What Are The Treatment Options for Ankle Pain Caused by Hypermobility?

What Are The Treatment Options for Ankle Pain Caused by Hypermobility?

Hypermobility is an excessive range of motion in joints. It is different from being flexibile and can cause discomfort, injury, and pain in the affected joints, including the ankle. Ankle pain is a common complaint amongst hypermobile individuals and the instability leads to falls and further injuries. In this blog, we will explore the causes, symptoms, treatment, and best exercises for hypermobility and ankle pain.

What Causes Hypermobility In The Ankles?

Hypermobility can be caused by a genetic predisposition or an underlying medical condition such as Ehlers-Danlos Syndrome(EDS). In cases of EDS or Hypermobile Spectrum Disorders (HDS), excess activation of mast cells cause looseness of the ligaments. This looseness results in joint instability.

Now, certain activities that require repetitive ankle movements in extreme ranges, such as ballet, gymnastics, dance, and cheer certainly feed the problem. These activities over-encourage the ligaments to be pushed to the extreme. This causes injuries that linger for a long time if not, a lifetime.

Whether you have EDS or another hypermobile condition, instability in the feet and ankles is something that should be addressed sooner rather than later. Our feet and ankles are our base and are what connect us to the ground. If that connection is unstable then everything above is going to be impacted.

Symptoms Of Hypermobility In Ankles

Symptoms of hypermobility include joint pain, fatigue, and frequent dislocations which can vary from person to person. Depending on the severity of the hypermobility and the joints affected symptoms may vary. In the case of ankle hypermobility, some of the common symptoms include:

  • Ankle pain
  • Swelling
  • Instability
  • Foot pain
  • Repetitive rolling of the ankle and
  • Feeling of the ankle giving way or buckling

As mentioned above, issues in the feet and ankles impact the structures above which can also result in overall poor posture, dysfunctional movement, knee issues, hip pain, lower back problems, and more.

Treatment Options for Hypermobile Ankles

The best treatment for hypermobility and ankle pain must focus on stabilizing the ankle joint and strengthening the deep muscles of the feet. And that’s not accomplished with ankle braces! Also, in treatment, it is important to not disregard the structures above the ankles but should include functional movement of the whole body.

Let’s talk about braces here! No brace is going to provide support to fix a problem. The only brace that provides value, in my opinion, is worn in bed to support the degree of extension at the foot and ankle which is accentuated by the weight of the blanket over the feet while sleeping. This brace simply limits how far extended and outwardly rotated the foot can get both movements being excess in hypermobile persons.

Now, regardless of the physical rehabilitation provider (Chiropractor or physical therapist) the following needs to happen when it comes to the treatment of hypermobile ankles and feet:

  1. Functional Movement such as Dynamic Neuromuscular Stabilization (DNS). This is movement according to the natural design and addresses the ankles, not in isolation, but in full body movements. Remember, the feet and ankles serve as the base for the rest of the body and are not an isolated issue.
  2. Postural Neurology: The brain controls every function in the body! With lack of function, certain parts of the brain, in regards to movement and posture can actually shrink. The good news is we can activate weak parts of the brain with specific exercises including proprioception, balance, and stability.
  3. Biological Breathing: Would you believe that almost every patient that walks into my office is not breathing correctly? This dysfunction directly affects movement and posture resulting in compensatory patterns and negatively impacting stabilization.

Exercises for Ankle Hypermobility

The best exercises for ankle hypermobility are those that include how the ankle functions with the rest of the body, not just in isolation. Here are some specific exercises that may help:

Ankle Hinge:

 Single-Leg Stand:

This is exactly what it sounds like! You practice standing on one leg at a time focusing on the whole foot and toes being engaged into the floor. The entire spine must be neutral and done with proper breathing. This is going to work on your balance and ankle stability while the rest of the body plays its part. This is a great exercise to work into your daily routine with an activity like brushing your teeth.

Bear Advanced Ankle Stability:

What To Do If You Have Hypermobility and Ankle Pain

If you know you are hyper-mobile, or suspect this, and want to find pain relief, full body stabilization, and postural correction all in one office, contact me.  Remember, you don’t have to be in pain to address the problem now.

Dr. Shakib

The Difference Between Flexibility, Hyper-mobility & Instability

The Difference Between Flexibility, Hyper-mobility & Instability

Hyper-mobility and flexibility are not the same and instability is where the difference girl with elbows hyper-extended in quadrupedlies. While some may mistake hyper-mobility as flexibility, especially in children, the difference is seen in movement and musculoskeletal function. In this blog you will learn how flexibility is a sign of health while hyper-mobility is instability, requiring extra measures to prevent injury and dysfunction. 

Flexibility vs Hypermobility 

Flexibility is a term that refers to the ability of a joint or joints to move without any restrictions. This requires muscles to lengthen allowing for movement. For example, if someone cannot reach and touch their toes this can be due to tight and short muscles of the hamstrings and tension in the lower back. Otherwise, someone whose muscles are overly tight, restricting mobility, may be considered inflexible.  

Hypermobility, however, refers to the excess laxity of the joints/ligaments. For example, this would be a person who:

  • Is considered “double-jointed”
  • Can hyperextend their elbows
  • And can manipulate their fingers beyond what the normal range of motion is

While being hypermobile, especially when you’re young, can seem like a cool thing and is sought after in certain sports, it can literally hurt you.

Hypermobility Affects Movement and Pain

When it comes to hypermobility, what is often ignored is the impact on movement, posture, and joint health. Because the ligaments and structure of a hypermobile joint allow for excess movement, the following must be considered:

  • Increased risk for joint dislocation
  • Postural instability 
  • Dysfunctional movement 
  • Increased risk of musculoskeletal injury 
  • Pelvic Floor Dysfunction 
  • Pathological breathing patterns 
  • Lack of coordination and balance 

When it comes to my practice, patients tend to come in with “unrelated issues” in their minds and we help connect the dots! At that point, it becomes obvious that their hyper-mobility either adds to their problem or is the root cause of their issue(s).

The most logical and effective way to create stability in otherwise unstable joints of the hyper-mobile individual is through  Dynamic Neuromuscular Stabilization and Postural Neurology. That is duplicating the methods with which the limber, helpless infant is able to become the strong, running toddler.

Hypermobility, Instability, and EDS 

Hypermobility can be present on its own or can be associated with other conditions such as Ehlers-Danlos Syndrome (EDS). If you have EDS, it is important to know the impact of hypermobility on your musculoskeletal system (bones, muscles, tendons, ligaments) and how its impact on movement can lead to pain. This is explored more in detail in the blog Ehlers Danlos Syndrome, Pain, and Posture.

Best Exercises for Hypermobility and Instability 

For someone who is hypermobile, full body stabilization exercises with attention to detail are crucial. You see, a hypermobile person can easily trick the untrained eye and appear to be performing the exercise correctly. This is because they have learned to function with joints in an extreme position, but it is holding a neutral position that becomes challenging. In fact, the biggest challenge is keeping stable in movement becomes the ultimate test.

Hyper-mobile individuals are no strangers to doctor’s offices; from gastrointestinal issues to headaches and neck pain. Even with injuries and re-injuries; they are typically great in sports such as gymnastics, cheer, ballet, and acrobatics. When it comes to those injuries, it is easy for them to see physical therapists and chiropractors and be treated the same way as others without hypermobility. That is where the continuous visits will continue.

Unless the rehab. provider, chiropractor, or physical therapist is familiar with functional rehabilitation such as Dynamic Neuromuscular Stabilization (DNS), those with hyper-mobility can suffer from pain, frustration, and disappointment.

Below is an advanced Dynamic Neuromuscular Stabilization exercise that when done correctly, points to the improvement of stability in our hyper-mobile patients and is a great milestone that we celebrate together.

Working with hypermobile individuals is different than those without hypermobility and there are specific ways to achieve the milestones of stability. Don’t hesitate to contact us when you are ready to start your adventure to a more stable world. You may also visit us on YouTube for Functional Movement Exercises and join our over 100K followers on Instagram for daily tips and tricks.

Dr. Shakib