Chronic Ankle Instability and Sports Medicine Acupuncture®

Chronic ankle instability is a condition characterized by a feeling of weakness of the ankle. The patient will often report a vulnerable feeling toward easily rolling or twisting the ankle especially with uneven surfaces. The history often consists of recurrent ankle sprains and persistent symptoms that include pain, swelling, and weakness. Chronic ankle instability often results from an earlier ankle sprain that never properly healed that eventually resulted in repeated sprains.

The pain of an ankle sprain is significant, and it often keeps the injured patient out of play or work for a period of time. With timely and appropriate treatment, ankle sprains often heal in 4-8 weeks and do not become a chronic problem. Unfortunately, many patients who suffer an ankle sprain or “twisted ankle” never seek treatment after injury, which can result in recurring sprains, altered muscle activation and chronic ankle instability.

Chronic ankle instability will commonly consist of:

• Ligament laxity: Overstretched or torn ligaments can result in a loose or unstable ankle. 
• Proprioceptive deficiency: The myofascial, ligamentous tissues and joint capsule proprioception becomes impaired contributing to ankle instability and inadequate rehabilitation.
• Muscle imbalance and weakness: Because of ligament laxity, the ankle myofascial tissues take on the role of ankle stabilization resulting in an uneven pull of the primary ankle muscles, perpetuating proprioceptive dysfunction which increases the risk of recurring sprains. 

Imbalanced leg musculature and altered or decreased proprioception are common findings in patients with chronic ankle instability. Patients with Chronic ankle instability typically have peroneal muscle weakness (as assessed by manual muscle testing, see video) and a decreased sense of proprioception (Cho, B., 2019) In an interesting study on muscle activation in patients with chronic ankle instability compared to normal subjects, the researchers found that not only was there an altered muscle firing sequence of the peroneals, but also of the gluteus maximus, the hip abductors and hip adductors in the chronic ankle instability group. (Van Deun S., 2007). 

The TCM practitioner should not only focus on assessment and treatment of the local channel condition (e.g. UB jingjin: peroneals, etc.), but to also include postural evaluations for foot over-pronation (SP and KID) and pelvis imbalances (e.g. elevated ilium: GB and LIV jingjin: hip abductors and adductors) that have most likely contributed to the chronic ankle instability condition. It is important for the patient to perform proprioceptive exercises immediately after the acupuncture treatment, as this will help to enhance the acupuncture effect of reestablishing proprioception and proper muscle activation resulting in the patient returning to activity expediently.