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Ankle Sprains: can physiotherapy help?

What is an ankle sprain?

Almost everyone has twisted their ankle at some in their life; in fact, it is one of the most common reasons for people to visit an emergency department.

Technically an ankle sprain has occurred when an ankle twists, causing damage to one of it’s supporting ligaments. The ligaments can be overstretched, partially torn or completely ruptured, depending on the force of the injury. The ligament that is most often involved is the ATFL, or the anterior-talofibular ligament, located on the outside of the ankle.

While there are many ligaments surrounding and supporting the ankle, this ligament is the most vulnerable as it stops the ankle from rolling inwards, which is the way that most ankles are injured. Athletes who jump while moving in different directions, such as basketball players, are the most prone to this injury as they often land on their foot when it is not completely flat, twisting it and injuring the ligaments.

What are the signs and symptoms?

Most people won’t have any problem diagnosing that they have a sprained ankle. The symptoms are pain, swelling and tenderness over the area of damage, usually the outside of the ankle.

Depending on the severity of the injury, there may be bruising, reduced range of movement, instability and pain with weight bearing. In more severe injuries there may even be a loss of function, where you are unable to walk on the ankle and numbness and/or a feeling of coldness in the foot.

Why should I see a physiotherapist?

Twisted ankles can also cause a fracture of the ankle, not just ligament damage and many times a bad sprain and a fracture cannot be told apart without proper medical assessment and an X-ray. Your physiotherapist is able to identify if your sprain is severe enough to need further investigation to rule out a fracture.

They will also classify the severity of the sprain, providing you with a clear course of treatment. There are many factors that can lead someone to be more prone to fractures, including general hyper flexibility, unsupportive footwear and anatomical structure, however by far the most common reason for an ankle sprain is the existence of a previous sprain without complete rehabilitation.

This is because, following an ankle sprain, many people are left with weakness, instability or stiffness, reduced balance and proprioception – which is a sense of where your body is positioned. These things can mean that the next time your ankle is in a vulnerable position you don’t have the strength, awareness of position, balance or structural control to ensure it is in the correct position before putting all your weight through it, causing another injury.

As well as helping you reduce and recover from the pain and swelling of the injury in the early days. Your physiotherapist is trained to identify which issues are likely to affect you in the future and assist you with a personalized rehabilitation program to ensure your ankle is as strong and stable as possible to prevent future injuries.

The information in this newsletter is not a replacement for proper medical advice. Please contact the Caboolture Physical Therapy Centre for advice on your individual condition.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.

Patella Dislocations: What are they and how can your physio help?

What is it?

The knee joint is composed of the thigh bone, (femur) and leg bone (tibia) and a small floating bone at the front, commonly known as the kneecap (patella). The interaction between these bones allows for smooth movement of the knee as it bends and straightens.

During movement, the kneecap sits in a groove at the front of the knee and acts as a mechanical see-saw. This protects the knee joint and improves the efficiency of the muscles working to move it. When the patella moves out of this groove it is called a subluxation. If the patella moves far enough out of this groove it becomes a dislocation.

What are the symptoms?

The first time the patella dislocates is usually the most traumatic and painful. The knee may give way, and a visible lump can be noticed where the patella has dislocated. There will often be bruising, swelling and the knee may feel unstable. First-time dislocations may also cause a heamarthrosis or bleeding within the knee joint. If there is damage to the ligaments of the knee, subsequent dislocations can happen more easily, and from everyday activities, causing the knee to give way suddenly.

What are the causes?

First-time dislocations often occur due to a traumatic event. The most common cause of patellar dislocation is a non-contact injury to the knee with a twist of the leg (the thigh bone rotates internally on a fixed leg and foot). In addition, a direct blow to the side of the knee can also dislocate the patella.

If there is some instability of the joint, dislocations can occur more regularly and from smaller forces.

Dislocations usually occur when the knee is bent and the kneecap slips back into place when the knee is straightened again. While the kneecap can be dislocated in both directions, it usually dislocates towards the outside of the knee.

Certain factors can make dislocation more likely, including overall hyper-flexibility, damage to the ligaments of the knee and muscular imbalance of the quadriceps. The structure and angle of the knee joint itself can also make dislocation more likely. This can be seen in the increased prevalence of dislocations for women as they have a slightly different angle of femur compared to the tibia than men. A traumatic dislocation can cause instability that can lead to future dislocations.

How can physiotherapy help?

An acute patellar dislocation should be treated like any traumatic injury and assessed by a medical professional to reduce pain and swelling, make an accurate diagnosis and check for fractures. While the kneecap may relocate itself quickly, ensuring that it is able to heal correctly to prevent further dislocations may require immobilization for up to six weeks.

Your physiotherapist will be able to identify any factors that may predispose you to further dislocations and provide you with a personalized treatment program to address any stiffness, weakness or instability surrounding the knee. Balance and proprioception (your sense of where your body is in space) are often reduced following an injury and your physiotherapist will help to rehabilitate these. Your therapist may provide you with education and advice regarding bracing or taping. In severe cases of instability, surgery may be recommended to stabilize the knee however this is usually not considered unless there has been a fracture or until a full rehabilitation with physiotherapy has been completed.

This info is not a replacement for proper medical advice. Please get in touch with one of our expert physios for advice on your individual condition.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.

A focus on Anterior Ankle Impingement

What is it?

Anterior ankle impingement, also known as anterior impingement syndrome, is a musculoskeletal condition where repetitive forces compress and damage the tissues at the front of the ankle, causing pain and stiffness. It is a common injury that can affect people of all ages, however, is usually seen in athletes of sports involving repetitive or forceful upward movements of the ankle, such as sprinting, landing from long jump, uphill and downhill running.

What are the symptoms?

Pain at the front of the ankle is the primary symptom of anterior ankle impingement. This can be felt as an intense, sharp pain occurring with ankle movements or a dull ache in front of the ankle following periods of exercise. Pain can also be felt when putting weight on the ankle while standing, walking or running. Night-time aching, stiffness, swelling and reduced ankle flexibility are also common symptoms of anterior ankle impingement.

How does it happen?

Anterior ankle impingement is caused by traumatic or repetitive compression of the structures at the front of the ankle as the tibia and talus move towards each other during ankle movements. The tissues that are affected become damaged and inflamed, causing the pain typical of ankle impingement. Chronic inflammation can lead to further stiffness, exacerbating the impingement process.

The most common risk factor for ankle impingement is a previous ankle sprain that was not adequately rehabilitated, as this can result in a stiff or unstable ankle. Another cause of impingement is the growth of small osteophytes or bony spurs around the ankle joint that press against the nearby soft tissues. These can be due to osteoarthritis or grow as a reaction to impingement itself. Training errors, muscle tightness, unsupportive footwear and a hypermobile ankle have also been shown to be risk factors for anterior ankle impingement.

How can physiotherapy help?

Depending on the cause, mild cases of anterior ankle impingement usually recover in one to two weeks with rest and physiotherapy intervention. For more severe impingement, the ankle may require up to six weeks of rest and rehabilitation to recover. In rare cases, surgical intervention will be required to remove any physical causes of impingement, such as osteophytes to restore impingement-free movement of the ankle. Your physiotherapist will first identify the cause of your ankle impingement and help you to choose the best course of action to reduce your symptoms. They are able to advise you on the appropriate amount of rest and provide stretches and exercises to restore strength and flexibility to the ankle.

Mobilisation techniques and range of motion exercises can also reduce stiffness of the ankle, restoring normal joint movement. Moreover, balance and proprioception exercises are included to prevent further ankle injury. Balance exercises challenge the way your body reacts to outside forces. With this, your balance will be improved, and you’ll have a more stable ankle.

Ideally, physiotherapy treatment is the first step before considering surgery. If surgery is required, your physiotherapist can help you to make a full recovery with a post-surgical rehabilitation program.

The information in this article is not a replacement for proper medical advice. Please contact the Caboolture Physical Therapy Centre for advice on your individual condition.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.
Shin Splints

A focus on Shin Splints

What are Shin Splints?

Medically known as Medial Tibial Stress Syndrome, ‘shin splints’ is a term used to refer to pain along the inside of the tibia or shin bone. The exact pathology that causes the pain of shin splints is unclear and imaging such as ultrasound produces similar results when compared to persons who don’t have shin splints. The pain of shin splints is usually felt over the area where two particular muscles insert into the tibia. These are Tibialis Posterior and Flexor Digitorum Longus, these muscles act to extend the foot and toes respectively.

Despite having an unclear pathology, this can be a debilitating condition that can impact activity levels significantly. The pain can be quite limiting and may even be an early warning sign of a stress fracture and this will need to be ruled out by a medical professional.

What are the symptoms?

Shin splints are typified by persistent leg pain, usually the inside of the shin, halfway down the lower leg. The pain might be felt during exercise or directly after. Some people experience a dull ache over their shin that lasts for quite a while after exercise stops, while for others the pain may be sharp and fades quickly.

The pain is often progressive, becoming worse with shorter distances. Eventually, shin splints can severely impact activity levels as the pain becomes too severe to continue exercise.

What are the causes?

Shin splints are predominantly seen in runners who increase their distances quickly, often while training for an event. Activities that require repetitive weight bearing of any kind, such as marching or high impact sports have also been shown to cause shin splints. Although the pathology of shin splints is unclear, studies have been able to identify certain risk factors that may predispose someone to shin splints. These include:

  • An abrupt increase in activity level
  • Improper footwear and support
  • Higher BMI
  • Training on hard or uneven surfaces
  • Tight calf muscles
  • Flat feet
  • Females are more likely to develop shin splints than males
  • Increased external rotation range of the hips
  • Prior history of shin splints
  • Wearing or having worn orthotics

How can physiotherapy help?

The first step for your physiotherapist will be to address any contributing factors and help to adapt your training program to a level that is optimum for you. A period of relative rest may be recommended along with a targeted strengthening and stretching program for any tight or weak muscles.

Switching to low-impact activities such as swimming, cycling and yoga may also help to maintain fitness during recovery. Your running technique will be analyzed and any training errors may be corrected. When getting back into your training routine, it is usually recommended that distances are not increased by more than 10% per week as this allows the tissues of the body to react to the increased demands and adapt accordingly.

The information in this article is not a replacement for proper medical advice. Please speak to one of our physiotherapists for advice on your individual injury.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.
Spondylolysis and Spondylolisthesis

What Are Spondylolysis and Spondylolisthesis?

One of the primary roles of the spine is to protect the spinal cord. This means that the spine needs to be strong while maintaining the flexibility required for a movable trunk. While the spine is very sturdy, spinal injuries do occur. Health professionals often use terms to describe and classify injuries of the body, two of these terms that you may have heard are Spondylolysis and Spondylolisthesis.

What are they?

Spondylolysis refers to a stress fracture of the pars interarticularis of the vertebra. This is the part of the vertebra that connects the body of the vertebra with the rest of the vertebra that surrounds the spinal cord. A separation of this fracture where the body of the vertebra is displaced forwards or backwards is called a spondylolisthesis.

Spondylolisthesis is a progression of spondylolysis and is given grades to classify its severity. Both spondylolysis and spondylolisthesis commonly affect the fourth and fifth lumbar vertebrae, found at the base of the lower back.

What are the causes?

Spondylolysis and spondylolisthesis can be a result of trauma with the spine being moved forcefully into extension, particularly in younger people. Certain sports such as gymnastics, football and weightlifting require repetitive backward movements of the spine and this can eventually lead to a stress fracture of the pars interarticularis. Growth spurts in teens have also been known to be responsible for the development of these conditions.

In older adults, common causes of spondylolysis or spondylolisthesis are degenerative changes in the spine due to aging, osteoporosis, infection or even a tumour. Some people have a genetic vulnerability in this area of their spine making them more susceptible to developing spondylolysis and then spondylolisthesis.

What are the symptoms?

Many people with spondylolysis and spondylolisthesis may be asymptomatic, which means they perform their normal activities without experiencing any symptoms. However, when symptoms do occur, common complaints are pain and tightness, much like a muscle strain, spreading across the lower back. This pain may be eased by bending forwards and aggravated by walking, running or leaning backwards.

In more progressive cases of spondylolisthesis, the shift of the vertebral body can cause narrowing of the spinal canal that can lead to nerve compression. This may cause hamstring tightness and even numbness and weakness of the lower limbs, affecting gait and daily activities.

How can physiotherapy help?

Your physiotherapist will work closely with you and any relevant medical professionals to determine exactly what is needed for your particular condition. Severe instability in the spine may require stabilization surgery, however this is rare and in most cases, symptoms of spondylolisthesis can be improved with regular physiotherapy management.

Physiotherapy that focuses on strengthening and improving the flexibility of both the lower back and the abdominal muscles has been shown to have positive effects on both pain and function for those with symptomatic spondylolysis and spondylolisthesis.

Speak to one of our physiotherapists for more information regarding your individual condition. The information in this article is not a replacement for medical advice.

Caboolture Physical Therapy Centre – serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.