Q: I’ve just taken up dressage and have noticed that when riding, especially at the rising trot, the outer side of my leg—just above the ankle—hurts. Is this something I should be concerned about? Is it muscle weakness or a tendon problem? In this case, could you give me any exercises that strengthen that area?
A: Your problem could have various causes, all most likely minor in nature. On the lateral side of the ankle are several structures—muscles and tendons as well as ligaments—that can be the source of your discomfort. If the problem is in the ankle area, the source of the problem could be the talofibular and calcaneofibular ligaments, which are responsible for maintaining your ankle integrity. If it is slightly above the ankle just behind the fibular bone, it is mostly likely the tendons of the peroneal muscles, which are responsible for creating ankle stability and motion.
As to whether the problem is caused by weakness, tightness or a strain/sprain is difficult to ascertain without a physical therapist treating you. If this has been bothersome to you for a period of time (two weeks or more), the most sound advice I can give you is to see a physical therapist so he or she can determine if it is a strain/sprain, tightness, weakness or a combination. An appropriate diagnosis would determine the interventions the physical therapist would apply. After inflammation, if present, has decreased, the physical therapist may apply soft-tissue manipulation to improve tissue mobility and fiber glide if there was a strain/sprain and stretching exercises to increase/restore the length of the muscles involved. Then he might use exercises to increase the strength of the muscles involved, followed by exercises to facilitate the coordination of those strengthened and conditioned muscles to provide the appropriate stability and performance.
As far as providing you with exercises that can help you strengthen the ankle area (if weakness is present), I will be happy to outline two tried-and-true strengthening exercises for the peroneal tendons/muscles. The peroneals, on the lateral side of the lower leg, and the tibial muscles, on the front and back of the lower leg, are better known in our profession as the stirrup muscles, as they provide support and stability during activities such as horseback riding. The exercises given will assume it is your left side that is the problematic side; if it is your right side, reverse the exercises.
To strengthen the peroneal tendon and tibial muscles:
Lie on your right side on a bed with your ankle off the edge of it. Apply a light ankle weight (start with 1 pound until you can perform three sets of 20 repetitions with ease before progressing the weight to 2 pounds, 3 pounds
and so on).
Allow your ankle to gently move toward the floor as far as it can comfortably go and then raise it toward the ceiling as far as it can comfortably go. Be careful to move only your ankle and no other portion of your leg. Perform this exercise in three sets of 20 repetitions.
Richard D. Asaro, PT, DPT, MTC, CEAS, earned his degree in physical therapy at the Hanzehogeschool van Groningen in the Netherlands and his doctorate at the University of St. Augustine for Health Sciences. He is also a Certified Ergonomic Assessment Specialist and has published several continuing-education guides for physical therapists.