Ankle Sprain Injury

At Sports Physio Ireland we see a lot of people with ankle injuries. The most common clients with these injuries are just after a classic ankle sprain injury. They go over on the outside of their ankle, hear a ‘pop’ and feel pain when they try to walk. The ankle then becomes swollen over the next few hours, limiting the range of motion in the joint.

Your ankle joint has 3 ligaments that help stabilise the joint and protect you from ‘going over on it.’ An awkward fall or forced inversion injury can rupture these ligaments. Often causing bruising to the surrounding bone surface. Swelling occurs as the body realises it is injured and begins the healing process. This is why your joint swells, it is promoting blood flow to the area to initiate healing. People are often obsessed with getting rid of ankle swelling or stopping it all together, but it is necessary for the first 36 hours.

Swelling increases the temperature and pressure in the joint resulting in quite a sensitive, hot, red coloured  joint. The best course of management for an ankle sprain is take the weight off it, use crutches or a physio boot. Swelling can be controlled in the first 36 hours by keeping the foot elevated as often as possible, submerging it in a bucket of ice for one minute at least 10 times throughout day one & two after the injury has occurred. A stretchy bandage also helps in this 36 hour window to keep the swelling under control.

At this point you must try regain full joint movement, through balance and strengthening exercises after the initial 36 hours. Once you have sufficient ankle balance and strength you can progress to hopping, straight line running, followed by cutting and change of direction drills, before you return to training.

Joey Boland

Head Physiotherapist and Dublin Senior Hurler

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Neck Pain: Four Ways to Reduce The Pain

Neck pain is fast becoming more and more prevalent in modern day life. The main triggers in the rise of neck pain seen include; poor posture, reduced activity levels, and prolonged periods of sitting.

While each persons case is completely unique and is treated as such. There is often similar issues and areas of dysfunctions found from patient to patient with neck pain.

Whether your MRI scan reads ‘disc bulge’ or ‘degeneration’ etc., very often the route cause of the issue is a lot more straightforward and can be alleviated with a combination of exercise, changes in activity, and rest.

I’m certainly not a person who thinks that it’s feasible to spend all day, everyday sustaining 100% perfect posture. No chance. It’s simply not realistic. However, I do believe that by introducing simple postural cues a few of times a day, coupled with some simple exercises can make a big difference and help you on the road to full recovery!

Here are 4 of the exercises that I find to be very beneficial with some of my clients suffering from neck pain. Give them a go.


neck pain, physio dublin 2

1.) The Chin Tuck
neck pain

2.) The Band Row

scap push up, neck pain, dublin 2

3.) The Scapular Push Up

neck pain, dublin 2 physio

4.) The One Arm Lat Pull Down

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Treatment for Achilles’ Tendon Injuries

The Achilles’ tendon is the largest tendon in the human body. It is made up of three different muscles and has a different type of sheath than the other tendons – a porous one, allowing blood to flow to the tendon itself. These particularities of the Achilles’ tendon explain in a great measure why its injury is considered one of the most serious ones both by doctors and physical therapists.

How do you know that you have hurt your Achilles’ tendon? In the lighter forms of the injuries, you feel constant pain in the heel and its back. This kind of pain usually signals an inflammation, either of the porous sheath or of the tendon itself. Left untreated properly (i.e. when you only apply topical treatment for pain relief), the inflammation may get worse over time and lead to rupture – the most serious form of Achilles’ tendon injury that leaves patients unable to walk properly, run or climb stairs.

Stage 1 – Diagnose

If you believe that you have suffered an Achilles’ tendon injury, it is very important to seek medical attention immediately and not attempt to put further stress on the injured leg. As explained above, even intermittent pain in the heel may signify an injury of the Achilles’ tendon, so do not self-treat the pain, ignoring its cause.

The most common test performed by doctors to determine a clear diagnosis is called the Thompson test: you will be asked to lie on your stomach, while the examining doctor will squeeze your calf. In healthy individuals, this action will result in a flexion of the foot. If your tendon is injured, your foot will not produce this response.

Stage 2 – Treatment

Depending on the severity of the case, the doctor may recommend either surgery or non-surgical treatment. The most common form of treatment is surgery, which is a routine procedure for medical professionals. It is the first choice for treatment in young, active athletes, and healthy individuals which do not suffer from conditions which pose a high risk in case of surgery.

Achilles’ tendon surgery can be either open or closed. Open surgery involves an incision allowing the surgeon to see the tendon clearly. Closed surgery is performed through several small incisions.  However, in both situations a cast or postoperative boot is applied on the injured leg to allow complete healing without risk of renewing the injury.

Stage 3 – Recovery

Once your doctor confirms that your injury has healed and you may begin the recovery phase, you should contact a physical therapist, who will develop a specific routine to regain mobility in your ankle. The purpose of the recovery plan after Achilles’ tendon injury is to strengthen the tendon again, and to recover the mobility and stability in walking and running.

The most common types of physical therapy are:

Stretching – Stretching and flexibility routines are essential for a complete recovery. Your therapist will start with light routines, and progressively increase their complexity until you achieve complete mobility in your ankle.

Deep massage – Professional massage therapy is aimed at stimulating blood flow, helping your muscles and tendons recover, and preventing further injuries.

Throughout the treatment and recovery procedures, it is extremely important to follow your doctor’s and therapist’s recommendations and not attempt any kind of physical effort involving the injured leg. Achilles’ tendon injuries are some of the most serious types of running injuries and, if untreated properly, may leave you unable to run properly and unable to put your full body weight on your leg.


Running Style: Forefoot Running?

Forefoot running amongst runners at the moment is the big buzz word. When speaking to runners in the clinic, it’s viewed as the optimum foot strike. While the heel strike is now seen among recreational runners as poor mechanics.

What does the research say about forefoot striking amongst runners? Most studies that have examined the strike pattern of runners have shown that heel striking is by far the most common pattern, with up to 90% (Larson et al., 2011) adopting this pattern. So it’s very fair to say that heel-strike is a pattern adopted by the majority, even amongst the holy grail of runners, the Kenyans.

But is forefoot running more economical for the everyday runner?

Gruber et al. (2013) “When the alternative footstrike pattern was performed, Forefoot running resulted in greater rates of V̇O2 than Rearfoot running in the Rearfoot group at the slow and medium speeds and across groups at the fast speeds”. So what does this mean in layman’s terms, basically that forefoot running is not more economical than rearfoot running. However, much more research is needed in this area.

So when would I ever change foot striking pattern?

One population group that it is useful to change the strike pattern is runners who present with knee pain. Research has shown that running with a forefoot strike reduces the overall forces that are absorbed through the knee itself. It’s a useful strategy to increase the overall step rate of a runner, which has a direct implication on step length during the rehabilitation process. Increasing the step rate by 5-10% will allow this to happen, but caution must be applied to this strategy as there will be increased forces placed on the calfs and Achilles tendon.

To summarsie forefoot running?

There is no research that supports increased running economy or reduced injury risk among a running population. However, it may be a useful strategy for certain population groups.

Thomas Divilly

MISCP, CSCS

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The Likely Causes of Calf Pain

Calf pain is a common compliant and if not managed correctly, they can persist for months and cause a lot of frustration. The calf muscles refer to two major muscles; the gastrocnemius and soleus and the small plantaris muscle. These muscles have a joint tendon called the Achilles tendon, which inserts into the heal.

As the upper part of the calf crosses both the knee and the ankle, it is more susceptible to injury. Muscle strains generally occur on the inside of the calf muscle. Soleus muscle strains are also common; tenderness is more often felt on the outside of the leg deep to the calf muscle. Stressing the muscles with the knee straight or bent can differentiate between the two injuries.

A sudden burst of speed, over-stretching or direct contact with a player or equipment may cause an acute injury. With chronic injury people often present with cramping pain in the calf that seems to come and go. This may be due to previous calf strains and weak scar tissue that hasn’t recovered fully.

Certain individuals can naturally be more susceptible to calf cramps, these may occur during exercise or at rest after activity. This is most likely due to excessive fatigue. Improving the strength and endurance of the calf muscles can improve these symptoms.

Collapsing of the upper part of the foot can overload the calf muscles as they are trying to push the body forward during running. This can lead to muscle tightness and soreness and increase the risk of muscle strains or tendinopathy.

Recovery from calf strains require progressive loading to prevent tight scar tissue developing, helping the tissue to repair. Chronic strains require more time to heal as scar tissue remodelling is necessary to reduce the chance of a recurrence. This is achieved through loading the tissues as they are lengthening  and shortening. Assessing the movement patterns during functional activities such as jogging, lunging, jumping and landing is used to help find the route cause of the issue. Looking at how the individual is adsorbing, distributing and creating forces that push them forward is a key component to understanding the cause of the injury. If necessary corrective training can then be used to help prevent injury reoccurring.

Catherine Simpson

MISCP, MSc Sports Medicine

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Physiotherapy for Ankle Injuries

 

Ankle injuries are one of the leading causes of absence from sport. Many top GAA, soccer and even pro golfer Rory McIlroy have suffered from ankle injuires througout careers. The ATFL ligament, on the outside of your ankle is one of a number of main stabilisers for the joint. Ankle injuries can be divided into three types depending on severity: grade one, two or three.

 

The ankle plays a crucial part in generating power during jumping, running, cutting and even a golf swing. In the case of a grade three tear, surgery may be considered. However a strong physiotherapy rehab programme has been shown to have equally good, if not better outcomes for grade three ankle injuries.

 

Initially, I would help the player to reduce pain around the ankle joint, swelling and restore movement. The PRICE principal can be helpful here: Protect, Rest, Ice, Compress and Elevate.

 

The key to returning to play  and preventing further ankle injuries is a dynamic and progressive rehab programme. This mainly involves strengthening the ankle, balance training and sports specific exercise.

 

The key aspects of my rehab programme are regaining full range of motion, improvement of balance and agility. This depends on the players sport of choice. Basic ways to achieve these are lunges, single leg work and plyometrics.

 

Ankle movement can be restored with mobilisations and by reducing swelling in the first week post injury. Balance reeducation can be initiated with jumping and landing exercises aswell as basic hopping. Agility is the final stage of physiotherapy. Here the physiotherapist must try replicate and train all movements the athlete is expected to perform when competing in their individual sport so return to top level performance is as easy as possible.

Joey

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Anterior Knee Pain

Anterior knee pain is one of the most frequently seen symptoms in the clinic at Sports Physio Ireland. Common causes of this pain in athletes and the general population is patellofemoral pain syndrome. Another common cause mainly in sportspeople is patellar tendinopathy (injury to the tendon running from your knee cap to the front of your shin). Osgood Schlatter’s disease is often the cause of anterior knee pain in young athletes. If a sudden growth spurt occurs the plate can overgrow and cause irritation of the insertion of the patellar tendon.

 

Patellofemeral syndrome is generally the result of a movement or mechanical abnormality. Whereas patellar tendinopathy is generally caused by overuse but mechanical abnormalities may predispose the tendon to being stressed excessively.

 

Distinguishing between the two is sometimes difficult as the clinical signs and symptoms can be similar. Running downhill, steps and repetitive activities like distance running are the common aggravating activities at the onset of pain in patellofemoral syndrome, although it may present in the sedentary population with gradual onset or after a dramatic episode such as falling on the knee. Patellar tendinopathy is mainly brought on by a history of repeated loading of the patellar tendon such as jumping and landing. The specific location of the pain is the main determining factor between the two injuries.

 

Knee injury associated with pain and or swelling may result in the quads not firing correctly. This can set up imbalances on the forces acting on the knee cap, with a tendency to patellofemoral pain. The same is true with excessive tightness of the IT band and hip muscles that could also cause your knee cap to be pulled outwards. More commonly, it’s weakness in the glutes that results in your hip and knee dropping in. Causing the structures on the outside of the knee to be in a lengthened position and pull on the knee cap.

 

The majority of the client’s that come in with knee pain tend to be knee and quad dominant which means they load these structures excessively during everyday movements. If the glutes are not activated then there can be excessive force through the knee, creating irritation at the back of the knee cap on the thigh bone. This is purely due to overuse and degeneration of the structures. If the knees are painful, using the glutes to offload them is a key component of retraining movement patterns.

 

Examination will include a thorough history taking, observation, palpation, special tests and functional tests to determine the cause of the client’s pain. For an example a squat done on a decline will stress the patellar tendon more and is therefore more specific to patellar tendinopathy.

 

Treatment will depend on the underlying cause of the pain and may focus on lengthening structures in one person and strengthening of the quads or glutes in another. One of the main components of the treatment is looking at how the individual naturally moves and ensuring they are not loading their knees excessively.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

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What are Shin Splints?

 

What are Shin Splints? Shin Splints is a common term used among people to describe a pain in the leg in and around the area of their shin bone. A more specific diagnosis must be made however to successfully treat the symptoms. The traditional clinical use of the term shin splints is to describe medial tibial stress syndrome, pain on the lower inside of the leg. Often people use it as a term to describe pain and swelling of the muscles to the outside of the shin (anterior compartment syndrome) as well.

 

Chronic symptoms of shin splints may lead to stress fractures so symptoms must not be ignored if they continue to persist. Abnormal biomechanics may lead to a greater risk of pain around the shin bone. A high rigid arch effects shock absorption increasing the forces on the bone. In individuals whose arches fall from normal into a flattened position (excessive pronation) overuse, fatigue and excessive pull of the muscles that support the arch can lead to medial tibial stress syndrome, otherwise known as ‘shin splints.’

 

Weakness of the tendons or ankle instability from previous sprains may also contribute to overuse of muscular and tendinous structures leading to shin splints. Tight calf muscles can also lead to shin pain, excessive tightness can prevent normal ankle movement increasing the load on muscles surrounding the shin.

 

A full history and physical examination including biomechanical assessment with reproduction of symptoms is needed to find the true cause of the symptoms, so a progressive rehabilitation programme can be implemented.

 

Treatment may consist of reducing the repetitive training load, stretching and loosening out tight muscles such as the calves and improving strength. If it is a chronic issue, training to improve shock absorption will be required through altering running mechanics. Assessing and treating the origin of the problem is the key to full recovery.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

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Shoulder Stabilisation

 

Shoulder stabilisation exercises make up a large part of our preventative programmes at Sport Physio Ireland. But what exactly is shoulder blade stabilisation and why is it important?

 

Essentially what we are talking about is the development of good posture during exercise and activity through ‘switching on’ or ‘activating’ muscles around our shoulder blades and mid-upper back. This is essential for the maintenance of shoulder health and for the prevention of injury.

 

The way in which our society has developed means that most of us spend large parts of the day in seated positions working at desks and slouching over computer screens. This can lead to individuals developing what is known as a ‘forward shoulder posture’ as a result of structures around the front of the shoulder becoming stiff and tight. This in turn can cause muscles of our posterior shoulder to become lengthened and become under active.

 

This phenomenon is not limited to those working in offices. Many individuals who spend large amounts of time training in the gym tend to overtrain these muscles at the front of the shoulder such as biceps and pecs and fail to realise the importance of complimenting this training with some stabilisation work. This is often referred to as ‘all show and no go’.

 

Over extended periods of time, in either one of the scenarios mentioned above, means an individual can lose the ability to recognise how to actually utilise these important structures around our posterior shoulder. They then will often begin to compensate by using other muscle groups to carry out everyday tasks that can place unwanted tension/stress on other areas such as the low back, neck, and elbow.

 

This is where we come in.

 

Demonstration of shoulder protraction (left) and shoulder retraction (right)

Demonstration of shoulder protraction (left) and shoulder retraction (right)

 

In order to combat this issue, you must start with the basics first. Learning to engage or activate these muscles in a non-weight bearing situation is the first step. Once this has been mastered you can then begin to introduce exercises such as shoulder blade push ups (as seen in pic above), or lat pull downs in order to strengthen and stabilise further. This will ensure that when you return to your normal everyday lives, you are at a much lower risk of injury recurrence.

Riain Casey
M.I.S.C.P.


High Hamstring Pain

Runners and sometimes field based athletes can present with lower buttock pain in the clinic. This can reduce performance and be painful carrying out normal daily activities. After assessment, this is usually diagnosed as a proximal hamstring tendinopathy.

A proximal hamstring tendinopathy is when the tendon that inserts into the bony point of the bottom, the ischial tuberosity, gets overused and causes structural changes in the type of collagen present in the tendon. This can cause pain to the bony area, especially with sitting on hard surfaces, in cars, etc.

The main symptoms are:

  • pain on running activities,
  • pain when sitting down, especially on hard surfaces,
  • pain when flexing the hip e.g. putting on a sock.

 

In a clinical setting, the main reasons behind development of the tendon issue is due to overload of the tendon i.e. the tendon has been asked to do too much work for it’s ability to recover. So the typical story of a patient who presents with high hamstring pain is how they felt great during their runs over the preceding weeks and decided to increase the volume or intensity of their runs, or sometimes both! Another factor that may cause the issue to develop is hill running, which causes the hamstring muscles to come under increased eccentric stress, leading to tightened hip flexors, which in turn will contribute to the hamstrings working harder.

It’s important to get the region properly assessed to rule out other pathologies such as: lumbar referral, bursitis of the ischial tuberosity, glute max pain, sciatic nerve irritation, referral from the hip joint.

 

The best solution short term is to reduce and avoid the causing factors until the pain has subsided and get a proper assessment from one of the team to get a good structured rehabilitation programme under way..

 

Thomas Divilly

MISCP CSCS