Ankle Sprain
A sprained ankle ligament occurs when the foot is twisted severely - usually inwards - under the leg, This often occurs when turning suddenly or landing on uneven ground.
There is often severe pain, immediate swelling and variable amounts of bruising. If pain on walking or putting weight on the foot persists an X-Ray may be needed to exclude the possibility of a fracture.
Repeated sprains may lead to joint instability and poor balance + co-ordination.
Exercises to prevent this should be included in the rehab programme.
Treatment can be provided by contacting us and includes
1. RICE Regime
2. Proprioceptive support taping / strapping
3. Relative rest / reduced activity
4. Functional Rehab: jumping, turning, ball drills
5. Balance Board exercises
6. Calf strengthening
7. Progressive jogging / running / jumping / kicking
Hamstring Strain
Treatment of Hamstring Injury
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RICE regime
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Activity without pain, initially in shortened position and static work (i.e. bridging) gradually increasing in ROM and intensity
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Activation of core
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Lumber movement and leg movements
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Dynamic running without pain or limp: Progress jogging + running,
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Technical drills: sidestepping, hurdle walk over, sumo walk, lunge, high knee walk, heel flicks
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Gentle Stretching of hamstrings starts after 5 days
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Strengthening programme – general and sport specific
To stretch the hamstring one must have both the hip flexed and the knee extended to achieve a full stretch of the muscle. Depending on the stretch used it is possible to focus it on the upper or lower hamstring.
When stretching it is important to support the back of the knee and to avoid hyper-extending the knee, as repeated stretching of the hamstring when the knee is un-supported and hyper-extending can introduce instability into the knee joint. Contact a Chartered Physiotherapist for more advice
The hamstring group of muscles is regularly injured in sporting activities. It is much less strong than the quads on the front of the thigh and works across 2 joints. .They function differently dependent on the activity being done - either as a postural or a dynamic muscle. They are not best suited to explosive activity.
Most often it is injured at the end of the leg swing during kicking or as the knee locks straight when accelerating in sprinting.
Hamstring muscles have a number of functions including pelvic positioning / posture and preparing the limb for loading during walking and running.
Risk factors for Hamstring injury include
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Increased tightness in muscle
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Previous Injury
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Reduced flexibility of muscles.
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Age
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Reduced Muscle Strength, L
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ow Back Pain
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Functionally mostly a posture muscle
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Works over two joints
Muscle Contusion / Dead Leg
This usually occurs in contact sports when one player strikes another player on soft tissues, including the thigh or calf muscle.
The incoming knee or boot crushes the muscle fibres against the underlining bone causing localised bleeding within and around the muscle, resulting in bruising + swelling in the area.
The injured player usually has difficulty bending the knee after this injury.
It is critical to avoid causing further bleeding in the 10 days following injury. Severe injury where bleeding is not dispersed and appears as bruising can lead to bone formation (Myositis Ossificans) within the muscle which is a major complication.
Treatment
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RICE Regime with quads on maximum painfree stretch during icing
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Gradual return to daily activity - without provoking pain
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Massage Therapy after 48 hours min.
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Functional Rehabilitation Exercises / restore strength
Anterior Cruciate Ligament Injury
The Anterior Cruciate Ligament is a key stabiliser of the knee joint. It prevents the knee from bending backwards too far (hyper-extension) and from bending inwards when flexed.
Injury is common in sports that require significant pivoting on one leg while changing direction or where direct contact is likely to occur forcing the knee to bend backwards or inwards.
Female athletes are more at risk of injury during sport than their male peers. This is due to differences in the shape of the leg - being slightly more knock kneed .
If the ACL is ruptured it leaves the knee unstable + at more risk of injuring other tissues in the future. Thus it is common to surgically reconstruct the ACL with a long period of Rehabilitation afterwards. The rehab period aims to
1. Restore normal Range of Movement to the knee
2. Restore normal strength to the muscles around the knee and throughout the lower limb
3. Restore good balance and co-ordination during movement
4. Maximise muscle balance and motor control during sport specific activities
Each surgeon generally has a preferred post operative protocol. The athlete can progress through the phases of the rehab they achieve the goals set out. Thus people progress at different speeds - professional players could expect a return to sport within six months. Committed amateurs are likely to experience slower progress depending on how much time and effort they can invest in their recovery.
The phases of recovery are broadly
1. Recovery of range of movement (ROM), normal muscle activity and control of swelling
2. Exercise for recovery of balance and proprioception - joint position sense
3. Recovery of functional movement in weightbearing, walking, jogging and running.
4. Exercise against resistance
5. Sport specific activities - no contact
6. During early rehab work may include on other parts of the body i.e. upper body
Achilles Tendon Injury
Achilles tendon injury is common amongst all populations.
An acute tendon injury that is inflamed is a tendonitis and a chronic injury where no inflammation is present is referred to as a tendinosis.
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Overuse tendinopathy is associated with gradual onset of pain + morning stiffness after an increase in activity. Symptoms diminish with activity but return several hours afterwards. Heat also is reported to alleviate symptoms.
Acute onset of symptoms is associated with partial tear of the tendon + possibly with full rupture. In the latter case people often report the feeling of being struck or kicked on the heel/tendon and of hearing a loud ‘shot’ like noise. The tendon is often thickened and creaks / crepitus on movement. Other factors that need to be considered are foot mechanics, tight calf muscles, weak calf muscles, poor balance, stiffness at the joints of the ankle + foot and an ability to single leg heel raise / hop.
Injury in sports people is often associated with changes in intensity of training or sudden increases in training loads. In a general population it may be associated with sudden changes in general activities or in footwear, a change to little or no heel or support / walking barefoot (as in on holidays)
Treatment is primarily aimed at restoring the tensile strength of the tendon to pre injury levels.
Where inflamed this must be controlled and eradicated prior to being rehabbed.
In the acute phase the RICE regime is implemented - rest from activity + ice for swelling/ pain.
Gradual increase in the loading on the tendon without pain during activity is begun. It is important to avoid aggravating the pain and swelling. .
Simple heel raise both concentrically and eccentrically - raising up onto the tippy toes are commenced as pain allows. Slow + controlled movement is best.+ is integrated into functional activities ASAP.
Gait re-education and stepping practice without limping prior to progressing to walking fast, striding, jogging, running and jumping.
Slow heel raises are progressed to rapid heel raises, rapid alternate heel raising, hopping, skipping and then jumping.
Acceleration is gradually increased in a controlled manner - changing walking + running speeds. A variety of walking and running drills can be used.
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Treatment duration varies depending on severity of injury and the demands of your activity. The following video gives an indication of some but not all of the treatment possibilities. Please note reference to Physical Therapist in the USA is the equivalent to a Chartered Physiotherapist in Ireland.
Joint Replacement Surgery
Joints that are severely injured or have degenerated significantly may need to be replaced.
There are many different types and different surgical approaches. The most suitable option is selected by the orthopaedic surgeon.
All persons undergoing joint replacement surgery will undergo rehabilitation afterwards. This will vary depending on a wide range of factors (joint to be replaced, surface Vs total replacement, trauma Vs planned surgery, age and mobility of person pre-operatively etc).
Typically a joint replacement is planned in advance and some prehabilitation is possible. This may include exercise to maximise muscle strength + ROM,, preserve balance + co-ordination, gait re-education / crutch walking, respiratory function and post op advice.
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The rehabilitation following a joint replacement begins with basic exercises on day 1 and progresses to more vigorous exercise in the days after. This will restore muscle ASAP..
For lower limb joint replacement getting back to walking independently ‘normal’ gait is a key priority.
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Special attention will be paid to particular muscle groups that are key to the recovery including the hip extensors + abductors, the quadriceps and the calf muscles. These are often most affected by joint degeneration or chronic under use.
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If you would like to discuss rehabilitation following joint replacement please contact Ennis Physiotherapy Clinic here
