Tag Archives: ankle sprain treatment Mississauga

Common soccer injuries

Ankle Sprain

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An ankle sprain is a common Sports injury which happens when the ankle stretches more than normal. This over stretch weakens the ligaments that hold the bones together. Ligaments are the fibrous bands that hold the ankle joint together.

The ankle consists of 3 joints. The joints are between the lower end of two long bones in your leg. They are called the Tibia and Fibula. They attach to the two bones in your feet called the Talus and calcanium.

Together with the muscles and ligaments, the bony ends on the sides of your long bones called malleoli provide stability to the joint. The ankle is least stable when the foot is down. Most stability is provided by the ligaments. As a result, the majority of ankle sprain injuries happen when your foot is in this position.

There are two types of sprains. An inversion injury happens when the foot rolls inwards. This causes injury to the ligaments on the outside of the ankle called lateral ligaments. Most of the time a ligament called anterior talofibular ligament (ATFL) is injured. The ATFL is the weakest of the lateral ligaments.   

An eversion injury happens when the foot is rolled outwards. This causes injury to the ligaments on the inside called the Deltoid ligament. As the medial ligament requires a greater force to be injured, these sprains always take longer to rehabilitate.

Risk Factors

Based on the severity of symptoms, an ankle sprain is classified into 3 grades.

If you have a previous history of ankle sprain, you will have more chances of re injury. This happens because the strength and integrity of the muscles and ligaments around the ankle joint will be affected.

The other risk factors are poor balance, sudden change in direction , age, poor condition of playing surface and inadequate warm up. Lastly, inappropriate footwear and a lack of external ankle support in case of recent injuries can cause increased risk.

Grade 1 – Mild swelling and tenderness with little impact on function.

Grade 2- Moderate swelling, pain and impact on function. You will have reduced range of movement and instability of the joint.

Grade 3 -Large swelling, loss of function and marked instability at the joint.

Symptoms

Symptoms of Ankle Sprain

Pain, bruising, swelling and difficulty to weight bear are the initial symptoms. As a result, pain is usually worst in the first two or three days. The location of pain indicates which ligament is injured.

In severe injuries where there is complete rupture of a ligament, you will feel instability in the ankle joint. If you have suffered from a severe ankle sprain, there is a chance of associated fractures. As a result, you may require an x ray to determine the possibility of broken bones.

Physiotherapy Treatment

Physiotherapy Treatment for Ankle Sprain

Your physiotherapist will be able to assess the possibility of some of the common fractures using a special palpation method.  The other aims of ankle examination are to check for any instability. Lastly, we look for loss of range of motion, reduced strength, reduced proprioception and associated injuries.

Exercises for Ankle Sprain

Initial treatment is focussed on Protection and optimal loading. That means the right amount of activity to stimulate healing. In addition, Ice, compression and elevation(POLICE) are also recommended in the first 48 hours after injury.


Protection of the joint?

 Taping, bracing, or crutches if needed. In addition, we also recommend the use of an aircast boot. As a result, this will restrict movement and allow for more rapid healing. PhysioNow stocks aircast boots in all sizes at the Applewood Office.


Optimal Loading ?

Optimal Loading

Avoid activities which cause pain. Minimize the amount of walking you do. Use of crutches, air cast boots, braces or taping  may be advised by your Physiotherapist on assessment.


Ice

 It is recommended that you Do Apply ice cubes or ice packs in a damp towel up to 15 minutes every 3 hours for the first 48 hours when you are awake. Do not apply ice directly to your skin. Please, Do not apply ice if you have cold intolerance due to any medical condition.

We do not recommend the use heat in the early phase of injury.


Compression

Compression involves using a bandage from toes to just above the ankle joint. Make sure that the compression does not cause more pain or restrict the circulation. If you are in doubt, your Physiotherapist can teach you how to apply the bandage in the early phase of injury.

Compression


Elevation

Elevate your injured leg above your heart level using pillows while resting.

Ultrasound therapy, Laser acupuncture, taping, bracing, and exercises are used to reduce pain and inflammation. In addition, manual therapy and exercises are used for improving the range of motion, strength and joint position sense (proprioception).

Once all the movements are pain free and there is adequate muscle strength and proprioception, functional exercises can be started. These exercises will be directed to your normal Sports Activities and Activities of Daily Living.

Bracing for Ankle Sprain

Healing Time for Ankle Sprain


  The healing of ligaments takes about 6 weeks, but also depends on the severity of the injury and other medical problems which you might have. Consequently, everyone recovers from the injury at different rates. As the ligament is healing it is important to do specific exercises advised by your Physiotherapist to improve flexibility and strength.

It is very important to complete the whole rehabilitation process. If you do this, it will reduce the chances of re injury. In conclusion, we want to get you back to your pre-accident Sports Activities as soon as possible!

How to reduce the risk of Ankle Sprain

To reduce the risk of ankle sprain, make sure that you:

Warm up before exercise or activity.

Cool down with slow stretches after the exercise or activity

Wear supportive shoes

Take extra care when you walk or exercise on slippery or uneven surfaces.

 Adequate stretching and strengthening of your muscles if you have a history of previous injury.

Give enough time to recover between training sessions.

 Use the right sports gear.

 Taping or use of brace in competitive games if you had a recent ankle sprain.


How to book an appointment with a Physiotherapist at PhysioNow?

Locations for PhysioNow clinics

We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. https://www.physionow.ca/locations/

You can call 289-724-0448 to book for a same day appointment with one of our highly trained Physiotherapists. Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40 minutes session. This appointment will be with a Physiotherapist and includes initial assessment, education and treatment.

You will have 40 minutes of follow up, which will be usually 2 to 3 sessions a week depending on the factors identified on initial assessment, treatment plan and your goals.

Call today to get started on your Physiotherapy for Ankle Sprain!

Acute Ankle Sprains

Acute Ankle Sprains

Acute Ankle Sprains

Acute Ankle Sprains

How do Acute Ankle Sprains happen?

Acute Ankle sprains are common injuries in people of all ages. They can happen in many different circumstances. However, they always involve some type of fall or twisting movement to the ankle. For example:

  • Going downstairs and missing the last step resulting in twisting the ankle
  • Landing on the ankle in a twisted position after coming down from a lay-up in basketball or in a Sports Injury
  • Slipping on an icy street while walking

In all of these situations, the ankle gets a sudden movement and/or trauma that causes it to twist more than its normal range of movement allows.

Acute Ankle Sprains

Acute Ankle Sprains

What structure gets injured with an acute ankle sprain?

The structures that are injured with acute ankle sprains are the ligaments around the ankle joint. Ligaments are soft tissue structures that connect two bones together. Their function is to prevent the bones from moving too far away from each other. Ligaments help maintain normal movement between the bones.

With ankle sprains, the ligaments get over-stretched beyond what they can tolerate which causes tears in their fibres. The ligaments that are involved in acute ankle sprains are present on the outside (lateral), inside (medial), and top of the ankle.

Are there different types of acute ankle sprains?

There are three main types of ankle sprains:

  • Inversion
  • Eversion
  • High Ankle Sprain

The terms relate to the direction of ankle movement that caused the injury to occur.

INVERSION ANKLE SPRAIN

  • An inversion sprain occurs when the ankle is forcefully turned inwards.
    • This type of acute ankle sprain is the most commonly occurring of the three because the ligaments on the outside of the ankle are generally weaker than the rest.
    • Another name for an inversion ankle sprain is lateral ankle sprain
    • A lateral ankle sprain injures the ligaments on the outside of the ankle.

EVERSION ANKLE SPRAIN

  • An eversion sprain occurs when the ankle is forcefully turned outwards.
    • This type of force injures the ligaments on the inside of the ankle.
    • The ligaments on the inside of the ankle are called the deltoid ligament
    • An eversion ankle sprain is also called a medial ankle sprain

HIGH ANKLE SPRAIN

  • A high ankle sprain is the rarest of the three types and it occurs when there is excessive twisting of the shin.
    • The ligaments that are injured with this type of injury are located above the ankle.
    • The location of the ligaments is why this injury is called a ‘high’ ankle sprain.

 

Are some people more at risk for Acute Ankle Sprains than others?

There are certain risk factors that may make ankle sprains more likely to happen. However, the research is a little inconclusive on why this is so. Some of these possible factors include:

  • Poor muscle strength/fitness
  • Increased weight
  • Decreased muscle-reaction time
  • Previous history of ankle sprains resulting in poor balance

Can there be different severities of Acute Ankle Sprains?

The severity of the ankle sprain depends on how much the ligament was overstretched in the process of the injury. Sprains are classified by different grades to explain the severity:

  • Grade I: mild stretching or tear of the ligament, with little or no instability at the joint
  • Grade II: incomplete tear of the ligament, with some instability in the joint
  • A Grade III: ligament is completely torn or ruptured and there is no stability in the ankle

Acute Ankle Sprains

Ligaments affected in Ankle Sprains

What should you do if you think you have sprained your ankle?

In all three types of Acute Ankle Sprains, it is important that you see a health care provider. The health care provider, whether it is a doctor or a Registered Physiotherapist, will first rule out the possibility of fracture. There is always the possibility of a fracture with Acute Ankle Sprains. The ligaments attach onto a bony area and if the twist is severe enough, it can pull off a chunk of the bone.  When this happens, it can cause a fracture. Signs and symptoms of a potential fracture include:

  • Lots of swelling
  • Increased bruising
  • Increased tenderness over specific areas of the ankle
  • Difficulty or inability to put weight through the injured ankle

When the signs and symptoms are suspicious of a fracture, then an X-ray must be completed. If there is no evidence of fracture, then your doctor may send you for an ultrasound.  In the end,  they should refer you for Physiotherapy treatment.  So ask your doctor to send you to Physiotherapy if they don’t think to recommend it themselves.

What will happen during my first Physiotherapy appointment?

During the Physiotherapy assessment, your Registered Physiotherapist will assess everything to do with your Acute Ankle injury, including:

  • Pain intensity and location
  • Swelling
  • Sensation
  • Range of motion
  • Ankle stability
  • Strength
  • Balance

This will provide some baseline information for your Physiotherapist.

How can Registered Physiotherapy help treat Acute Ankle Sprains?

The treatment for acute ankle sprains depends on the type of sprain as well as the severity of the injury.

Immobilization

  • Because of their affect on ankle stability, a Grade II or III injury will require some immobilization. This is usually done through a removable walking cast.
  • The purpose of the immobilization is to protect your injured ligaments from movement and external stressors, so that they can heal.
  • The period of immobilization will depend on the injury and your health care provider will provide specific instructions.
  • A grade I sprain will not require any immobilization because the stability of the ankle is still intact. However, your Physiotherapist will recommend activity modification to help with the healing process.

Physiotherapy Treatment in the acute phase?

  • In the initial phase of the treatment, the Physiotherapist may focus on pain relieving modalities
  • Electrical modalities like IFC and Ultrasound can help relieve pain and swelling
  • The Physiotherapist will also prescribe gentle mobility exercises to help improve or maintain movement through the ankle
  • The length of the acute phase depends on the severity of the sprain

Registered Physiotherapy for Acute Ankle Injuries

Ankle Rotations for movement Recovery

Treatment in the later stages of Acute Ankle Sprains

  • Once the ligament healing is underway and the patient feels a little better with their pain, the treatment will get more progressive
  • It will focus on regaining mobility, strength and function through the ankle
  • Your Physiotherapist will prescribe exercises that are going to help regain the lost range of motion and strength.
  • Over several weeks, the exercises will be progressed as you improve.
  • Another important aspect of treating an ankle sprain is including balance re-training in the program.
  • Balance is very much affected after an ankle sprain and it is something that must be improved with specific exercises. This is very important no matter whether you are returning to Sports or just everyday living!  Balance Retraining is key to Falls Prevention!
  • We use our balance ability on a regular basis with walking on uneven surfaces or when trying to recover from a stumble. Therefore, it is important to improve balance ability to prevent any possible re-injury of the ankle.
  • If you have had an acute ankle sprain before, and DID NOT attend Physiotherapy, it is likely that you are at increased risk of reinjuring your ankle or falling again!

Acute Ankle Injuries

Physiotherapy Mobilizations

Do I need to get Physiotherapy treatment after Acute Ankle Sprains?

There are some people who have sprained their ankle multiple times and never sought out treatment for the injury. They usually give themselves some time for the pain to get better and then go about their usual activities.

This type of management is not usually recommended because multiple ankle sprains can affect the stability of your ankle. As a result, this may create problems in the future. Also, the reduced stability in your ankle may cause compensations in your knees and hips. This can complicate the picture and make your injury more complex.

It is therefore recommended that you seek out proper Registered Physiotherapy care to address an ankle sprain soon after it occurs. This ensures that your acute ankle sprain heals in a timely manner without added complications.  The most important part of treatment is regaining your balance.  If you do not do this, another injury in quite likely.

To get started on your Acute Ankle Sprain Treatment, Give PhysioNow a call Today!

Peroneal tendinopathy

Peroneal tendinopathy

Peroneal tendinopathy

Peroneal tendinopathy or peroneal tendonitis is characterized by an aching pain and swelling in the perineal tendons. These are located in the lower, outside portion of the ankle. A tendon is soft-tissue that attaches a muscle to a bone. The muscles involved in this condition are the 2 peroneal muscles in the lower leg, called the peroneus longus and the peroneus brevis.

Anatomy

?There are two peroneal tendons that run along the back of the fibula. The first is called the peroneus brevis. The term “brevis” implies short.  It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and connects to the side of the foot.  The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to connect on the other side of the foot. Both tendons, however, share the major job of turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula bone.

Causes of Peroneal Tendonitis

  • A sudden increase in weight bearing activities, particularly walking, running or jumping
  • Inadequate or unsupportive footwear
  • Muscle imbalances of the lower limb
    Poor lower limb biomechanics
  • Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

Symptoms of Peroneal Tendinopathy

  • Gradual worsening pain over the outside of the ankle
  • Pain during and/or after weight bearing activities
    Pain with turning the foot in and/or out
  • Instability around the ankle when weight bearing

Diagnosis

A full examination from a physiotherapist can be all thats needed to diagnose peroneal tendonitis
Patients with this condition usually experience pain behind the outside ankle during activities putting stress on the perineal tendons. Pain can also be noticed following these activities or following a rest period. This may be noticed especially upon waking in the morning. There may be swelling when the injury first happens. There will also be pain when testing resisted foot movements.  Stretches into various positions of the foot inversion, and resisted movements can cause pain behind the outside ankle.
Diagnosis may be confirmed with an MRI scan or ultrasound investigation
a diagnostic Ultrasound may be used for detecting all types of peroneal injuries.

What else could it be?:

Symptoms of peroneal tendinopathy mimic various other conditions of the ankle joint. So, before diagnosing peroneal tendinopathy we should rule out other possible injuries by doing the following tests:
Ankle Sprain: ligament testing by the Physiotherapist
Ankle fractures: special tests by the Physiotherapist
Os trigonum syndrome: MRI, physiotherapy testing
Chronical lateral ankle pain with other cause: MRI
Longitudinal peroneal tendon tear: MRI
Peroneal subluxation: ultrasonography, CT, MRI or peroneal tenography
Flexor Hallucis longus tendon injury

Physiotherapy rehabilitation

Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation. It also includes proprioceptive exercises, icing, ankle bracing or k-taping during contact sports. If symptoms are severe, a cast or ROM boot immobilization may be worn for 10-20 days. After symptoms resolve, you will begin a progressive rehabilitation programme along with a gradual increase to full activity.

The use of a biomechanical ankle platform (BAPS), deep tissue friction massage, ultrasound electric stimulation can also be included in the physiotherapy
Also, shock wave therapy (ESWT), acupuncture is used to treat tendinopathy. But there is only limited evidence from studies for these treatments.
There is evidence for using manual therapy, specifically the lateral calcaneal glide.

If you have any further queries please call PhysioNow. Our experienced physiotherapists would be happy to help you. Call Today to get started 289-724-0448.!