky toe and heel). The rolled-in foot can't do this. The hip has to rapidly internally rotate to get the big toe down. The tensor fasciae latae muscle on the outside of the thigh is chiefly responsible for this.

As we step through on this leg, the muscles that externally rotate the hip (namely the piriformis and gluteus medius) have to rapidly over-correct to get us back to neutral.

Just as a seemingly innocuous cookie can corrupt our computer, an old ankle sprain can wreak havoc on our bodies. The hip rotators are massively overworked, and the big toe is strained from excessive loading. I have seen bunions, blisters, pseudo sciatica (pain radiating from the buttocks down the leg), piriformis syndrome (irritation of sciatic nerve), labral tears, hip replacements and sacroiliac joint pain (lower-back pain) that all stemmed from an old ankle sprain.

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There is hope. Overworked muscles can be calmed and underworked muscles recruited. Using neurokinetic therapy, we can identify and resolve these faulty muscle pairings throughout the body. Through the use of blocks and wedges, we can re-teach the foot how to move from a rigid lever to a mobile adaptor. Teach the joints to act, and the muscles have no choice but to react. Give the body the appropriate stimulation, and the motor control center in the brain lights up and say, "Oh yeah, that's what I'm supposed to be using or doing."

As with all injuries, there is no magical silver bullet or one-size-fits-all solution. An ankle sprain is not the root cause of all pain. The point is that all pain has a source. Rather than treating the symptoms, find the source.

Julie Peterson, MPT, is the owner of Concierge Physical Therapy Colorado. She is a certified neurokinetic therapy specialist with a strong background in manual therapy. She can be reached at 970-306-3006 and For more information, visit