James limped into my clinic 6 months after ankle replacement surgery. Following an active career in the navy and warehouse management the cartilage in his ankle had worn away and bone was scaping on bone. His surgeon had given him 3 options with all the associated pros and cons. James opted for full joint replacement which was the most drastic option but what he hoped would be of greatest long-term benefit.
James was pleased with how the surgery had gone and the reduction in pain he was already experiencing. However, he was keen to explore his options in terms of minimising his limp, improving movement in his ankle joint with the overall aim of returning to the activities he enjoyed; going to the gym, gardening, walking the dog and playing with his grandchildren.
During our first session a detailed assessment identified that there was a significant difference between the lower legs. The calf muscles of the lower leg were tense and the range of motion in this ankle was significantly restricted. I created a personalised plan that focused on using a combination of general massage techniques and muscle energy techniques (MET).
I used general massage techniques to work on the muscles of the lower leg. My focus was to relax the muscles, reduce tension and increase local circulation. There are a number of benefits of MET three of which were exactly what James needed;
- Restoring tone to hypertonic muscles
- Strengthen weak muscles
- Increasing joint mobility
MET is an active treatment, James was involved in his treatment there was no lying back and drifting off – we had work to do. We worked on the muscles that control the plantar flexion (pointing toes away as if pressing on the accelerator of a car to go) and dorsiflexion of the foot (pulling the toes to the shin as if taking the foot of the accelerator of a car to slow down).
The technique works by moving the muscle to the point of bind – where the restriction is first felt. At this point I would hold the position and ask James to contract the muscle against my resistance for 10 seconds therefore using the muscle’s energy. After 10 seconds James would take a breath and then relax. As he released his breath and relaxed, I would move the joint further. This would be repeated until no further gains could be made.
Following the MET treatments, we would observe the ankle movement again this is always the best part of this type of treatment as you can see the progress in joint movement before and after. The technique is based upon lengthening the muscles and “tricking” the nervous system to accept this restored length.
James undertook a series of 7 sessions over 5 months. We did have one set back half-way through. As many of us do when we achieve progress we like to push ourselves and of course this is what James did. He came to clinic one week in pain, there was swelling and a slight difference in temperature between each leg. He was sent home to rest and instructions to adapt his routine.
Hi Alison,
I bet you thought that I had forgotten you but not so! I saw my consultant on Tuesday and he has signed me off, he has no further need to see me. The X-rays show that all is healing well and he thinks another six months should see me as close to being healed as I will get.
I explained to him the work you had done on my ankle and he felt (as I do) that you had done a lot to improve the movement in said ankle. I also told him about the set back I had a few months ago and your conclusions and he agreed with your thoughts.
The lengthening and shortening of the ankle should continue as it will improve movement up to a point, side to side movement should be avoided (and walking on uneven ground).
Regards
James
At his final session we were both confident that the range of movement in his ankle was inline with the expectations his surgeon had identified. James was able to engage in the activities he enjoyed and how to challenge himself without overdoing it. It is sad to say goodbye to a client but even better to recall the progress made and be part of someone’s journey towards reaching their goals.