January 21, 2014 3:03pm | CORE PT & MC | by CORE Movement Specialists
There are a lot of us out there who have pain in one or the other; knee, hip ankle, back, etc. When things are painful the general consumer will seek out treatment for this area by seeking medical treatment. As we seek treatment one would think that interventions would be focused on the joint or area that is painful, right? So why would your physical therapist give you an exercise for your hip or back when your came in for an ankle sprain?
As physical therapists we are trained to look at the whole body and to analyze full body movement and control. A good physical therapist will definitely assess the area that is painful, but a great physical therapist will also check the joints above and below to assess how they move and screen for faulty movement patterns that may be a contributor or cause of your pain. This is especially important in recurrent injuries. A recurrent ankle sprain cannot be solely due to just being clumsy; there must be a reason that the ankle is susceptible to injury.
To illustrate how this is, take the ankle sprain example. As the foot hits the ground during weight bearing exercises (walking, running, or landing from a jump) our body must be able to control itself through the ankle, knee, hip, and spine. For the body to properly control this motion, muscles up and down our leg must work together and in the proper balance to keep our leg and foot in the correct alignment. When the correct alignment cannot be achieved either due to faulty ligaments or muscle control the risk for injury to structures up and down the leg occurs. One common area of fault in control of the lower extremity is poor control of femoral medial rotation. This means the ability to not let your thigh bone rotate inward as the knee bends during weight bearing. Increased femoral medial rotation, leads to increased knee valgus (“knock knee” position), which causes tibial external rotation (rotation of the lower leg bone outwards), which can cause increased pronation at the foot (the foot excessively rolling inwards).
Whoa, that’s a lot of motion to control with every step! That is why having correct muscular and motor control up and down the “kinetic chain” is vital to a patient’s rehab success. If the poor movement control at the hip pre-disposed the ankle to injury then you could do ankle strengthening exercises for weeks and still have a risk of injury. This idea of having control though the entire kinetic chain can be applied to the upper extremity and the spine as well. It’s all connected! So stop blaming those pesky ankle tweaks, aches, and sprains on weak ankles or being clumsy, it just might be your hip that’s the culprit.