Does Chiropractic Have an Answer for Recurrent Ankle Sprains?
By Scott Cuthbert, DC
Is there a measurable reason why an athlete will sprain an ankle with a turning activity that has been done thousands of times before with no trauma? Orthopedist Jose Palomar Lever, MD,1 recently evaluated 200 asymptomatic patients for the involvement of ligaments in many of the different joints of the foot. The research design consisted of spreading apart the ligament and then manual muscle testing 40 different muscles throughout the body to see how this inhibits or facilitates remote muscles.
Twenty-one joints and ligaments were tested in these 200 patients, and the specific correlations between the joints and ligaments and the muscles they affected were listed. Generally, the calcaneal ligaments were found to affect pelvic and lower limb muscles, while the talar ligaments were more involved with neck, upper thoracic and shoulder muscles.
Lever suggests, "Because of the importance of foot proprioception and the foot's relationship to so many body problems from neurological disorganization to gait imbalances, fascial disturbances, and the inhibition of so many muscles when faulted, physical evaluation of patients should include more attention to the feet."
Setting the Stage for Ankle Sprains: Stressed Adrenal Glands
A possible answer for recurrent ankle sprains is the failure of the tibialis posterior, soleus and gastrocnemius to act in the role of approximating the tibia and fibula during strong plantar flexion (part of an inversion or eversion sprain of the ankle). A number of chiropractic systems recognize that these muscles are related with the adrenal glands. This is especially of interest in an athlete under the stress of the game, but with adrenals incapable of meeting the body's needs.2
The ligament stretch reaction is also related to stressed adrenal glands.7-8 This is a condition in which previously strong associated muscles test weak immediately after ligaments of the joint are stretched. This association between ligament stretch and muscle weakness patterns has been presented by Solomonow;9 additionally, the relevance of adrenal hormones (particularly their mineralocorticoid function) to ligament injury has been expanded in the chiropractic approach.10-11
Troubleshooting: Testing the Ligament Stretch Reaction
Schmitt12 designed a clinical study (n=16) to determine the reproducibility and apparent association of the ligament stretch reaction to the adrenal gland. The study (like Lever's) consisted of stretching the ligaments of various articulations in the body and then retesting muscles associated with the articulation, as well as remote indicator muscles. After this was accomplished, various factors associated with the adrenal gland were evaluated by a chiropractic technique called "therapy localization."7-8, 13
If therapy localization to an adrenal gland viscerosomatic reflex abolished the ligament stretch reaction, there was probable adrenal involvement associated with the mechanical stretch to the ligament. After all reflexes were tested, the individual was asked to chew adrenal concentrate; its effect was evaluated by retesting for ligament stretch reaction. Results of the nutritional administration tested in the 16 individual are as follows [see table].
If therapy localization to the adrenal reflex listed abolished the positive ligament stretch reaction, it was listed as positive. Note that in 50 percent or more of the subjects, each reflex or the nutrition cancelled the positive reaction, with the exception of the neurovascular reflex.
Treatment indicated by the positive tests was initiated. The ligament stretch reaction was removed with these approaches in 14 of the 16 patients. Two cases required specialized meridian therapy to abolish the positive ligament stretch reaction. "In all but one case, the symptoms of the patients were generally improved at the next office visit. In most cases, there was no recurrence of the ligament stretch/muscle weakness patterns. In the few where the pattern did recur, fewer reflex areas were found to be involved."
Durlacher14 points out the importance of evaluating athletes for ligament instability or ligament stretch reaction. A rapidly moving individual places strain on the ligaments, appearing to cause immediate weakening of the muscles supporting the articulation just when they are needed.
Under these circumstances, weakening appears to be the same as that observed when the articulation is stretched and manual muscle testing is performed immediately afterward. It is possible that the weakened muscle could even be more significant in an athletic endeavor, because muscle demand occurs at the same time the ligament is being stretched.
Sprieser15 also reports on an in-office clinical trial (n=50) in which the ligament stretch reaction was present in every case that had a confirmed adrenal stress disorder. (Each of the patients in this study showed a drop in systolic blood pressure from lying to sitting or sitting to standing, or a positive Ragland's sign.) Nutritional support was needed in all cases to correct the ligament stretch reaction and included adrenal support with choline or adrenal tissue extract, and/or a low dosage of vitamin E from wheat germ oil or octacosanol.
Hansen16 reports on a case-series of five patients with a medically diagnosed mitral valve prolapse who were also found to demonstrate the ligament stretch reaction. On physical examination, those patients were found to be hypoadrenic. The patients were treated to stabilize the ligament stretch reaction. This included dietary measures such as eliminating stimulants like coffee, tea, cola and refined sugars. Oral nutrient testing showed a need for adrenal gland nutritional support. Hansen suggests that a mineral imbalance due to depressed adrenal function may cause a systemic weakening of ligaments, including those of the heart valves.
In this discussion, Selye's observation about the adrenal gland's pervasive influence should be noted. "A general outline of the stress response will not only have to include brain and nerves, pituitary, adrenal, kidney, blood vessels, connective tissue, thyroid, liver, white blood cells and especially muscles, but will also have to indicate the manifold inter-relations between them."17 The endocrine glands are controlled by the nervous system, of course; and this is why chiropractic and the other manipulative professions have been helpful throughout their history for endocrine-related disorders.18-19
Clinically, it has been observed that patients susceptible to the ligament stretch reaction have exacerbations of symptoms when under considerable stress. Stress is cumulative and can be classified as emotional, chemical, thermal or physical. The athlete has some – and probably all – of these stress factors during competition.
Clinical evidence shows that performance is superior, and injury less probable, when all factors known to influence the adrenal gland are functioning normally. This provides an opportunity for the stress of the endeavor to properly enhance performance and not be a possible cause of injury.
From the diagnostic viewpoint, the chiropractic manual muscle test has significance because it makes possible the detection of a "dis-ease" process affecting the ligamentous system in advance of the emergence of symptoms. Whether the muscle inhibitions found are primary (as in a postural subluxation) or of secondary reflex origin (as in a ligamentous disturbance due to impaired adrenal gland function), we must recognize that this component in the musculoskeletal system's function is a contributing, exacerbating and perpetuating influence that must be specifically diagnosed and given effective treatment, regardless of the primary etiology.
The therapeutic effort is directed toward support of the adrenal gland. The appropriate reflexes and muscles described in previous chiropractic literature should be evaluated and corrected, if involved. Nutritional support -– usually in the form of adrenal concentrate – is frequently of value.2, 20-21 Evaluation of stress and the entire endocrine system is important in treating the functional hypoadrenic, and particularly patients with recurrent ankle or other extremity sprains.
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