Acute Inversion Ankle Reflexogenic Strain
By Dr Seymour Pisarek DC, RTP, FIIT Canadian Chiropractor- Vol 7, #4, September 2002
Dr. Seymour Pisarek is a 1981 CMCC graduate practicing in Richmond Hill, Ontario. He is a faculty member of the Trigenics® Institute. He is a featured columnist with the Fairways Golf Magazine. He has developed teaching modules for the neurophysiology of Performance enhancement for Golf and Hockey.
An on-site challenge for the Trigenics® team chiropractor of the Provincial Champions of the National Women’s Hockey League
When an elite athlete presents to a team chiropractor during competition with an injury, it can be a stressful, yet satisfying experience. There are higher standards of care duet to the increase in both the level of athletic competition and the expertise of the team doctor. The responsibility, standard of care, and patients that exist in the rehabilitation arena for these athletes now requires the doctor to have at his/her disposal the necessary ability and tools to apply the best care on demand. The differential diagnostic implications that are present when attending to the immediate needs of the injured athlete can present a milieu of possibilities. The practitioner must react quickly and responsibly when a player’s health is at risk and, secondly, when the outcome of a championship game is at stake.
In the early part of this year, I was the attending team doctor with the Provincial Champions of the National Women’s Hockey League (NWHL) at the National Championships in Ottawa, Ont. Cherie Piper, Olympic gold medalist and forward for Team Canada was on the ice and had just been pushed into the boards, landing awkwardly on her ankle. She immediately held her ankle and realized she was in trouble, and maybe out of the game.
She was carried off the ice towards the dressing room where I immediately attended to her injury. She was unable to put any pressure on the foot. In this instance, Cherie had sustained an injury directed toward the supinated phase of ankle movement, causing the regional stabilizers to initiate foot inversion and dorsilflexion. These immediately come into play to hold the foot into a supinated, inverted and dorsilflexed position.
The mechanism of injury, and primary and secondary injury surveys completed to Cherie’s condition, indicated any red flags from injuries of this type were not present. Immediate pain and an inability to place pressure onto the base of the foot in this position will notify the practitioner of this reflex contracture. This can mimic an obvious sprain of the lateral compartment ligaments and stabilizing retinaculum that cover the underlying tendons. This poses a significant challenge in the decision regarding the appropriate Trigenics® treatment. With immediate attention, the resultant swelling will be kept to a minimum and the player will be able to safely resume activity.
With no specific contraindications noted, I was assured that the Trigenics® Neurophysiological Performance Enhancement protocols would not create further tissue changes or enhance local swelling. Due to the carrying position of her ankle and the limited active and passive movements, I diagnosed an acute inversion strain to the tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles. The musculotendinous insertions reflexogenically created a splinting of primary and associated muscles. This resulted in a rebound of acute reflexogenic shortening of the aforementioned muscles. The inverse effect is found on the opposite, or lateral side, where there is an acute Reflexogenic lengthening of the peroneal longus/brevis, and posterior tibialis muscles.
Special attention is paid to both the flexor and extensor compartment to ensure a balanced state of regional soft tissues and the reduction of the pain, swelling, and re-establishment of normal muscular strength and flexibility.
I decided to keep her skates and shin pads on. If they had been removed, her pain and swelling could have been intensified. This would pose some obvious challenges in this specific application.
I started to apply Trigenics® protocols directly into the space between the skate and the shin pad. This three-inch square is where the tendons traverse the tibial-talus junction. The specific Trigenics® Strengthening (TS) protocol for the tibialis anterior muscle was initiated first with an ultra light application of Proprioceptive Dynamic Acupressure (PDA). The ankle is places in slight dorsilflexion and inversion with the Trigenist’s hand holding the plantar surface of the foot. This enables the reflexogenic response to produce the desired effect at the site of PDA and along the length of the target muscle. The Trigenist must be specific as the everted endpoint that the foot will take to ensure that the effect is enhanced throughout the entire patient-directed movement.
Through subsequent application of the protocol, Cherie felt less pain and became more relaxed as we continued. This occurred because of diminished nociceptive afferent responses, resulting in a reduction of adhesions with enhanced tissue glide, functional ability, range of motion, and an accelerated rate of recovery.
Simultaneously applied Autogenic breathing and visualization, Acugenic PDS, and Neuromyogenic movement produced an immediate restoration of functional mobility and reduction of pain. So much so, that within approximately 10 mins, Cherie was back in the game and scored a crucial goal for the team.
The barometer of acceptance for Trigenics® Performance Enhancement in the marketplace is evident by the number of coaches, trainers, athletes, and health professionals who refer athletes. It represents a high standard in the marketplace due to Trigenics’ inherent neurological model. The patented process that Trigenics® incorporates into it’s protocols, namely Acugenics, Autogenics, and Neuromyogenics, (see glossary of terms) are what make this a stand-alone therapy. It effectively treats athletes for both injuries and performance enhancement.
INJURY MANAGEMENT BENEFITS
Restoration of biomechanical function Tissue integrity maintained Enhanced rate of recovery Pain-free range of motion Reduced inflammation Enhanced tissue repair Immediate results
References: Austin A. Trigenics® Module II, pp.148-149 Austin A. Trigenics, Theory module, pg 88-96 Allan N., Trigenics® Neurophysiology, a description and preliminary thoughts towards a rationale, Trigenics® Clinical Applications Module III, 1st edition, pp 48-49.