ANKLE SPRAIN - How the Thoracic Spine and Hip Can Contribute

Recovering from an ankle sprain appears to be pretty straight forward, however there are other factors which can hinder recovery. The two areas we will focus on are the hip and thoracic spine (upper back). Daily activities in the sitting position, such as computer use, reading and driving, etc., results in an increase stiffness in our hips and thoracic spine.
The tissue surrounding the gluteals become stagnant from prolong sitting making it difficult to generate force and absorb energy. At the same time, the hip flexors in the front of our pelvis shorten from sitting.
The thoracic spine is another region which is affected from prolonged sitting. The muscles of the thoracic spine work to fight gravity which pulls our trunk forward. Most daily activities which are performed in front of our body also contributes to increase pull forward.  To make matters worse, the thoracic spine is a difficult area to stretch due to the bony anatomy and rib cage.
Limited mobility of the hip and thoracic spine changes our biomechanics which can impair the body's ability to recover from a lateral ankle sprain.

HIP

Hip Mobility

When the heel hits the ground, the bony anatomy of the ankle generates a rotational force up the lower leg and into the thigh. At the same time, the body weight shifts from the back leg to the lead leg which produces a lateral motion of the hip and pelvic junction.

If there is a limitation of frontal plane motion of the hip, the movement will find another path. A common pathway is the ankle.  As the body shifts laterally to the front leg with a limited hip motion, the lateral movement will be forced at the ankle causing a lateral ankle sprain.

Hip Mobility Assessment

Stand with your legs hip width apart. Bring your arms up next to your head. Reach to the side as far as you can, then to the other side. Feel for any difference in motion in your hips from side to side. You may need to stand in front of a mirror or have a friend to give you feedback.

The above pictures show less mobility on the left hip (picture on the right). The larger hip/pelvis angle reveals there less motion occurring at that joint. Side note: I roll my left ankle during this run.

Hip mobility Treatment

Lateral hip stretch -

To stretch the side of the hip, stand next to a low bench or step. Place the leg across body onto the step with the knee bent. Allow the body to move over the stance hip until you feel a stretch. Use your pelvis to drive forward, sideways and twist. Please refer to the video above.


***Bonus lateral hip stretch - Instead of crossing the leg in the front, cross my leg behind my body.  Make sure the back leg does not twist the body away from the stance leg. Shift toward the stance leg. Then use the pelvis to drive the body in the sagittal plane, frontal plane and transverse plane. Please refer to the video below.

Gluteal Stretch -

Place one leg on a table ( at home I use the end of my couch, kitchen or bathroom counter) at about mid thigh to hip height depending on flexibility. The knee should be bent to 90 degrees and thigh perpendicular to body. From there, hinge forward in the sagittal plane, reach away sideways in the frontal plane and rotate towards in the transverse plane to the stretch leg. These motions create length at the hip and pelvic junction. Perform about 10 repetitions per plane of motion or until you feel improvement in flexibility.
Refer to the video above for planes of motion.
*** Hinge at the hip NOT the lumbar spine.

THORACIC SPINE

Thoracic Spine Mobility

When one leg is swinging forward, the same side arm is swinging back. The swinging of the arm backwards drives rotation of the upper back. For example, as the right leg swings forward the right arm swings backwards. A rotational motion is created at the core since the opposite leg is behind the body. This position helps to load the abdominals in a rotatory fashion, similar to a spring.
If the thoracic spine is tight, the rotation will bypass the region and the motion in transferred elsewhere. Occasionally, this force causes a shearing motion in the back. Other times, the force goes into the ankle.

Thoracic Spine Assessment

Place one leg in front of the other with the knee slightly bent. Bring your arms in front of your body at chest level. Turn as far as you can towards the front leg then towards the back leg. Switch so the other leg is forward. Feel for the rotation in the thoracic or have a friend watch for you.
Watch the video below.

 

Thoracic spine treatment

Rotation T/S stretches- These stretches improve the rotation of the spine.

To improve rotation of the thoracic spine while the arm is swinging forward - Take a step forward with L leg and L arm next to head, bring R arm in front of body and reach forward. 
To improve rotation of the thoracic spine when the arm is swinging backwards - With L leg in front and R arm next to head, swing L arm behind the body.
Refer to the video below.

To maximize the effects of the stretches, follow up with strengthening exercises. Performing strengthening exercises after stretching will stimulate sensors in the newly acquired range of motion which may have been dormant for weeks, months or years.

Stay tuned for my next post on strengthening exercises for runners!