Ankle Stability – The Retinaculum
Usually when we think about ankle problems, we think about sprained ankles or a strained muscle, not something called a retinaculum. Yet these fascial structures play a significant role in a wide variety of chronic ankle problems.
So what is a retinaculum? From one perspective a retinaculum is a band of thick deep fascia that holds the long tendons of your ankle (those that cross the ankle) in place. Retinacula also act as part of a pulley system increasing mechanical advantage.
From the second perspective, retinacula are a major source of neurological receptors involved in balance and proprioception. Essentially retinacula have been hypothesized as key structures in spatial control for foot and ankle movements.
The following section is an overview of specific retinacula and what structures pass underneath them. As you look over the individual sections of the retinaculum also think of these areas as part of one large fascial interconnecting unit.
When functioning correctly, tendons glide under these retinacula without hindrance. With injury (trauma, repetitive strain), the retinaculum can become a site of tendon restriction, nerve impingement and circulatory compression. Injury to the retinaculum will cause mechanical and neurological damage.
From a mechanical perspective, when tension is created between the retinaculum, and the structures that pass under them, a considerable amount of tension occurs. This tension can be a major problem since tension creates friction, which can cause micro-tears in the tissue, inflammation, and eventually adhesion formation. These adhesions inhibit relative motion, alter lower extremity biomechanics, and lead to a host of compensations.
From a neurological perspective, injury causes an alteration in neurological receptors (mechanoreceptors and proprioceptors). This leads to both ankle and foot instability. Instability of the ankle and foot creates abnormal motion patterns, compensations which can lead into numerous injuries throughout the body.
Restrictions of the retinacula can be treated quite effectively with Manual Therapy (Active Release Techniques, Graston Technique, and Massage Therapy) and a series of corrective exercises. Treating with manual therapy involves breaking down restrictions between the retinaculum and the tendon. Essentially the practitioner is restoring relative motion between the retinaculum and the tendons (and of course the muscles that the tendons are attached to).
The practitioners should also be focusing their treatment on the fascial lines of stress. Lines of stress in fascia are often created during injury in multiple locations not just at the site of pain. If these areas of fascial stress can be released, then normal fascial tension can be restored.
Restoring overall fascial tension, besides releasing adhesions between retinaculum and the soft tissues that pass under them, can have significant effects in resolving an injury.
Fascial interconnections are not theoretical entities; they are actual physical structures that have been mapped out. Researchers such as Thomas Meyers (Anatomy Trains) and Luigi, Carla, and Antonio Stecco (Fascial Manipulation) have spent decades researching these interconnections. During the last International Conference About Fascia at the University of Amsterdam, I had the privilege of listening to medical experts from around the world confirm this and related fascial research.
Exercise plays a significant role in the rehabilitation of a retinaculum injury. Strengthening and flexibility exercises are needed, but because a significant component of a retinatculum injury involves neurological receptors, balance and proprioception exercises are also essential for full recovery.