Snow Shoveling Safety

If you are like us, you have probably spent a good chunk of time clearing off your car, driveway, and sidewalks these past few weeks. If you are not used to this kind of strenuous activity, you also might have felt tired and sore once you were finished. At BodyTech Physiotherapy we have already seen an influx of people with low back pain due to shoveling snow. As a result of this, we have compiled a list of safety tips to keep you moving injury-free until spring rolls around.

1. Consider hiring snow removal services if you have lower back issues or heart problems, including a previous heart attack, a known cardiac disease, high blood pressure, and/or high cholesterol.
   • Snow shoveling can be as strenuous on your body as lifting weights – a sudden increase in physical activity levels, especially without proper form, can predispose you to injury.
   • Studies have shown that exercise using your arms (like shoveling) significantly increases blood pressure levels compared to leg exercise (like walking), putting you at a higher risk of a heart attack.
2. Use the proper tools
   • Sturdy, non-slip winter boots and salting are essential to prevent slips and falls.
   • An ergonomic shovel can help reduce excessive amounts of forward bending, which could otherwise put a lot of strain on your lower back.
3. Use proper form
   • Stand with your legs hip width apart
   • Hold the shovel close to your body
   • Space your hands apart to increase leverage
   • Bend from your knees, not your back
   • Engage your core/tighten your stomach while lifting
   • Avoid twisting while lifting
   • Walk to dump your snow instead of throwing it
   • Pushing is easier than lifting
4. Warm up
   • Cold, stiff muscles are more prone to injury. Get your body warmed up and ready to go by marching on the spot, doing some small squats, and rotating your upper body from side to side.
5. Shovel early and often
   • Freshly fallen snow is lighter and fluffier than snow that has been sitting for a few hours, which makes moving it much less stressful on your body.
6. Slow and steady wins the race
   • Though it may be tempting to power through and get your shoveling done as fast as possible, work at a slow and steady rate while focusing on proper form to decrease your risk of injury.
   • If there is a large amount of snow, work in layers of 2-3 inches instead of trying to lift it all at once.
7. Take breaks and hydrate!
   • We recommend shoveling for 15 minutes followed by a 15 minute break
   • Remember to drink water or other non-alcoholic beverages during your break – shoveling is hard work!

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Tennis Elbow

Lateral epicondylitis, more commonly referred to as “tennis elbow”, is a term used to describe pain just above the elbow joint on the outer side of the arm. Contrary to popular belief, tennis elbow is not a condition that is exclusive to tennis players or athletes. The term tennis elbow was coined from the fact it can be a significant problem for as many as 50% of tennis players during their careers. However, less than 5% of reported cases of tennis elbow result from playing tennis!

More specifically, tennis elbow is a tendinopathy at the origin of the extensor carpi radialis brevis tendon (the tendon that is responsible for wrist extension). This tendinopathy is due to degeneration of, or damage to the tendon causing inflammation and subsequently, pain. In order to understand what causes tennis elbow, it is important to first understand tendons and how they function. Tendons are like “ropes” made of collagen tissue. They are flexible, but do not stretch when pulled. It is the job of the tendon to connect muscle to bone. In the case of tennis elbow, the area on the bone where the tendons attach, just above the elbow on the lateral side (or outer side) of the arm, are sometimes incapable of handling the force of the arm muscles. Strong forces or sudden impact to the tendons at this point of attachment are what cause damage, like small tears in the fibers of the tendon (similar to a rope becoming frayed).

Activities that exacerbate tennis elbow symptoms are those that involve repetitive motion of the arm, forearm, wrist, and hand. Movements that are commonly associated with the development of tennis elbow are: lifting, gripping something tightly in combination with inward or outward rotation of the forearm, jerky throwing motions, swatting with the hand, and simultaneous rotation of the forearm and bending of the wrist. Racquet sports may be the most “popular” activity to associate with tennis elbow, but as previously mentioned most cases are the result of a wide range of actions that include, but are not limited to: painting/plastering, excessive and repetitive use of a computer mouse, carpentry work, gardening and repetitive lifting and carrying.

Tennis elbow can be suspected when performing routine tasks, such as gripping objects or turning doorknobs, become painful. A physician or physiotherapist can diagnose tennis elbow by discussing symptoms and examining the affected arm. Diagnostic tests are not typically necessary for an accurate diagnosis, however, a physician may request an X-ray or MRI imaging if symptoms do not improve with treatment.

Treatment options for tennis elbow include modifying activities that exacerbate symptoms. Movements that cause an increase in pain should be avoided to help allow the tendon to heal. Pain management is also important to consider. Anti-inflammatory painkillers are commonly used for some symptomatic relief, however physiotherapy remains the most successful tool in the treatment of tennis elbow long-term. A physiotherapist will perform manual therapy on the affected arm, to mobilize the underlying stiff joints and tight structures. Modalities such as ice, and ultrasound, as well as taping may be used to ease pain and encourage healing. A physiotherapist will implement stretching and strengthening exercises to help restore normal function of the arm, and also prevent tennis elbow from occurring in the future.

What is Trauma?

Physiotherapy is an effective tool to treat injuries that can range anywhere from minor to catastrophic. Occasionally, regardless of the severity of the injury, some people experience symptoms such as hypersensitivity or emotional stress as a product of, or in addition to, their physical trauma. For some, these psychological and emotional stressors can act as a difficult obstacle to overcome, and can actually hinder the success of physical injury recovery. Physiotherapists will often recognize these psychological and emotional symptoms, and will recommend the injured person see a qualified therapist who specializes in dealing with trauma. Working with a therapist is a great adjunct to physiotherapy and helps the client to achieve their recovery goals. The following article is a guest blog post by John Roche from Transformation Counselling. 

Trauma. It’s one of those words that gets thrown around without ever really being explained. Derived from the Greek word for “wound,” trauma could refer to an overwhelming psychological experience or the psychological imprint left by such an experience. Either way, it’s important to know how to recognize trauma and post-traumatic stress and how to recover from them.

Trauma is caused by an overwhelming experience in which someone perceives their survival to be threatened and/or their fundamental beliefs about themselves and the world are shattered. Sexual assault, military combat, child abuse, car accidents, and natural disasters are well-known examples of traumatic events.

Lesser known instances of trauma involve what’s called “attachment trauma.” Children’s development is extremely dependent on the attentiveness and responsiveness of their “attachment figures” (usually parents), and if an attachment figure is not attuned and responsive to the needs of a child, then, as far as that child’s brain is concerned, its survival is threatened and it will adapt accordingly.

Post-traumatic symptoms are painful and overwhelming, but, as scary as they are, they’re simply the result of the brain’s adaptation to traumatic situations. From an evolutionary perspective, this adaptation is an attempt to ensure the person’s survival, which is pretty much the brain’s number one priority.

Imagine that every brain has its own smoke detector. When it’s functioning properly, this smoke detector alerts us to legitimate threats and cues the release of protective firefighters who come and rescue us: heightened alertness, a pounding heart and restricted digestion to make sure we have plenty of energy to fight or run away, rage to help us fight off attackers, or, as a last resort if escape or self-defence aren’t possible, a freeze response like a deer in headlights.

Trauma hyper-sensitizes the smoke detector. At the slightest hint of smoke, these firefighters come rushing in to put out a fire that doesn’t actually exist.

People who have experienced trauma therefore tend to struggle with anxiety, rage, concentration difficulties, digestive issues, feelings of disconnectedness, and hypersensitivity to perceived threats. Understandably, survivors of trauma also tend to feel depressed, develop addictions as a means to escape their pain, and avoid anything that might trigger their smoke detectors.

Faced with such nightmarish symptoms, trauma survivors tend to imagine they’re broken. In reality, their brains have done exactly what they were supposed to do: adapt to threat and facilitate survival. Once upon a time, these adaptations made perfect sense and helped them survive. Unfortunately, such adaptations persist beyond the traumatic event and cause pretty major problems.

Recovery from trauma is essentially about training the brain to re-establish an internal sense of safety and leave behind survival adaptations that are no longer necessary. EMDR therapy in particular has been proven to be extremely effective at eliminating post-traumatic symptoms by healing trauma at its roots.

If you’re a survivor of trauma, you are not crazy. Your brain has actually done exactly what it was intended to do and, as unbelievable as it may sound, full recovery is possible. If you’re ready to get on with your life, contact us today to get started.

John Roche, MDiv, MSW, RSW
John is a therapist with two Master’s degrees in counselling and three years of clinical experience. He has specialized trauma training in both Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). In his spare time, he loves to hike, reflect on the meaning of life, and eat nachos.

The Importance of Hydration

With increases in temperatures during the summer months, ensuring adequate hydration is extremely important, especially during activities requiring physical exertion.  Every cell and system in the human body relies on water to survive and to work correctly and efficiently, but water is lost every day through sweating, urination and breathing. Sweating is the body’s cooling mechanism, so naturally we sweat more when outdoor temperatures are higher or during exercise. A combination of hot, humid temperatures and physical activity can easily put the body into a state of dehydration. Dehydration decreases the ability of the body to regulate core temperature and decreases blood flow, both of which can have a detrimental impact on exercise performance.

Certain people will be more susceptible to dehydration than others, i.e. children lose water more quickly due to smaller body size, while older adults have difficulty conserving water and have a decreased sensation of thirst. Anyone who works or exercises in hot and humid conditions is also more likely to become dehydrated due to an increased level of sweating. Humidity makes it difficult for sweat to evaporate from your skin, which means it is harder for your body to regulate its temperature and keep cool. Although heavy and prolonged exercise makes people most at risk for dehydration, there is a cumulative effect.  This means with inadequate fluid intake over a few days, even mild or moderate exercise can create a state of dehydration. For athletes, mild dehydration of 1-2% of body weight can decrease the ability of muscles to use glucose, which diminishes aerobic performance and causes fatigue more quickly. Therefore, it is very important to ensure proper hydration in the days leading up to races or games.

How to tell if you are dehydrated:

• Little urine output and/or urine that is darker than usual
• Dry mouth, thirst
• Fatigue
• Headache
• Dizziness, lightheadedness
• Muscle cramps
• Nausea

Drinking fluids and replacing electrolytes is the easiest and quickest way to treat dehydration. If you have any of the above symptoms and think you may be dehydrated, drink small amounts of water frequently in order to prevent an upset stomach. Sports drinks can also be helpful in treating or preventing dehydration, but take caution as the sugar in sports drinks can cause diarrhea. Eating foods high in water content, such as fruits and vegetables, will help in the rehydration process; and be sure to avoid anything that will continue to dehydrate you further, such as caffeine and alcohol. Severe dehydration will require a trip to the hospital for rapid hydration through an intravenous line. Symptoms of severe dehydration include loss of consciousness, rapid or weak pulse, low blood pressure, and confusion. Untreated severe dehydration can lead to complications, such as heat stroke, and can damage kidneys and muscles. Heat stroke occurs when the body overheats and is no longer able to sweat and cool itself down, usually due to prolonged physical exertion in hot conditions. This is extremely dangerous and requires immediate medical attention, before brain or other organ damage occurs. A milder form and precursor to heat stroke is heat exhaustion, which has symptoms such as heavy sweating, lightheadedness, and muscle cramps. It is very important to treat heat exhaustion before it becomes heat stroke, by moving the person into a cool, shaded area, cooling off with wet towels, and giving liquids if possible. If symptoms continue to worsen, call for emergency medical attention.

How much do you really need to drink?

Although there are many recommendations for how much water to consume, a general rule of thumb is to consistently drink throughout the day, before you feel thirsty. Exercisers will need to consume more than non-exercisers due to water loss through sweating. In the hour or so prior to a workout, try to consume 1-3 cups of water. During exercise, if possible, drink about ½ cup or a few mouthfuls every 15-20 minutes. This will help to prevent dehydration and is especially important if the weather is hot, or the activity is particularly long and strenuous. A handy trick to know how much to drink after finishing a workout, is to weigh yourself before and after. For every pound that you have lost during the activity drink about 3 cups of water. If you weigh the same amount before and after, it likely means you hydrated adequately throughout the activity, and can just continue drinking normally for the rest of the day.

Keeping cool and staying hydrated should be a priority in the hot summer months. Dehydration negatively impacts the body and can lead to a decrease in athletic performance, heat exhaustion or even heat stroke. Drinking water consistently throughout the day, and increasing this amount before and after exercise will help to keep you hydrated and safe during the summer.

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BodyTech Physiotherapy
519.954.6000 | BodyTechPhysio.ca

 

Acupuncture

Acupuncture is a form of treatment which involves the insertion of tiny needles into the skin at very precise points throughout the body. The needles are solid, sterile, and single-use. No medication is injected. The presence of the needles creates a therapeutic effect by encouraging healing, reducing pain, and promoting energy.

How does acupuncture work?
There are two approaches to acupuncture: classical acupuncture and anatomical acupuncture.

Classical acupuncture is rooted in Traditional Chinese Medicine (TCM). In TCM theory, energy flows through the body in predictable channels, called meridians. Pain and dysfunction occur when the flow of energy is deficient or out of balance. TCM theory proposes that acupuncture relieves pain and promotes good health by restoring the body’s energy balance. The acupuncture points are located along the meridians. Needles are inserted to correct energy imbalance and restore energy flow throughout the meridian. Therefore, pain and dysfunction in one part of the body can be treated with acupuncture points at a distant location in the body.

Anatomical acupuncture was developed based on Western anatomical and physiological concepts. In this theory, acupuncture has both local and distant effects:

• Locally, acupuncture needles stimulate the release of endogenous opioids at the site of the needle. Endogenous opioids are natural painkiller molecules that are synthesized in the body and released to decrease pain. Blood supply to the area is increased, which promotes healing by improving the delivery of oxygen and immune cells to the injured tissue. Immune cells, such as mast cells, macrophages, and fibroblasts aid the natural process of tissue healing. The needles also suppress the local inflammatory response, which further helps to decrease swelling and pain.

• Distal to the needle site, acupuncture stimulates peripheral afferent nerves. Afferent nerves carry sensation signals from nerve endings to the brain (such as sensations of touch, temperature, and pain). The acupuncture needle interacts with the afferent nerves to modulate and suppress the transmission of pain to the brain. This reduces the perception of pain.

What are the benefits of acupuncture?
Acupuncture is effective in treating a wide variety of neurological and musculoskeletal disorders, including:

• Tendonitis and tendinopathy
• Ligament sprains
• Muscle strains
• Myofascial pain and inflammation
• Osteoarthritis
• Nerve pain, such as sciatic pain
• Low back pain and disc bulges
• Whiplash and other neck pain
• Muscle tension headache and suboccipital headache
• Bell’s palsy and trigeminal neuralgia
• Fibromyalgia

In Traditional Chinese Medicine (TCM), acupuncture is used to treat many other conditions:

• Digestive problems (nausea, vomiting, constipation)
• Respiratory problems (sinusitis, congestion, bronchitis)
• Urinary problems
• Menstrual pain
• Insomnia
• Anxiety and stress

What can I expect from acupuncture treatment?
The reaction to treatment is unique to each person. Some people feel relief immediately, while others notice improvement after hours or days. Some people require several treatments before noticing improvement. Some people do not respond at all. The number of treatments required varies for each patient and condition. Similar to most types of treatment, acupuncture works best if it is repeated a few times.

Are there any side effects?
There are usually no side effects to acupuncture treatment. The most common side effects are tenderness or slight bruising/bleeding at the needle site, but these only occur approximately 6% of the time. Occasionally, someone may feel nauseous, faint, or dizzy. This occurs less than 1% of the time.

Your physiotherapist will assess you thoroughly to ensure that you are a safe and appropriate candidate for acupuncture treatment.

Preparing for acupuncture treatment
Prior to treatment, have a light meal and be well-rested. Avoid alcohol or sedative medications for 4 hours before treatment, and avoid smoking tobacco for 1 hour before treatment. Continue to take medication as prescribed by your doctor.

After acupuncture treatment avoid alcohol, caffeine, and smoking tobacco for 1-2 hours. If you are being treated for pain relief, avoid strenuous activity for 1-2 days after treatment, even if you feel pain-free.

Conclusion
Acupuncture is a useful adjunct treatment to physiotherapy. It is effective for treating a wide variety of musculoskeletal and neurological problems, including acute and chronic conditions. Your physiotherapist will assess you thoroughly and create a treatment plan to address your unique needs.

References
ZQ Zhao. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. (2008)

ZJ Zhang, XM Wang, GM McAlonan. Neural acupuncture unit: A new concept for interpreting effects and mechanisms of acupuncture. Evidence-Based Complementary and Alternative Medicine (2012)

SM Wang, ZN Kain, P White. Acupuncture analgesia: I. The scientific basis. Anesthesia and Analgesia (2008).

 

The Truth behind Core Activation

Development of a strong core can be a common goal for numerous reasons, such as:  improving physical physique, preventing/relieving back pain, improving performance in recreational or competitive activities and building a stable base for our arms and legs to perform normal activities of daily living. This article will correct any myths about proper core activation. It will explain how development of a strong core will improve overall function for not only the lower back, but our bodies in general.

The first key to a strong core is developing a stable inner core. The inner core works as a unit to create dynamic stability around the spine and pelvis.

The inner core is made of up of four muscle groups:

• transversus abdominis
• pelvic floor muscles
• multifidus
• diaphragm

 

Transversus Abdominis (TA):

Transversus abdominis is a muscle that lies deep within the abdomen, attaching to fascia at the spine and wrapping forward towards the belly button, creating an internal corset. The function of the TA muscle is to stabilize your low back and pelvis prior to moving your arms or your legs. This muscle should be engaging subconsciously with any arm/leg/back movement throughout the day; however for many of us this is not the case. Reasons for inhibition of this muscle include: low back pain, surgery to the low back or abdomen, or pregnancy. To re-educate this muscle you must learn to tighten your lower abdomen without tilting your pelvis or puffing out your chest. Engagement is achieved by gently drawing your belly button in towards your spine feeling tension develop on the sides of your pelvic bones. Make sure you remember to breathe naturally from your abdomen as you hold this contraction. Once the muscle is activated, movements of the arms and legs can be added to increase the difficulty and by integrating TA contractions into activities of
daily living.

 

Pelvic floor:

The second wall of the inner core is composed of the pelvic floor musculature. This creates the floor or base of the inner core unit. Contraction of these muscles can be achieved by envisioning that you are stopping your urine flow midstream. This exercise is very similar to the traditional Kegel exercise, and adds a second component of stability to our inner core. Please note that if you are experiencing any incontinence or retention issues you should visit a pelvic health physiotherapist before starting pelvic floor exercises.

 

Multifidus:

The third component of our inner core is the multifidus muscle. Multifidus is located on either side of the spine. This muscle is a segmental spinal stabilizer, and atrophy can be seen at one or multiple levels.  To retrain this muscle you will likely need the help of a physiotherapist. Your physiotherapist will palpate (touch) the sides of your spine and you will be asked to swell the muscle under their fingers. This is difficult for many of us to do without the help of additional muscles. Common ways we cheat to mimic this muscle function is by tipping the pelvis forward, flexing the hips or tightening the muscles of the buttock. A good way to feel multifidus activate would be to take a step forward while palpating the gutters beside the spine; you will feel a small bulge of muscle under your fingers as multifidus contracts.

 

Diaphragm:

The fourth component or roof of the inner core is the diaphragm muscle. To ensure correct stability/function through this muscle, make sure you breathe from your stomach (abdominal breathing) rather than from your chest during the inner core contraction. Breathing from the chest is less than ideal for proper core function and limits the use of the diaphragm muscle.

 

Why Core Engagement Helps Prevent Muscle Injury:

Dysfunction of the inner core results in increased pressure placed on passive structures (ligaments, bone/joints, discs, capsules) of the lumbar spine due to lack of support and stabilization when moving. If the passive structures are not supported with the core, repeatedly or over a prolonged period of time, injury or dysfunctions such as stiffness or poor movement patterns may occur, creating pain.

 

Lack of Proper Inner Core Strength Can Lead to Injury:

Often exercises that are meant to strengthen the core can lead to injury. A common mistake individuals make is performing exercises that challenge outer core muscles without proper endurance of the inner core. Performing exercises such as sit-ups and planks without a stable foundation can lead to injury of the lower back/pelvis due to the lack of dynamic stabilization around these joints. Without a strong core, maintaining the correct exercise position is also difficult and can lead to injury. Similarly, if an individual performs a lift without anticipatory engagement of the inner core, increased load is placed on the passive system of the back and pelvis, possibly leading to an injury.

 

Functional Retraining of Proper Core Engagement:

The core acts as a foundation or stable base on which all body movements are generated to maintain back and pelvic stability. Strength of core musculature enables effective load transfer throughout the body with functional movement and activity.

The exercise strategies listed above can be utilized to re-educate use of the inner core muscles. Once inner core activation is successfully achieved, activation should be performed in differing functional positions and levels of difficulty. Following successful re-training of the inner core, your physiotherapist will begin to introduce outer core exercises (to challenge your rectus abdominus, external obliques, internal obliques). Isometric outer core engagement will be integrated while performing arm and leg movements, ensuring that the spine remains stabilized in neutral throughout.

The outer core can be categorized into four sling systems, which exist in the body to help with stability around the trunk and pelvis. Your physiotherapist can create a graduated outer core retraining program using these slings once correct inner core engagement is achieved.

 

Outer Core Sling Systems:

Four sling systems (specific groupings of muscle) exist in the outer core. These sling systems are designed to help with Force Closure to the joints of the low back and pelvis (SI joint). Force closure describes use of the muscular and fascial system to assist with stability around joints.

 

Posterior Oblique Sling:

The posterior oblique system assists with force closure by use of the following muscles/fascia:

• Gluteus maximus
• Opposite latissimus dorsi (lats)
• Thoracodorsal fascia (band connecting trunk to lower extremity)

An example of an exercise that incorporates use of the posterior oblique sling is bird dog.

Functionally the posterior oblique system is used during walking and rotational activities (ie. swinging a golf club).

 

Anterior Oblique Sling:

The anterior oblique system assists with force closure by use of the following muscles/fascia:

• External obliques
• Opposite internal obliques
• Transversus abdominis

An example of an exercise that encourages use of the anterior oblique sling is dead bug.

Functional use of the anterior oblique system is used during the acceleration phase of throwing.

 

 

Longitudinal Sling:

The longitudinal sling system assists with pelvic stability. The muscles/fascia making up the longitudinal sling include:

• Erector spinae (low back extensors)
• Multifidus
• Thoracodorsal fascia
• Sacrotuberous ligament (ligament at the SI joint)
• Biceps femoris (outer hamstring muscle)

An example of an exercise that would engage the longitudinal sling is the reverse boat pose in yoga or a superman exercise.

The longitudinal sling is functionally utilized during walking and running activities.

 

Lateral Sling:

The lateral sling is important for force closure across the pelvis, and also ensures positional control of the pelvis during single leg stance and walking. Muscles/fascia included in the lateral sling system are:

• Gluteus medius and minimus
• Opposite hip adductors (inner thigh muscles)

Exercises designed to promote activation of the lateral sling are often performed in a single leg stance position, ensuring correct core and pelvic control. Specific exercises for the lateral system include: step ups, step downs and side step ups.

The lateral sling is used functionally during walking and any single leg activity.

The final step to successful core retraining is to obtain full function. Performing functional movements while maintaining controlled trunk and limb movements in changing environments is the first step in functional retraining. Once you are comfortable with this activity, speed of activation and increased load can be added to challenge the core further. Further information and a staged exercise program can be discussed with your physiotherapist.

Diane Lee & Associates: training for the deep muscles of the core (Internet). South Surrey: D G Lee Physical Therapist Corp;  (cited 2016 Jan 12). Available from: http://www.dianelee.ca/article-training-deep-core-muscles.php

The importance of Physiotherapy for Ankle Sprains

An ankle sprain is one of the most common soft tissue injuries experienced. It is estimated that up to 100 000 ankle sprains occur each year in Canada. Spraining an ankle can happen to virtually anybody, whether during vigorous physical activity and sports, or from something as simple as losing your balance or stepping onto an uneven surface during everyday tasks.

In most high school and college level sports ankle sprains are the number one or two most frequently reported injury for both men and women with basketball, soccer and volleyball players being the most at risk. Unfortunately, there are very few definitive risk factors to watch out for that predict ankle sprains. Some factors such as flexibility, strength and excessive pronation can provide some indication to future sprains, but the results of studies researching these are still unclear. One single factor that has consistently shown to be a risk factor for future ankle sprains is past ankle sprains. This is a major reason why proper treatment is key for full recovery of an ankle sprain and to decrease the chances of sustaining a similar injury in the future.

Typically, a person sprains their ankle through excessive inversion, or rolling over onto the outside of their foot. This can occur during any walking, running or jumping activity and happens immediately after the foot makes contact with the ground, as this is when the joint is in its least stable position. Sometimes a sprain can occur when stepping or landing on an uneven surface, for example, another athlete’s foot during a game. This excessive inversion motion stretches the ligaments of the ankle past the point of which they are capable and results in a partial or complete tear. The most common signs and symptoms that indicate a sprained ankle are: pain at the top or outside of the foot when weight bearing or during certain movements; swelling; bruising; reduced range of motion; and for more severe sprain’s, sometimes a distinct popping sound at the moment of injury.

The most commonly injured ligament during an ankle sprain is the anterior talofibular ligament (ATFL), which connects the fibula (one of the lower leg bones) to the top of the foot. The second most commonly injured ligament is the calcaneal fibular ligament (CFL). This ligament connects the same lower leg bone to the calcaneus, or heel bone. Occasionally, a ligament called the anterior inferior tibiofibular ligament (AITFL) is affected during a high ankle sprain. In this injury, the pain is located more in the front of the lower leg than in the foot. It is important to not overlook this symptom because high ankle sprains often have a much longer recovery period.

Ankle sprains can be graded into 3 categories:

Grade 1:

• Very slight tear of ligament fibres, no significant structural damage
• Swelling, pain and instability is minimal
• Treatment: Weight bearing as tolerated, range of motion and stretching exercises with quick progression into strengtheningexercises

Grade 2:

• Partial tear of ligament
• Moderate swelling, pain and instability, decrease in range of motion
• Treatment: immobilization if necessary, only pain free range of motion exercises, slower progression of stretching and strengthening exercises

Grade 3:

• Complete rupture of ligament
• Significant swelling, pain and instability, unable to weight bear
• Treatment: Short-term immobilization with cast/crutches, similar progression as grade 2 but over longer period of time, surgical reconstruction occasionally recommended

How Physiotherapy Can Help:

Because ankle sprains are so common, there is a misconception they do not require much treatment and you should just ‘walk it off’. Many people assume that once the pain of an ankle injury subsides, they have fully recovered. But, without seeking treatment from a physiotherapist, regardless of the severity of the injury, lasting symptoms can be a problem with activity and increases the chance of re-injuring the weakened structures. People who do not seek treatment can experience long term issues such as pain, instability and stiffness, which can remain problems for months or even years after the injury occurred.One research study discovered that as many as 75% of people who have sustained an ankle injury report residual symptoms more than 1 year after the injury occurred.

Stiffness is the most common complaint in the later healing phases of an ankle injury, which can be present for months,and is often ignored. This stiffness is not likely to disappear on its own without proper treatment and joint mobilizations from a physiotherapist. Incomplete recovery of an ankle sprain leading to instability or pain in the ankle joint may cause compensation by other joints or muscles in the lower body. The compensation often changes normal walking and running patterns, causing them to become unnatural and inefficient,placing unexpected stress on other structures in the legs and hips. This stress creates an ideal environment for injury, so it is not uncommon to see lower back, hip or knee pain in people with a history of an unresolved ankle injury.

Seeing a physiotherapist after an ankle sprain can help you return to your pre-injury activity levels as quickly as 3-8 weeks, depending on the severity of the sprain. The primary treatment goals after an ankle sprain are to protect the structures of the foot from further damage and to reduce pain and swelling. This is accomplished through protected weight bearing (using crutches or air cast if necessary for more severe sprains), ice, compression and elevation, followed by pain free range of motion exercises. Research completed on the use of ice has shown it to be most effective when applied in the first 36 hours after the injury. Apply for 10 minutes on, 10 minutes off and repeat. Once the healing process has begun, your physiotherapist will assist you in fully restoring your range of motion, and begin to strengthen and promote stability in your ankle joint. Increasing stability in your ankle is a very important part of recovery, as it will help prevent chronic pain and greatly reduce the chance of another ankle injury down the road. In the final phase of treatment, the goal is to return you to your original strength and power levels, which is achieved through more difficult balance and functional activity exercises. This phase of treatment is very important because early return to activity without completing a comprehensive strengthening program can result in re-injury of the ankle.

Prevention of Injury:

Using prevention strategies can help reduce the chance of an ankle sprain from even occurring in the first place. Ensuring that you begin each sport or activity with a proper warm up is very beneficial for preventing any type of injury. As outlined in a previous blog post, a dynamic warmup will increase circulation, warm your muscles and prepare your joints for exercise.Warming up for a minimum of 5-10 minutes will allow your joints to move through a greater range of motion with ease, which will reduce the chance of ligament or muscle tears.Strengthening the muscles within the lower leg and foot will also help in preventing injury. There is a group of muscles along the outer side of the lower leg and foot called the peroneals. Research has indicated that strong peroneals reduce the amount of inversion, which is the most common mechanism of injury for ankle sprains. Strengthening the peroneals can be accomplished by performing calf raises on a flat surface or from a step, or walking on the toes.

Many people complain of feeling unstable through the ankle joint, and practicing balance exercises can be a great way to combat this problem. One simple way to fit this into your everyday life is to try to stand on one foot while doing an activity such as brushing your teeth or washing the dishes. Once this exercise becomes easy, more difficult modifications can be made by closing your eyes, standing on a pillow or hopping on one foot. While beneficial for everybody, balance exercises are especially important for those who are trying to prevent a second ankle injury.Using a brace or taping your ankle can also help reduce the risk of a second ankle sprain, but this should only be a short term fix as you continue to strengthen and stabilize your ankle structures.Ensuring proper footwear during any physical activity is another key way to prevent ankle injuries. Your shoes should fit well through the toe box and have a good amount of both cushioning and stability at the heel.

Visiting a physiotherapist to address your ankle injuries or instability will help prevent any long term problems. Getting proper treatment will greatly reduce the chance of further ankle injuries or any other injury that may result from compensation due to pain or instability of the ankle joint.