Cumulative Injury Ankle Pain NASM

The Cumulative Injury Cycle: The Feet

“When you look down all you see is de-feet…”

How much do you think that your feet affect the rest of your body?

Maybe a little… maybe a lot? On a scale of 0 to 10, 0 being none and 10 being completely, where would you say your thinking falls?

The title of my article is just for laughs, but all joking aside, I have met many people who have given up hope for addressing their issues in “de feet.” It’s my mission to let you in on a little secret: there is so much you can do! Knowledge is power, and I’d like to share some insights I’ve found helpful in my years as a professional athlete, as a trainer working with athletes and desk jockeys, and also learning from other professionals. Our pursuit of maximized results in the quickest amount of time has lead to some great insights.

Have you ever found yourself engrossed in your feet, studying your own walk, or asking yourself:

Why are my feet pointing out?

Why are they pointing in?

Do I have fallen arches, or are they too high?

Why am I wearing out the outsides of my shoe, why do they always ware out at this particular spot?

And so the list goes on.

I’m sure if you haven’t considered any of these questions before now, you’ll probably catch you studying yourself soon. And if you haven’t asked yourself about your gait tendencies, you can be sure your clients have not either.

Let’s consider foundations. When you’re building a house, one aspect that needs to be in order before any framing begins is the foundation. It’s crucial for the rest of the structure’s stability. How about when you find that the doors or windows don’t close properly? There’s most likely an issue with the foundation sinking and the rest of the structure has to compensate for the shift… leaving some things not functioning like they should.

The same can be said for your feet as they relate to the rest of your body. When the foundation (the foot) is off, the rest of the body has to shift around, compensating throughout the whole structure. Doors don’t shut correctly (stiff back) and windows are stubborn to open (losing mobility in the shoulder).

In many spheres of healthcare, this chain reaction of compensations can be the result of something called The Cumulative Injury Cycle. Now, if we’re talking about this in it’s purest form, the whole process would have to start with an injury. This injury could have occurred anywhere in your body and it is likely it has not fully healed.

How I understand the Cumulative Injury Cycle:

“A cycle where an injury will trigger inflammation, muscle spasms, adhesions, altered neuromuscular control, and muscular imbalances. It begins as dysfunction, when movement becomes impaired through muscle tightness, muscle weakness, altered reciprocal inhibition/length tension relationships, altered force-couple-relationships, altered joint arthrokinematics. These (if left unaddressed) can lead to altered sensorimotor integration which (if left further unaddressed) can lead to altered neuromuscular efficiency which (if continued to be left unaddressed) can lead to tissue fatigue and breakdown.”

If left unaddressed this vicious cycle will continue to spiral through these steps over and over again, worsening; not just in the local injured area, but it will begin to take affect on the surrounding structures.

To draw from personal experience, I encountered the cycle as a competitive gymnast in high school. Early on in my training I can remember spraining my ankle, I was told to “walk it off,” and so I did. I continued to do so every week when I would re-injure it. This cycle created tissue trauma (made abundantly evident by the pain I experienced), the area was noticeably inflamed, and I would feel regular spasms in the area. I was also developing a lack of range of motion, which showed that adhesions were forming.

Because I continued to press my ankle for performance, my body began to function under altered Neuromuscular control/movement; the lack of range of motion now in my ankle meant that the next joint up had to compensate for the movement needed that my ankle would not give. So my knee took the brunt of it. This cycle began to take place in my knee until one day I tore my patellar tendon.

The vicious cycle did not stop after my knee injury. The cycle found its way up to my hips, which took on the demand from my weakened ankles and knees; I pulled my groin (adductor complex). Again the cycle continued until it finally developed into Anterior Spondylolisthesis, a condition that could have prevented my future as a fitness professional or even active individual. My doctor told me initially that I would be paraplegic for the remainder of my life. I am grateful to have adventured back through this cycle, unwinding my body through the years of unaddressed movement system impairments. This experience shaped my future and the vicious cycle was a large reason why I became a Trainer.

Unlike my personal experience, the Cumulative Injury Cycle doesn’t always have to start with an injury (at least not from my perspective). Conceptually, if we were to consider the house foundation again, the house doesn’t need a natural disaster to shift that massive block of concrete; likewise, just the position of your ankle alone could change, to an incredible degree, the way force travels up through your entire body, the way gravity flows back downward through it, leaving every joint to have to figure out the safest way to respond.

Now you might be thinking about how you can better serve clients with injury prevention and correct movement assessments. What’s the best way to get started? What kind of information or training will you need? There’s also diving deeper into the issue, which asks you to address a client’s complete movement history, which can include how they sleep or what kinds of shoes they wear on a daily basis. In part two of my article, I’ll detail more potential issues and how to best address them with yourself and clients.

The author’s opinions are their his own and neither ELIVATE nor NASM takes responsibility for content, statements and opinions. You should seek expert counsel in evaluating opinions, treatments, products and services. For more info see our Editorial Policies.  

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