I am certain that this world class speed skater has more than adequate muscle strength and has received the best training the world has to offer, but a question I would ask him is did he ever sprain or injure his ankle, and if he did, what treatment did he receive? Of course the following is hypothetical regarding Dan Jansen, since I have no knowledge of his training or medical history, but it represents an interesting hypothesis.
Freeman et. al.,1 showed that a chronic old sprain of an ankle that caused instability and gave way was not necessarily due to poor ligamentous and muscular dysfunction, but to altered proprioception and irritability of mechanoreceptors in the capsule and ligaments. The result is altered signaling from the ankle joint causing incoordination, inhibition and weakness of local muscles. Treatment on the balance board resulted in a rapid improvement in coordination.
Bullock-Saxton, Janda and Bullock2 had patients wear "balance shoes" (shoes with a ball under the surface creating an unstable base of support during walking). For one week, the patients walked five times each day for three minutes wearing the shoes. At the end of this period, the gluteus maximus and gluteus medius "reached a 75 percent level of maximum contraction more quickly in each gait cycle." This study proved that stimulation of the vestibulocerebellar pathways through subconscious recruitment of muscles (as differentiated from active conscious exercise) facilitated neural pathways resulting in better pelvic control.
Barry Wyke3 stated that, "interruption of the flow of impulses from the mechanoreceptors in a joint capsule into the central nervous system should result in clinically evident disturbances of perception of joint position and movement and of the reflexes concerned with posture and gait."
Bullock-Saxton4 showed that individuals with a history of unilateral severe ankle sprain affected hip extension in that there was normal activation of the hamstrings and lumbar erector spinae muscles and delay in activation of gluteus maximus muscle not only on the side of ankle injury but also on the uninjured side. The injured ankle resulted in central changes in motor control thereby altering the patterns of motion.
Sherrington defined proprioceptors as end organs which are stimulated by actions of the body itself. They are somatic sensory organs located so as to secure inside information and to bring about cooperation and coordination among muscles effectively. The nervous system uses these sensory receptors to modify and adjust muscle function so that peripheral automatic (subconscious) regulation will dominate in most of our so-called voluntary or volitional movements.5
Every back pain patient should be asked if they ever had a severe ankle sprain. Serious athletes should make proprioceptive stimulation a standard part of their routine.
References
- Freeman MAR, Dean MRE, Hanham IWF: The aetiology and prevention of functional instability of the foot. J Bone Joint Surg 47B: 678, 1965.
- Bullock-Saxton JE, Janda V, Bullock MI: Reflex activation of gluteal muscles in walking. Spine 18: 704-708, 1993.
- Wyke B: The neurology of joints. Ann R Coll Surg Engl. 1967;41: 25-50.
- Bullock-Saxton JE: Local sensation changes and altered hip muscle function following severe ankle sprain. Phys Ther 74,1:pp 17-31, 1994.
- Gowitzke BA, Milner M: Scientific Bases of Human Movement (3rd ed). Baltimore, MD: Williams & Wilkins, 1984, pp 256-257.
Warren I. Hammer, MS, DC, DABCO
Norwalk, Connecticut
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