Your physio will provide hands on treatment for pain relief and to restore movement. However, exercises are often provided to help maintain these changes or to assist with healing, correcting bio-mechanics and returning to full function. Exercise based treatment is critical to rehabilitation and prevention. So what do these exercises actually do?
Is your injury a sprain or a strain and what do these terms mean? This week we will bring you definitions and explain the difference between these two common injuries.
Sprains and strains both have potential to reoccur. Risk is reduced risk reduced with proper rehabilitation.
One of the most common sporting injuries is a sprain to the ligaments on the outside of the ankle. This occurs when the ankle 'rolls' outwards and the ligaments are overstretched. This is often caused by weakness in the ankle when it is put in a more challenging situation, for example, stepping in a hole or off a curb.
It is best to see a physiotherapist ASAP after injury to assess the damage, get appropriate treatment and rehabilitation to get the best recovery
Reference: Hubbard, T.J., Wikstrom, E.A., 2010, Ankle sprain: pathophysiology, predisposing factors, and management strategies, Open Access J Sports Med., 1: 115–122.
The ankle joint is very commonly injured in the active population. In sports such as rugby, AFL and hockey, an ankle sprain is the most common ankle injury. Ankle sprains are commonly referred to as a ‘rolled’ or ‘twisted’ ankle.
What is an ankle sprain?
Surrounding all our joints are ligaments that connect our bones and protect the joint by limiting excessive movement. An ankle sprain is when the joint is moved forcefully to the end of the available range and one or more of the ligaments gets overstretched, resulting in damage. There are 3 grades of ligament sprain; grades 1-3. These are diagnosed according to the severity of the damage, with grade 1 being minor damage and grade 3 being full rupture of the ligaments.
Types of Ankle Sprains
Mechanism of Injury
Most people sprain their ankle when walking and running on uneven surfaces or in sport when accidentally landing or standing on something, such as uneven ground or an opponent’s foot. The most common way to sprain an ankle is to roll onto the outside aspect of the ankle joint, causing a lateral ankle sprain.
Signs and Symptoms
The ankle will be painful, swollen and occasionally bruising will come up around the joint. It may be painful to take steps and the ankle is often reported as feeling unstable. In severe sprains people are unable to put weight through the injured foot.
Ankle Sprain Management
The first important step is to ensure that there is no fracture – if there is significant pain and an inability to place weight through the foot, then a visit to the hospital emergency department is recommended. Otherwise when your physio assesses the ankle in the clinic they will determine whether imaging is required and refer appropriately.
Of people who experience an ankle sprain and do not manage their symptoms appropriately, 70% will experience long lasting symptoms. Therefore, it is important to take your ankle sprain seriously. In a recent review of the literature, it was found that most management approaches are too short in duration, and unless treatment is tailored to the severity of the ankle sprain, most people will have lingering symptoms. However not surprisingly, having at least some treatment was more effective than a ‘no treatment’ approach in ankle sprain management.
Stages of Rehabilitation
Acute (approx. 0 - 10 days)
What to expect from us
Booking an appointment with us in the first few days post injury is very important to protecting your sprain appropriately. Then physio is important to complete the correct rehabilitation and get you back to activity safely and then reducing the risk of re-injury in the long term.
Your first physiotherapy appointment will involve:
If you have had multiple ankle injuries or experience chronic ankle instability, physio can help! The treatment is very similar to an acute sprain, without the initial care following after an acute injury.
If you have an acute ankle injury, want to reduce your risk of injury, or need advice on any of the above please do not hesitate to call us to book an appointment on 9970 7982, or alternatively book online.
Dijk van, C.N., Mol, B.W.J., Marti, R.K., et al. (1996). Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthop Scand, vol. 67, pp. 566-70.
Fong, D. T. P., Hong, Y., Chan, L. K., Yung, P. S. H., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, vol. 37, iss. 1, pp. 73-94.
Kannus, P., Renström, P. (1991) Treatment for acute tears of the lateral ligaments of the ankle. Journal Bone Joint Surgery [Am], vol. 73, pp. 305-12.
Pijnenburg, A.C.M, Dijk van, C.N., Bossuyt, P.M.M., et al. (2000). Treatment for lateral ankle ligament ruptures: a meta-analysis. Journal Bone Joint Surgery [Am], vol. 82, pp. 761-73.
The application of ice or cold packs are a very common treatments used to manage an acute injury or to help with muscle recovery. Originally it was believed that ice therapy reduced pain, swelling and helped with recovery from injury. However, recent studies have challenged the original theories behind the benefits.
How does ice work and how helpful is it?
Ice applied to the skin slows and reduces the activity of the nerves in the area, which then decreases the pain sensation. Several studies have found that following a soft tissue injury, such as a hamstring strain, or joint replacement surgery the use of ice significantly reduced pain. However, it is important to note that these studies found that function and recovery were not improved.
In the first few days after joint replacement surgery it is crucial to improve range of movement at the joint. Ice therapy in conjunction with pain medication is used to allow for range of motion exercises to be completed with minimal pain.
The theory behind using ice therapy for swelling is that the cold temperature causes our blood vessels to constrict, resulting in reduced blood flow to the region. New evidence has found that the cold does not penetrate deep enough for this effect to occur and therefore ice does not reduce swelling.
More effective ways to reduce swelling include:
Compression - Compression bandaging or taping to prevent the swelling from accumulating.
Elevation - Positioning the injured area raised up to allow the excess fluid to drain with gravity.
Cold Water Immersion
Athletes often use cold water immersion to assist with muscle recovery during periods of intense competition. Immersion in cold or iced water causes an increase in heart rate, blood pressure and metabolism, as well as increasing the amount of air we expire. However, the role of these in recovery are still unknown. While it is thought that these factors may help flush out toxins in the muscles that are caused by intense exercise, there is no evidence to support this. There is some evidence that cold water immersion reduces delayed onset muscle soreness (DOMS) and reduces athletes perception of general fatigue and leg soreness.
Risks of Using Ice Therapy
There are risks you need to be aware of when using ice therapy. When placing ice on the skin, there is potential for an ice burn. This is more likely to occur with direct contact on the skin for an extended period. For this reason, avoid the ice being in direct skin contact (use a thin towel in between) and do not apply for longer than 20 minutes at one time.
When using cold water immersion, be aware that a significant change in body temperature can cause shock in some people. Athletes should be supervised at all times by someone with first aid qualifications to ensure that any symptoms of shock can be dealt with immediately. Shock if left untreated can be life threatening.
Overall, ice therapy and cold water immersion may be useful for reducing pain and there are relatively low risks associated with its application. However, elevation and compression are more effective to manage swelling.
The application of ice, compression and elevation are just the initial phase of injury management. To ensure return to full function, appropriate assessment, treatment and rehabilitation is essential.
If you need treatment for an injury or advice on any of the above, please do not hesitate to call us to book an appointment on 9970 7982, or alternatively book online at beachlifephysio.com.
Adie, S., Kwan, A., Naylor, J., Harris, I. and Mittal, R. (2012) Cryotherapy following a total knee replacement, Cochrane Database of Systematic Reviews.
Bleakley, C. and Davison G. (2010) What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review, British Journal Sports Medicine, 44(3): 179-187.
Crystal, N., Townson, D., Cook, S., LaRoche, D. (2013), Effect of cryotherapy on muscle recovery and inflammation following a bout of damaging exercise, European Journal of Applied Physiology.
Kullenberg, B., Ylipää, S., Söderlund, K. and Resch S. (2006) Postoperative Cryotherapy After Total Knee Arthoplasty: A Prospective Study of 86 Patients, The Journal of Arthroplasty, 21(8), 1175-1179
Rowsell, G., Coutts, A., Reaburn, P. and Hill-Haas, S. (2009) Effects of cold-water immersion on physical performance between successive matches in high-performance junior male soccer players, Journal Sports Science, 27(6): 565-73.