Tag Archives: Sports Physiotherapy

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!

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome

            Patellofemoral pain syndrome

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome happens when your knee cap does not track properly.  The knee joint consist of two joints.  The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint.  This  is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.

Knee movements are controlled by a number of muscles connected to the knee cap. Your  thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove.  When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.

Causes of Patellofemoral pain syndrome or Anterior knee pain

Patellofemoral pain syndrome, is one of the most  common causes of pain in the knee. Pain is usually felt under the knee cap.  This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.

Common Causes of Patellofemoral pain syndrome

  • Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle  will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
  • Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
  •  Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
  • Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect  how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
  • Previous injury or dislocation of knee cap
  • Desk top work, where a lot of sitting can cause pressure on the kneecap.
  • Irritation of fat pad around the knee
  • Tendinitis of quadriceps tendon
  • Bursitis around the knee
  • Osteoarthritis

When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.

Symptoms

  • The onset of  knee cap pain is normally gradual rather than traumatic.
  • Pain at the front, back and sides of the knee with or without swelling.
  •  Bending and straightening of knee can cause pain.
  • Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
  • Clicking or grinding when you bend or straighten your knee.
  • Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
  • Poor knee control or stiffness

Physiotherapy Treatment

Patellofemoral Pain Syndrome treatment

  • Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain.   They will  provide a customized rehabilitation program.
  • In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will  use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
  • Once the pain and swelling reduces, treatment is focused towards modifying the  factors that have been identified as a cause for the problem.
  • Rehabilitation typically emphasizes increasing strength and pain free movements.  It also will address postural correction, improving the  stability of the pelvis, balance and functional abilities.
  • Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
  • Successful rehabilitation requires adherence to your exercise program .
  • You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
  • Prior to discharge you will be given a safe progression of exercises and functional activities.
  • For long term management, your foot and knee control will be assessed by your Physiotherapist.
  • As a result, you may require  custom foot orthotics to correct your foot position.
  • This will  help to improve foot and knee control.
  • Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.Custom orthotics for Patellofemoral Pain syndrome

How long it will take to get better?

We expect to see improvements with Physiotherapy over a 3 to 6-month period.   Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation.  Some modification of activity may be all that is needed.

If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position.  This will  improve alignment of your knees.

How to book an appointment with a Physiotherapist at PhysioNow?

We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics  for an appointment with a Physiotherapist.

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 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.

Your follow up appointments  will typically take  40 minutes.  Normally, we would recommend 2 to 3 sessions per  week depending on the factors identified on initial assessment, treatment plan and your goals.  If you have limited funding available, we will be happy to work with you to develop a home exercise program.

Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!

Heat therapy

Heat and Cold therapy

How it works

When we apply Heat therapy, it improves circulation and blood flow to  that area due to increased temperature. Heat therapy can relax and soothe muscles and heal damaged tissue.

Heat therapy

Types

  • Dry Heat therapy includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
  • Moist Heat therapy includes sources like steamed towels, moist heating packs, Theratherm heating pads that take moisture from the air, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.

Contraindications

  • diabetes
  • dermatitis
  • vascular diseases
  • deep vein thrombosis
  • multiple sclerosis (MS)

 Heat is useful for relieving:

  • osteoarthritis
  • strains and sprains
  • tendonitis, or chronic irritation and stiffness in the tendons
  • warming up stiff muscles or tissue before activity
  • relieving pain or spasms relating to neck or back injury, including the lower back

Cold therapy

How it works

Cold therapy is also known as cryotherapy. It works by Louis- hunting reaction theory. When we apply Ice to an injured site, it reduces the blood flow by vasoconstriction. After some time, it causes vasodilatation and increases the blood flow to the area. This process goes on continuously. This reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

Types of Cold Therapy

There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

  • ice packs or frozen gel packs
  • coolant sprays
  • ice massage
  • ice baths

Cold treatment can help in cases of:

  • osteoarthritis
  • a recent injury
  • gout
  • strains
  • tendinitis, or irritation in the tendons following activity

Contraindications

  • people with sensory disorders
  • uncontrolled diabetes
  • You should not use cold therapy on stiff muscles or joints.
  • Cold therapy should not be used if you have poor circulation.

Here’s a general guide that helps you to decide which to use heat or ice : https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#cold-therapy

In General,  use ice for the first few days after an injury.  Beyond that, heat usually does the trick.  There is some evidence that suggests that using ice beyond the first few days can actually slow down injury healing.  It pushes away the healing agents that help you to get better.

If you have been injured and need advice or treatment, please call PhysioNow today.  We are always happy to help!

Concussion

Concussion

The topic of concussion has been in the media quite frequently in the last several years. Top athletes, like Sidney Crosby, have definitely put concussion in the spotlight.

Crosby was unable to return to his game for almost a whole year because of persistent symptoms related to concussion. Furthermore, research has shown that 96% of deceased ex-NFL players have a form of brain damage called Chronic Traumatic Encephelaphathy (CTE), which may be related to repeated head traumas like concussions.

Safety Of Athletes Involved In Contact Sports

Concussion

This calls into question the safety of athletes involved in contact sports. In contact sports, there seems to be a higher incidence of these injuries.

However, concussions do not just happen to the famous pro-athlete. They can happen to athletes playing at any level or any age. They can do more than take away playing time.

Rowan Stringer, a high school rugby player, sadly made headlines in the media in 2013 after she lost her life to Second Impact Syndrome (SIS). This occurs when multiple concussions occur in rapid succession. SIS specifically affects the peadiatric and adolescent populations.

Concussions can also happen to anyone who is involved in an accident involving some form of head trauma. This includes falls and motor vehicle accidents. It is important to understand, that concussion is a serious injury.

If not managed appropriately, it can lead to persistent symptoms. Concussion can prevent you from returning to your beloved sport and/or regular life activities including work and family.

What Exactly Is Concussion?

So, what exactly is concussion and why does it have such a major impact? The changes that happen with concussion happen at a deep cellular level of the brain.

The injury starts with some form of trauma to the head, which creates stretching of the cells in the brain. These changes are microscopic and most often not picked up on imaging exams. As a result, concussion is often labelled as an invisible injury process.

Symptoms of Concussion

These chemical processes produce symptoms such as headache, nausea, dizziness and fogginess that are classic to concussion injuries.

Another major hallmark symptom of concussion is fatigue. This feeling of persistent tiredness is due to the energy crisis in the brain that results from the initial cellular stretching. These symptoms can wreak havoc on a person’s life and take them out of their sport or work.

How long do Concussion symptoms last?

Although the chemical reactions from the initial trauma take about 7 to 10 days to stabilize, the symptoms that are experienced by the patient can last for several weeks and months or even years. The lasting symptoms happen as a result of the changes that have been made to the different processing systems of the brain.

These changes produce an inability to make sense of either the visual or vestibular information in our environment. This overwhelms the brain and further aggravates the symptoms. It is vitally important, that appropriate management strategies have to be in place to treat these symptoms in an effective and timely manner so that an individual can return to their life.

How Do You Treat Concussion?

So how do you treat concussion if it is an invisible injury? The mechanism may be invisible but the symptoms are definitely not. Therefore, it is important to do a thorough assessment. This helps to understand what the exact symptoms are and which brain systems are at fault.

imPACT Testing

During the initial assessment, the patient will most likely be starting the appointment with a computerized test called imPACT, which is a heavily researched and validated neurocognitive test. This test looks at a variety of categories including verbal memory, visual memory, speed and reaction time. At completion it provides important information on a patient’s performance.

The test can be repeated over time and it can be used to check if there has been any meaningful change in performance. Once the imPACT test is completed, the patient will be assessed by the physiotherapist.

The Physiotherapist will go through a detailed history of the injury and symptoms to get an understanding of what the patient is going through and which brain systems are affected. The Physiotherapist will then go through a series of physical tests that test the visual and vestibular systems.

The therapist will be looking at how the patient is performing on the test and what symptoms are produced with the tests. If there are any other injuries present, such as neck pain, the physiotherapist will assess these issues as well.

Concussion Treatment

With the information gained from the assessment, the therapist will start providing the appropriate treatment to start reducing the symptoms of concussion. The treatment provided will vary from person to person because each case of concussion is unique.

Therefore, there cannot be a cookie-cutter approach to treating this complex injury. A large component of the initial treatment plan will involve education to rest and reset the brain and modify work/home/sport activities to allow for appropriate healing.

FOLLOW UP VISITS

On follow up visits, the therapist will prescribe specific exercises to start healing the affected systems in the brain. These exercises are important to be continued at home. Consistent and regular practice of these exercises will ensure improvement in the symptoms. It is important to understand that these exercises will produce some of the symptoms of concussion but they are meant to do so.

It is in this manner, that the visual and/or vestibular systems are retrained. Once the exercises are mastered at one level, the physiotherapist will continue to progress them to be more and more challenging until the patient is able to perform them without any symptoms. It is through these progressions that the therapist will be able to help the patient return to work and/or play and just life in general.

SUMMARY

Concussion symptoms can be very debilitating and can go on for a long time. It is important to seek out a qualified Physiotherapist trained in concussion management as soon as possible so that these symptoms are not affecting a person’s quality of life and taking them away from the things that they love.

At PhysioNow, we have highly trained Registered Physiotherapists ready to assess and treat Concussions.  Call today to get started on your recovery!

Symptoms of ACL tear

Symptoms of ACL tear

Signs and Symptoms of ACL tear

This blog will talk about signs and symptoms of ACL tear. The Anterior Cruciate Ligament, or ACL, is a very important structure of the knee joint. Its main function is to stop the shin bone from moving too far forward when the knee is straightened. The ACL also prevents the knee from rotating too far inward. As a result, a tear to this ligament can have very negative effects on knee function and stability.

A potential injury to the ACL has fairly easily recognizable signs and symptoms.

Mechanism of injury of ACL Tear

  • The mechanism of injury is very important in identifying an ACL injury. The ACL ligament is often injured when the leg is pivoted with the foot planted. It can also result from a direct blow to the outside of the knee. It is common to see ACL injuries in soccer and basketball because these types of movements happen quite often with these sports.

    Symptoms of ACL tear

  • Signs and Symptoms of ACL tear

  • A key sign of an ACL injury is the distinct “popping” or snapping sound that is heard at the time of the injury.
  • The presence of intense pain near the top of the shin bone also relates to the ACL.
  • The immediate presence of a lot of swelling within 2 hours of the injury is another important symptom of ACL tear.
  • With some other common knee injuries, swelling is very minimal or occurs much later.
  • The inability to weight bear on your knee is another clue that it might be an ACL injury.

How to know for sure if it is an ACL tear

The degree of ACL injury can vary from a partial tear to a full rupture. There are special tests that can be done to confirm the presence of an ACL injury and test the extent of the tear. However an MRI will provide the most detailed information about this type of injury.

Treatment for symptoms of an ACL tear

Surgery may be recommended if it is a full ACL tear. However, some individuals will opt to not proceed with surgical intervention. Instead, they proceed with conservative treatments such as Physiotherapy and Custom Knee Bracing. Patients with partial ACL tears will definitely require Physiotherapy treatment. This will promote healing, regain strength and optimal function.

Symptoms of ACL tear
Custom Knee Brace

Check out this link for further information regarding symptoms of ACL tear.

A fully trained Registered Physiotherapist will be able to guide you through an appropriate rehabilitation program so that strength and stability is restored in the knee. The goal is to return you to play and competition as quickly as possible!

If you or someone you know has suffered from symptoms of ACL tear, please call PhysioNow today. We have fully trained, Registered Physiotherapists ready to help! We also have fully trained staff able to guide you in your decision if you decide that you would like a knee brace. Both off the shelf and Custom Knee Bracing is available at all of the PhysioNow offices. Call today to get started on your recovery.