Chronic Ankle Instability, Manual Muscle Testing & Acupuncture

Figure 1. A modification of the classical Qi Ci needle technique. Twisting the coil-handles of two needles together at GB 40 greatly enhances ankle ligamentous proprioception.

Chronic ankle instability (CAI) is a condition characterized by a recurring ankle inversion injury with the patient, more times than not, reporting that their ankle easily “gives way” on the outer (lateral) side of the ankle. This condition often develops into anterior talofibular and calcaneofibular ligament instability that results in permanent or a temporary loss of ankle proprioception. Acupuncture can greatly affect these ligaments proprioceptive abilities (Fig. 1), which should be combined with other acupuncture points that will strengthen the low back, hip and lower extremity.

CAI can become severe enough that even walking up an incline or simply stepping downward onto a stair, the ankle can can excessively roll into inversion resulting in pain and injury. The frequency of the ankle rolling in CAI patients, especially in the 40+ age, is often reported when the person is feeling tired or weakened from overwork and stress. In these cases, the TCM practitioner should examine for Kidney qi pathology that is decreasing the Kidney’s ability to assist in stabilizing postural integrity. Refer to the author’s earlier blog on “The Kidney Influence on the Ligaments”.

There is much to discuss in CAI assessment and treatment cases from both sports medicine and traditional Chinese medicine perspectives. Check out the Module III Sports Medicine Acupuncture courses coming up in San Diego, CA and Bloomfield, NJ this July for more discussion on this CAI condition and many more lower extremity injuries.

With most cases of CAI, there are usually myofascial imbalances between muscles acting on the ankle such as seen with the tibialis posterior, peroneus longus and brevis muscles. When assessed with manual muscle testing (MMT), these muscles in CAI conditions are often found to be weak, which further leads to this ankle instability.

For this blog article, the author demonstrates four easy and quick to apply manual muscle tests that are used to screen chronic ankle instability, in which the results develop into an acupuncture treatment protocol.

The second video, the author demonstrates acupuncture to the peroneus longus and brevis motor entry points and how it can help to strengthen these weakened muscles, which is an important part of the CAI rehabilitation program.