The most frequent sports injury is the classic ankle inversion sprain. The outer ligaments are overstretched causing pain and inflammation whereas the big toe side of the ankle is impacted, and this area of the body potentially might attempt to cope with the force by loading the Subtalar joint.
The Role of the Pelvis
To stand upright and walk requires a balance between stability and flexibility. The weight of our body presses down through the spine, into the sacrum, through the sacroiliac joints, and down the legs. To maintain our upright posture while walking requires that the pain-sensitive sacroiliac joints allow a small amount of movement. Restriction or excessive play in these important joints can give a deep local ache on the belt line on either side of the spine, or opposite the joint over the hip.
Intervertebral Disc Pain:
A very good reason to not round your back while lifting heavy weight is that spinal flexion switches on the 6 pack, (8 pack), and inhibits the muscles that support the spine potentially allowing the load to twist the joint and the disc.
In the low back, each bone is cushioned by a cartilage gel-filled disc that absorbs and redirects forces that press down the spine. These discs help us move with a good degree of freedom. When the polysaccharide-based fluid inside the disk loses some of its ability to resist forces, then either the fibrous outer rings can sustain damage or the top and bottom of the end plates can sustain injury. Damage in the body produces an inflammatory response with swelling, heat, and pain. The prolapsed disk (or slipped disk) is where the fluid gel inner bulges or comes out from the disc. Discs tend to bulge out posteriolaterally which can chemically interfere with the nerve roots of the spine and cause perceived pain in the legs: this is sometimes called Sciatica. Do you do activities that cause pain, like sitting, bending, coughing and sneezing, that is relieved when you lie down?
A reasonable question would be how might we confirm that a disk has been damaged? Typically osteopath’s use tests like the Straight Leg Raise (SLR) and the Slump test to aggravate the Sciatic Nerve ruling disk damage in. The classic disk injury has a noticeable pop as the disk contents discharge, with considerable pain upon getting up the following day. Your posture may be affected where you stoop or bend away from the pain. We would ask you about Pins n Needles, numbness, altered sensation and weakness to indicate the involvement of nerves.
Bend backward or twist around while standing upright and feel a local pain in your back which stops your movement. Excess movement in your back is limited by little synovial joints called Facets. These joints are highly endowed with nerves that report pain when the nerve endings are stimulated when the joint is compressed or the surrounding joint capsule is stretched. Held within these joints is a tiny fibrocartilage ball that can leave the joint when you bend forward and then, as you straighten up, the fibrocartilage ball becomes trapped between the upper and lower facet surfaces causing severe pain.
Ligaments connect bones to other bones and have a role in limiting the mobility of joints. Research states that two ligaments in your back produce pain: the Interspinous and Iliolumbar ligaments. Each ligament then has certain movements which provoke pain.
The Interspinous ligament stops the spinous processes from over-separating and can report pain when you bend forward, this pain will initiate as you progressively bend forward and then cease as you continue. Pain can be local to the spine and also perceived as referred pain down into the lower limbs.
The Iliolumbar ligament connects the lowest Lumbar vertebra to the pelvis and resists spinal rotation, forward and side bending: this when pressed on directly, will report tenderness. Some research suggests that other structures may be responsible for tenderness over the area. These include the LIA Lumbar Intermuscular Aponeurosis, the lumbosacral joint or the muscles of the low back.
Nerve Root Pain:
Nerve root pain arises from where the nerve in the spine emerges from the foramina between the upper and lower vertebrae. Nerves carry signals containing messages about sensations and the control of muscles and organs, and so disorders of nerves can cause pain, pins, and needles, numbness, increased sensitivity or weakness of muscles. The pain is often felt in the area of the
body supplied by that nerve. It is common for the nerves in the legs and arms to be affected. Nerve roots can be compressed or pinched, perhaps due to a trauma, normally this pain occurs from a combination of irritation and compression. Anything that can fill up the hole where the nerve root emerges can cause a physical or chemical irritation.
Nerve injuries can occur anywhere in the body. Within the brain, they show a myriad of confusing signs and symptoms that can mimic musculoskeletal pain.
- Muscle Weakness – Pyramid Weakness where bending being stronger than straightening in the arms and the reverse in the legs.
- The slowness of movements with a loss of control.
- An increase in the tone of muscles, known as spasticity.
- Clasp-knife response where resistance applied to an arm will elicit initially a strong then weak response like a knife which resists being opened.
- Babinski’s Sign is normal for infants up to 12 months in age, but a sign of injury in adults where we stimulate the sole of the foot causing the big toe to bend up rather than down.
- Increased deep tendon reflexes. Many people have been tested at the GP with a Patellar hammer at the knee, ankle, elbow and middle finger. This tests the responsiveness of the nerves supplying the area. No one would use a Patellar Hammer on the middle finger, rather the hand is held in a relaxed position and the fingernail is clicked downwards, a positive Hoffman’s has the other fingers curling in response to the nail click.
- Pronator Drift is a test where we ask you to hold your hands out with the palms straight up while closing your eyes. If one hand is observed to drift down into pronation then the test is positive.