The ankle is a critical area for athletes because it forms the primary connection between the body and the ground, and as a result, a tremendous amount of force and pressure passes through the foot and ankle every day. Athletic activities involving running, jumping, kicking, swinging, and rapid changes in direction require a considerable amount of strength and flexibility from the ankle and its surrounding muscles. Due to the high levels of force and mechanical stress placed on the foot and ankle, this region is frequently the site of injury. Foot and ankle injuries prevent optimal performance and can progress to the point of preventing competition and training. Most frustrating is that many of the most common foot and ankle conditions are slow to respond to traditional types of treatment. Fortunately, a new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to treat many common foot and ankle problems, and is helping athletes get back to their sport quickly. Before we explain why ART® works so effectively, we want to talk about how the ankle becomes injured.

The ankle joint forms the connection between the tibia and fibula bones in the lower leg and the talus bone on the top of the foot. Proper strength and mobility of this area is critical because the ankle serves as both a pivot point and an energy-transfer station between the body and the ground. For example, with running, as the foot pushes off the ground, the force that is generated from the muscles in the leg is transferred to the ground through the foot and ankle, causing the body to be propelled forward. For optimal performance and to prevent injury, the foot and ankle must have the capacity to effectively generate and transfer force not only in a forward direction, as in running, but also in the side-to-side and rotational directions, which is important for sports involving swinging (baseball, golf) or cutting movements (soccer, football, basketball). In order to stabilize the foot and ankle and prevent excessive strain to the area, the ankle relies on the complex system of muscles and tendons that surround the ankle in all directions. These muscles, which begin high in the lower leg just below the knee, have long tendons that travel down and across the ankle and attach to the heel and foot. These muscles must contract to protect and stabilize the foot and ankle. When there is adequate strength, flexibility, and balance of these muscles, the chance of injury is low, but because of the demand placed on the foot and ankle in many sports activities, problems can develop in these critical muscles, leading to a variety of athletic injuries.

Athletic activities require a considerable amount of strength, flexibility, and coordination from the foot and ankle muscles. The increased demand can place a tremendous workload on these muscles, because they are required to generate an incredible amount of force to protect and stabilize the ankle region. Most sports demand that the same running, cutting, kicking, or swinging motions are repeated over and over again. This combination of repetitive motion and high demand can cause problems to develop in the foot and ankle, because the muscles often cannot keep up with the workload. Over time the muscles of the lower leg can become strained and develop small-scale injury, called micro-trauma. Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the foot, ankle, or lower leg. Although small, the damage needs to be repaired, and the body responds by laying down new tissue (scar tissue) to repair the damaged area. The scar tissue itself is not a problem; in fact, it is a normal and necessary part of healing. The problem occurs when the ankle is subjected to the same high workload due to continued repetitive high-force athletic movements. This causes the same muscles to become strained and subsequently repaired over and over again. Over time this scar tissue builds up and accumulates into adhesions. As these adhesions form, they affect the normal health and function of the muscles. In fact, adhesions often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow. As scar-tissue adhesions accumulate in and around the muscles of the foot, ankle, and lower leg, more and more strain is placed on the area because the muscles and associated tendons must now stretch and contract against these adhesions in an attempt to move and stabilize the ankle. This places even further strain on the muscles, which leads to more micro-trauma. Essentially, a repetitive injury cycle is established, causing continued adhesion formation and progressive ankle dysfunction. As the cycle progresses, the ability of the muscles to contract properly is affected and the protection and stability of the ankle becomes compromised. At this point it is not uncommon for the muscles to give way and more severe and debilitating pain to occur, such as a muscle injury or ankle sprain. Many athletes come into our office saying that they have hurt their foot or their ankle during a routine task that they have done thousands of times before. These athletes almost always describe some mild pain or tightness that has been building over time, and the result is a more acute injury that could be called the straw that broke the camels back.

In an attempt to relieve foot and ankle pain, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include anti-inflammatory medication, rest, ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Most of these traditional techniques often require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms, instead of fixing the underlying cause of the problem. The main reason that these traditional approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that develop within the muscles and surrounding soft tissue. These adhesions bind the tissues together, restrict normal movements, and interfere with the normal flexibility and contraction of the muscles surrounding the ankle. Passive approaches such as medication, rest, ice, and steroid injections focus on symptomatic relief and do nothing to address the muscle restrictions and movement compensations. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercise are often less effective and much slower to produce relief or recovery from the foot or ankle condition.

artpurple-transparentART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART® treatment is highly successful in dealing with foot and ankle injuries because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissue. Locating and treating the soft-tissue adhesions with ART® allows the practitioner to:

break up restrictive adhesions
reinstate normal tissue flexibility and movement
more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain
You can think of an ART® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring. An additional benefit of ART® is that it allows us to further assess and correct problems not only at the site, but also in the other areas of the kinetic chain that are associated with movement compensations, and are often contributing to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet developed pain. One of the best things about ART® is how quickly it provides results. In our experience, the majority of ankle conditions respond very well to ART® treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and several factors determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. These results are the main reason that many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series. To book an appointment to see if ART® can help with your Athlete’s Ankle, call our office at (248) 477- 2100.