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Lower Leg - Ankle Injuries

Rehab Guidelines

Self-Help Supplies

All of the supplies needed or necessary that are mentioned in our rehab guidelines and rehab exercising self-help programs are available in our Bookstore.

Let's start this chapter with the explanation of most common underlying cause of effect of the majority of unnecessary joint injuries.

Custom Molded Arch Supports (Orthotic)

Ankle joints are one of the more common type injuries found in many sports including motocross and Supercross. And believe it or not over 92% of all ankle and knee injuries have the same underlying "cause and effect" condition. This underlying condition is called Foot Pronation or more commonly known as Flat Feet. This underlying condition places the ankle and knee joints in a condition known in martial arts as a joint lock. Normally any joint can absorb and manage impact forces but when that same joint is placed in joint lock it can be broken with very little force. Foot pronation places many joint in the body in threatening joint lock angles including:
1. Neck
2. Upper Extremities (Shoulders, Elbows, Wrist, & Hands & Fingers)
3. Thoracic and Lumbar (Low Back) Spinal Regions
4. Pelvic, Sacrum-Ileum, & Hip Joint
5. Knees, Ankles, Feet, & Toes.

The the more frequent joint injuries seen due to the underlying condition of foot pronation the upper and lower extremities as in the Red Bold Print hi-lite above. Joint injuries are more difficult to treat and case manage over other common musculoskeleto type injuries such as, muscles, tendons, and bone injuries. To learn more about how foot pronation is the major underlying causative factor in joint injuries click on and read Arch Supports.

Did You Know?

Foot pronation predisposes the individual unnecessary joint conditions. Did you know that research studies show that a high majority (95%) of most joint conditions can be successfully treated with conservative treatments and measures, such as, static and dynamic joint stabilization that only comes from the correction of foot pronation. Simple testing in an office or at home can demonstrated and confirmed this fact to be true with all of the joints listed above. If you are an individual who wanted to avoid surgery, if at all possible then consider performing our simple taping of the arches test as demonstrated in our chapter on Arch Supports.

It is a well-known fact that 90% of all injured joint conditions and 90% of the joint surgeries could have been avoided with very low cost effective and highly successful non-invasive conservative applications such as this method.

The medial necessity for this special appliance is due to the patient’s foot imbalance (pronation). This can be easily identified by the following simple examinations:
1. By visually identifying foot pronation on one or both feet
2. Examining the individual’s shoes for improper wear.
3. Noted muscle weakness improvement in found muscle weaknesses
    in the area of joint complain of the individual.
4. Noted decreases pain in the same area of complain following the
    taping of both arches to temporally remove his foot pronation as
    outlined in the chapter titled Arch Supports.

Foot pronation causes an improper weight distribution to occur that transmits up into the pelvis and spine as the patient walks. This directly affects the patient’s strain/strain of the cervical spine, upper & lower extremities.

The foot orthotic, custom molded to the rider’s individual foot, is based on 16 different measurements that corrects this imbalance and allows for the proper weight and forced distribution to occur. Without this correction, the rider’s condition will continue to recur and progressively get worst making surgical intervention necessary.

Hopefully, this explains the necessity of the custom molded foot Orthotics.

Next, let's take a look at normal anatomical bone structure of the ankle.

Normal Ankle Anatomical Views


                Normal Foot                     Foot Pronation / Flat Foot

        Very common fractures in ankle injuries in motocross & Supercross
       Foot Pronation is over 92% of the underlying cause & effect for this
       unnecessary injury

Let's review the treatment protocol

1. Hot and Cold Applications mixed with water.
Apply the RICES-Rule from the chapter on "Hot & Cold Application" as outlined in the chapter.

2. Skin Brushing is one of the best self-help applications for
accelerating recovery, bruise, swelling and pain elimination,
and connective tissue regeneration. It is listed as Skin Brushing.
Do this two to three times a day at least. See Skin Brushing.

3. Epsom Salt & Apple Cider Vinegar Bathing at least once a
day, preferably just before going to bed. Combine this one with
skin brushing. It is listed as Epsom Salts Bath.

4. Bio-Cleanse Procedure
The Bio-Cleanse process is a method that removes cellular debris from injured tissues and other unwanted toxic materials. The body detoxifies while you are comfortably seated with your feet placed in a container of warm water. This method has been proven to be a very efficient way of removing the accumulations of injured tissues, cellular debris, and many toxic materials regardless of where they are located in the body.

The Bio-Cleanse Process is unique in that it generates a stream of positive and negative ions (charged atoms), which attract and attach themselves to oppositely charged cellular debris and toxic particles and draws them out of the body through the skin. For more information of this amazing process see below or click on Bio-Cleanse.

5. Piezo Electric Stimulator is a small hand held unit about the size of a ink pen. Electric stimulation to troubled or injured areas allows these areas, not only heal faster, but in most cases heal without the formation of scar tissue. Applying electrical stimulation early in any problem allow the body to repair before the advance needs of chemical poisonous (drugs) or surgery. Electricity allows the body's repair program to repair and regenerate the troubled or injured tissues back to an identical replacement tissue, making it like new.

6. Essential Oils
Essential Oils is a soothing, penetrating herbal oil and balm that
eases pain and, at the same time promote healing for a wide variety of conditions including aches, pains, soreness, tenderness, swelling, and tightness. It was originally developed by the Sholin Priests to aid their recovery from injuries they sustained while practicing extremely rigorous martial arts training and activities. It is a highly successful home treatment for over 30 known conditions including; injuries, sinus, back pain, headaches, high stress conditions, sore throats, heartburn, arthritis, rheumatism & sprains & strains.

Historical, Essential Oils was applied in different manners to produce its amazing successful results. The Chinese would rub Essential Oils (in Herb form) gently with a circular motion (CW = increases its action, CCW = slows its action, in the Northern Hemisphere). The Essential Oils would begin to liquefy, and a small ridge would adhere to the finger. With that amount of balm or oil, the Chinese would then use it for many conditions and ailments.

7. Balancing & Stabilizing The Knee Joint
Also read about how Arch Supports can accelerate broken bones to heal by balancing the body's biomechanical musculoskeleto system and greatly reduces stress. Do the simple tape test listed towards the end of the chapter to see if arch supports will help your condition.

8. Herbs and Vitamins
Nothing can perform or compete against the listed herbs below:
1. Solomon's Seal
2. Cal Phos.
3. Horsetail
4. Golden Seal

To learn more about the above herbs click on them. We carry the above herbs in our bookstore. You will need to call us to order them. Our phone number is 843-669-5794.

9. Electromagnetics
Electromagnetic therapies (Diapulse) have performance of healing this bone fracture to a level 2 (normal activity) within 7 days. And it will reach a level #3 in 14 days (practice riding and racing) and will reach a level #4 by 21 days (fully race ready). Medical protocol will have you do nothing for 6 to 8 to 12 weeks. After surgery MD's offer you nothing that works well at all and in the process encourage the connective tissues at the site to atrophy. I have never been impressed with their protocol. For Diapulse treatment settings see Diapulse Treatment Protocols.

Diapulse Treatments

Ceramic Magnetic Initial Treatment

North Pole surface facing North Pole surface

Q-2 Bio-Cleanse Unit & Process

The Q-2 Bio-Cleanse Unit

Bath at starting point

Bath after 30 minutes

Note the injured cellular debris (orange & red colors) shown in the bath following 30 minutes of positive and negative ion exposure. This reddish orange debris is some of the injured tissues hurt in the accident. The rider commented that his pain, stiffness, soreness, and tenderness levels had decreased a lot by the end of the treatment. This therapy is unique in that it can be used in the corrective rehab program and for prevention of future injuries, as well. To learn more about this amazing piece of raci41 self-help care equipment click on Bio-Cleanse.

Also see
1. Ceramic Magnets
2. Piezo Stimulator
3. Rehab Guidelines
4. Rehab Exercising
5. Skin Brushing

Exercising

All lower leg and ankle joint muscle groups are exercised with exercising tubing and/or bungee cord. Let's review the slow and fast twitch muscle contraction times.

Slow Twitch
Remember it should take 2 seconds to travel through each direction of its 90 degrees range of motion. And it should take another 2 seconds to travel back to initial starting position. There will be a total of 4 second of time per rep in all of the below exercises. Doing 1 set of 6 reps will take 24 seconds to complete. Rehab practice makes permanent. Do it slowly and perfectly. Be demanding on yourself to perform it correctly every rep and every set.

Also remember that if the exercising unit is to difficult for your muscles to pull, move towards the exercising unit a little closer. This action decreases the stress load on the exercising unit and it becomes less tight. Remember this ir rehab exercising not athletic body building and development. Remember to read and review the chapter on Rehab Exercising before starting your exercise program.

Now let's take a closer look at how to specifically exercise the lower leg and ankle joint muscle groups.

Remember it should take 2 seconds to travel through each direction of its 90 degrees range of motion. And it should take another 2 seconds to travel back to initial starting position. There will be a total of 4 second of time per rep in all of the below exercises. Doing 1 set of 6 reps will take 24 seconds to complete. Rehab practice makes permanent. Do it slowly, accurately, and perfectly. Be demanding on yourself to perform it correctly every rep and every set.

Also remember that if the exercising unit is to difficult for your muscles to pull, move towards the exercising unit a little closer. This action decreases the stress load on the exercising unit and it becomes less tight. Remember this ir rehab exercising not athletic body building and development. Remember to read and review the chapter on Rehab Exercising before starting your exercise program.

Now let's take a closer look at how to specifically exercise the lower arm muscle groups.

Rehab Exercising For the Ankle & Knee Joint

Remember that you can start rehab exercising the good arm the very next day even though the involved arm is totally unable to move or even be exercised. Start of with one set of six reps exercising the slow twitch muscle fibers of the below listed muscle groups. To review sets, reps, slow and fast twitch exercising read Rehab Exercising.

1. Wobble Board
Start with the wobble board set to its lowest setting of the three setting available. As the ankle improves move the settings up to its medium height. And finally, move the wobble board up to its highest setting.

Rolling a full circle on the outside edge of the wobble board

Here is the list of sets and reps to be performed three to four times per day rolling the outside edge of the wobble board around on the ground in a circular direction both clockwise and counterclockwise. For more information of wobble board exercising see our chapter titled Wobble Board Rehab Exercising Methods.

1. Sitting - good ankle first:
    10 full rotations of the wobble board in a clockwise direction first
    10 full rotations of the wobble board counterclockwise second.
2. Sitting - involved ankle second:
    10 full rotations of the wobble board clockwise first.
    10 full rotations of the wobble board counterclockwise second.
3. Standing - with both feet on the wobble board
    10 full rotations of the wobble board clockwise first
    10 full rotations of the wobble board counterclockwise second.

2. Ankle Exercising
Ankle exercising should be performed initially on the good ankle while the involved ankle is in a splint or case and cannot be exercised. You can start the good ankle rehab exercising the day following the actual injury. Do 3 sets of 6 reps 4 times per day. Each direction of muscle contraction should follow a 2-second contraction with full range of motion followed by a 2-Second contraction in the opposite direction over the same full range of motion. In other words, 2-second movement in one direction first followed by a 2-second contraction in the opposite direction. The directions of motion to be exercised are:
1. Ankle Flexion
2. Ankle Extension
3. Ankle External Flexion
4. Ankle Internal Flexion
5. Ankle Inversion
6. Ankle Eversion

Reminders

Let's go over them as they are listed above. Remember the following points before starting the listed lower leg exercises below:
1. Your are rehabbing an injury even though you are exercising the good
    side.
   A. Always exercise the fullest or greatest range of joint motion of each
        joint
   B. But only exercise within the "Pain Free" range of motion
         (The Green Zone)
   C. Start off with a 2-second muscle contraction over its fullest pain
        free range of motion.

4. Sets & Reps
    A. Start with 1 set of 6 reps on the good side once a day for the first
         two days.
    B. Then go to exercising 2 sets of 6 reps twice a day.
    C. On the 5th and 6th days do 3 sets of 6 reps 3-times a day.
    D. From the 7th day and beyond do 4 sets of 6 reps 4-times a day.

5. You can adjust the bungee tension or resistance by moving towards or away from its point of attachment. Remember to always stay and work the injured area within its Green Zone for both its range of motion and muscle strength.

1. Exercising Tools for the lower leg and Ankle
    All of rehab exercising tubing and/or bungee tools are listed in our
    Bookstore.