Long-Term Effects of Ankle Injuries: Seeking Rehabilitation Solutions

Sequelae of left ankle injury?

Hello Doctor, five years ago, I accidentally stepped into a hole, resulting in an ankle injury.
At that time, the doctor said I had a ligament tear.
Due to my work environment, I couldn't take a long leave for recovery, so I wore a brace and forced myself to walk (though I often didn't wear it), which was quite reckless.
I continued rehabilitation at a physical therapy clinic, but because I didn't allow my ankle to rest properly, the pain persisted for over six months; I couldn't touch or pull on it, and I continued therapy for more than a year before stopping.

About two years ago, I noticed that the entire left shoulder felt off and very tight.
Sometimes, after sitting for too long, my left side would feel uncomfortable; during some stretching movements, I would also feel tightness along the entire left side, and the range of motion for my left arm when drawing circles backward was noticeably limited, with a clear sensation of it getting stuck.
However, there were also some movements where my right side couldn't fully extend.
There was even a period when I couldn't lift my left arm, and I had to use the wall for some stretching exercises to improve it.

Sometimes, when doing yoga stretches, I experience tingling in my neck, face, and chest that lasts for a long time, and I'm not sure if it's related.
I'm wondering if my initial failure to allow my left foot to heal properly led to over-reliance on my right foot, which might have caused compensatory effects over time, possibly shifting my body's center of gravity.
I would like to check if my skeletal alignment is off and seek treatment to correct it.
Should I consult a rehabilitation specialist or an orthopedic doctor? How can I improve this situation? Thank you, Doctor.

Niming, 40~49 year old female. Ask Date: 2022/02/12

Dr. Li Yanheng reply Rehabilitation

For pain issues, you may consider seeking treatment at a rehabilitation clinic.
However, based on your description, it seems that the problem is due to an old injury that has not healed.
It is advisable to address the old injury first before seeking physical therapy to correct your posture.

Reply Date: 2022/02/12

More Info

In your case, it sounds like you have been dealing with the long-term effects of an ankle injury that occurred five years ago, which has led to a cascade of compensatory issues throughout your body. This is not uncommon, as injuries can lead to changes in movement patterns and postural alignment, which may result in discomfort or pain in other areas, such as your shoulder and neck.

Understanding the Long-Term Effects of Ankle Injuries
When an ankle injury occurs, especially one involving ligament damage, it can lead to instability and altered biomechanics. If the ankle does not heal properly or if rehabilitation is inadequate, the body often compensates by shifting weight to other joints. This compensation can lead to overuse injuries in other areas, such as the knees, hips, and spine. In your case, it seems that the compensatory mechanisms may have contributed to the tightness and discomfort in your left shoulder and possibly other areas of your body.

Rehabilitation Solutions
1. Physical Therapy: Since you have already undergone physical therapy for your ankle, it may be beneficial to return to a physical therapist who specializes in post-injury rehabilitation. They can assess your current movement patterns, identify any compensatory strategies you may be using, and develop a tailored rehabilitation program that addresses not only your ankle but also your shoulder and any other areas of concern.

2. Strengthening and Flexibility Exercises: A well-rounded rehabilitation program should include both strengthening and flexibility exercises. Strengthening the muscles around the ankle can help improve stability and reduce pain. Similarly, addressing the tightness in your shoulder and neck through targeted stretching and strengthening can help restore range of motion and alleviate discomfort.

3. Postural Assessment: A thorough postural assessment can help identify any imbalances or misalignments in your body. This can be done by a physical therapist or a chiropractor. They can provide insights into how your body mechanics may have changed since your injury and recommend exercises or adjustments to help correct any issues.

4. Manual Therapy: Techniques such as massage, myofascial release, or chiropractic adjustments may be beneficial in addressing tightness and discomfort in your shoulder and neck. These therapies can help release tension in the muscles and improve overall mobility.

5. Cross-Training: Engaging in low-impact activities such as swimming or cycling can help maintain fitness without putting excessive strain on your ankle. This can also help you stay active while you work on rehabilitation.

6. Consultation with Specialists: Given the complexity of your situation, it may be helpful to consult both a physical medicine and rehabilitation specialist (physiatrist) and an orthopedic surgeon. A physiatrist can provide a comprehensive approach to rehabilitation, while an orthopedic surgeon can assess if there are any structural issues that need to be addressed surgically.

Conclusion
In summary, your situation appears to be a classic case of compensatory patterns following an ankle injury. It is essential to address not only the ankle but also the resulting issues in your shoulder and neck. A multidisciplinary approach involving physical therapy, postural assessment, and possibly consultations with specialists will likely yield the best results. Remember, recovery takes time, and it is crucial to be patient with yourself as you work towards regaining full function and alleviating pain.

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