Exercise GuidelinesMany clients ask how much exercise should I be doing? It is a question that is often asked and not many people seem to be able to answer. In many cases, injuries are caused by deconditioning and muscle atrophy, which leads to problems with pain and loss of physical function. It is important that people get sufficient exercise to maintain their level of function and current fitness levels, however it is important that people know how much activity they should be doing.
General Exercise GuidelinesThe Australian Government department of health states that adults between the ages of 18-64 should accumulate a total of 300minutes of vigorous exercise per week, including completing specific muscle strengthening exercise on 2days. For people aged 65 years + it is recommended that people complete 30 minutes of moderate intensity exercise every day.
What is vigorous exercise?Vigorous exercise is counted as exercise where you are breathing hard and fast, with a moderate increase in your heart rate.
What is moderate intensity exercise?Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat. One way to tell if you're working at a moderate intensity is if you can still talk but you can't sing the words to a song.
Is walking enough?People often ask if walking is enough. If you are walking at a moderate intensity as described above, for 30 minutes per day, then you should be meeting recommended exercise guidelines for people aged 65 +. However, if your physio advises strengthening a muscle group or area, then walking is not sufficient.
How to build strength?https://www.youtube.com/watch?v=2tM1LFFxeKg Strength is often recommended to rehabilitate an injury and protect an area of the body. Strength is built by placing the tissue under stress so that you are causing microscopic damage to the tissue. Once this damage occurs, the body will heal the area, making it stronger and able to withstand greater stresses in future. Our bodies have adapted to be able to cope with the demands of everyday activities, so it is important that when strengthening a muscle you are placing it under sufficient loads that are greater than what the body typically experiences. If you are not meeting the recommended exercise guidelines including 2 sessions of muscle strengthening per week, you may be vulnerable to muscle loss or atrophy, and may be developing a greater risk of injury. In summary, completing adequate levels of activity are important for maintaining physical functional and limiting the effects of injury. Physiotherapists are experts in instructing people on how to exercise in the presence of injury or pain. If you are unable to meet your activity levels due to injury, then ask the physio how to work around the injury whilst we help the body to heal.
What is degenerative disc diseaseDegenerative disc disease is commonly seen in lower back and neck CT’s and MRI’s. It is a radiological term used for explaining anatomical changes in a disc rather then a pathology. Having this in mind when degenerative disc disease is coupled with pain it is most commonly due to issues with surrounding structures e.g. weakness and/or stiffness. Having degenerative disc disease does not always mean that it is causing pain output. Weaknesses of surrounding structures can lead to shear, compressive or tensile forces which make the more vulnerable discs stress. The protocols to then treat a painful back with a history of degenerative discs is to make sure surrounding structures are strong and supple. This will take away the forces on the vulnerable discs. It does not mean though that those discs will heal it only means a better managed pain state. These discs will always be structurally vulnerable due to their lifetime of stressors. Do not wrap yourself in bubble wrap to avoid this natural wearing of discs as it will most likely happen quicker. Be aware of remaining constantly active throughout your lifetime and treat your body with the respect it deserves.
Benefits of GardeningWhether you’re growing fruit and veggies, flowers or succulents, getting your green thumb on can have a surprising number of health benefits for you and your family. Stay fit and active in the garden Depending on the size of your garden, maintaining it can be also be a great way to be physically active. This could be as strenuous as mowing the lawn, or as gentle as getting a good stretch and practice stabilising yourself while kneeling, sitting or reaching. In fact, gardening is a recommended activity as it can encourage the use of many motor skills, improve endurance and strength and keep you moving. Eat your greens Do you have a picky eater at your dinner table? Kids who are picky eaters may be keener to try new foods that they’ve helped to grow. Watching the plants sprout and grow and waiting until fruit and veggies are ripe and ready to eat can help build their enthusiasm and excitement about healthy foods. The effect works on everyone, not just those with hard-to-please tastes. Growing your own fruit, vegetables and herbs will encourage you to eat seasonally, add more variety to your diet, encourage you to prepare homemade healthy dishes and learn to appreciate fresh produce. Understand seasonality These days, we can buy pretty much any fruit and vegetable we want from the supermarket, at any time of year. But eating seasonally has important benefits for our bodies. Different fruits and vegetables are “in-season” at different times throughout the year. For example, asparagus and apricots grow in spring and summer, while Brussels sprouts get going in winter. Eating seasonally can keep healthy eating exciting by encouraging you to try new recipes using in-season produce. You will also get a wider variety of different coloured produce, providing nutritious vitamins and minerals in your diet throughout the year as the produce you eat changes with the seasons. Find out what’s in season at different times of the year in Queensland using the Healthier. Happier. Fruit and Veggie Seasonality Charts [PDF 369KB] and ask about the ideal planting times for your area at your local garden centre or nursery. Relax and meditate Gardening is also a great way to relax, providing opportunities to still the mind and get away from the busyness of everyday life. There is even evidence to suggest that gardening can help ease symptoms of mental illnesses like depression and anxiety. Whether you’re gardening by yourself, or getting the whole family involved, it’s a great way to spend some time outdoors, away from screens and to-do lists, and engage with nature. From repetitive tasks like weeding that provide opportunity for meditation, to practising patience while waiting for plants to grow, gardening is a great exercise for your mind as well as your body. Breathe easier Gardening doesn’t have to be an outdoor activity – there are many varieties of plants that can be grown inside, too. As well as making rooms look nice, indoor plants can help improve air quality in enclosed spaces. Some studies also suggest that indoor plants can boost the concentration and focus of office workers. Not all plants will grow well indoors, so you’ll need to research which varieties will grow well in the lighting and temperature of your room. Things to keep in mind when starting out Different fruits and vegetables grow best at different times of the year. The Healthier. Happier. website has articles on what plants to grow during different seasons and a guide to easy grow-your-own healthy foods. If you’re planting an edible garden, remember that not all plants are safe to eat. Make sure you plant non-toxic varieties, checking at your local garden store if you’re unsure. Don’t use chemical sprays or fertilisers on your edible garden. Always wear gloves when working with plant material, soil and fertilisers, and be sure to wash your hands when you’re finished. When working outside, remember to be safe in the sun by wearing a broad-brimmed hat and protective clothing, wearing sunglasses, using a broad spectrum SPF 30 or higher sunscreen, working in the shade when possible and drinking plenty of water. Some councils and community groups offer gardening workshops, or set up community gardening sites, to help locals learn about gardening and growing edible plants. You can also find more information about starting a garden on the Better Health website and from this list of links on the Healthier.Happier Website Information care of the QLD Government website https://www.health.qld.gov.au/news-events/news/health-benefits-of-gardening
WHY YOUR DOCTOR SHOULD REFER YOU TO AN EXERCISE PHYSIOLOGISTWe all know we should exercise, and the science is clear, exercise is medicine. The following explains what an Exercise Physiologist is and why your doctor might refer you to one. What IS AN EXERCISE PHYSIOLOGIST? Accredited Exercise Physiologists (AEPs) are university-qualified allied health professionals. They specialise in designing and delivering safe and effective exercise interventions for people with chronic medical conditions, injuries or disabilities. Services delivered by an AEP are also claimable under compensable schemes such as Medicare and covered by most private health insurers. When it comes to the prescription of exercise, they are the most qualified professionals in Australia.
WHAT CAN AN EXERCISE PHYSIOLOGIST DO FOR YOU?EXERCISE TO IMPROVE YOUR MENTAL HEALTH Mental illness can have an impact on a person’s cognitive, behavioural and social functioning. Those with a mental illness often struggle to engage in their regular work, social and physical activities which can further impact the illness. Mental illness includes anxiety, depression, schizophrenia, bipolar affective disorder and personality disorders. There is mounting evidence that suggests exercise is an effective treatment method for people suffering from acute and chronic mental illness, with some studies suggesting that exercise is just as effective, if not more effective than pharmacological intervention in alleviating depressive symptoms. EXERCISE TO MANAGE CHRONIC PAIN AND ILLNESS Chronic pain is pain that persists beyond the expected healing time of an injury. Unlike acute pain which is caused by tissue damage, chronic pain is less about the structural or tissue damage and more about the sensitivity of the nervous system and ‘non tissue related factors’. Significant research has shown that exercise is an essential component in the treatment of chronic pain. Studies have shown that it can be an effective way to reverse this downward cycle of deconditioning and worsening pain, and gradually over time help those with chronic pain engage more in activities of enjoyment and essential activities of daily living with greater ease. EXERCISE TO REDUCE YOUR RISK OF FALL AND IMPROVE YOUR BALANCE Falls can result in permanent disability, restriction of activity, loss of confidence and fear of falling, all of which reduce quality of life and independence. There is now good evidence that exercise can prevent falls in older people by decreasing a number of key risk factors. For example, exercise can improve muscular strength, balance, balance confidence and walking speed, as well as psychological factors such as mental ability and mood. EXERCISE TO INCREASE YOUR MUSCLE MASS AND BONE STRENGTH Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone thickness (bone density). Any bone can be affected by osteoporosis, but the most common sites are the hip, spine, wrist, upper arm, forearm or ribs. Exercise can help bones modify their shape and size so they become stronger and this can prevent injuries. Exercise also increases muscle strength and improves balance which can help reduce the risk of falls. EXERCISE TO CONTROL YOUR DIABETES OR PREDIABETES Diabetes mellitus is a metabolic disease indicated by an elevated fasting blood glucose level due to deficiencies in insulin secretion or inability to use insulin. Everybody benefits from regular exercise but for people with diabetes mellitus (Type 1 or 2) exercise can play a vital role in the management of their condition. Exercise cannot reverse the damage to the cells in the pancreas that leads to the decreased production of insulin. Exercise can improve the way the muscles respond to insulin, which, in turn, helps regulate the blood glucose level for some hours after the exercise. Exercise also increases glucose uptake by the muscles and can lower the dose of insulin required by improving the body’s response to insulin. EXERCISE TO IMPROVE OUTCOMES DURING CANCER TREATMENT AND BEYOND Cancer is developed when abnormal cell function occurs. can develop within all parts of the body and can invade surrounding and distant sites by spreading through the blood vessels and lymphatic systems. If diagnosis and treatment are not administered in the early stages of the disease, cancer can be life-threatening. The potential benefits of exercise during and after treatment are significant and research has proved its effectiveness. Exercising during chemotherapy can help ease side effects, such as fatigue and nausea, and can help to boost the immune system of those undergoing cancer treatments. Our Accredited Exercise Physiologist at Pottsville and Cabarita Physiotherapy will take you through a full screening to assist in prescribing you the appropriate program to achieve your goals in a safe manner. You can book an appointment with our Exercise Physiologist Sammy here or call 6676 4000
THE IMPORTANCE OF ACTIVE AGINGFor Australians aged 65 and over, physical activity becomes important in maintaining energy levels, increasing joint movement, preventing, and managing mental health problems (by reducing stress and anxiety), and improving mood and memory function. Older adults are a diverse group, with different ages and socioeconomic backgrounds and different life experiences and lifestyles. These factors all influence the ageing process. In our younger years, we grow well and experience positive change in wellbeing. Through mid-life we plateau in health, even in the presence of stress and poor lifestyle choices. But in later life, it is these unhealthy choices that will come back to bite us with a decline into poor health, a possible loss of functional independence and increased likelihood and severity of chronic disease. The cheapest and most effective countermeasure to this decline is choosing to be physically active at every age. Even if you start for the first time tomorrow, measurable, noticeable improvements will occur and not just physically but also psychologically. There is no doubt about it, exercising regularly, combining resistance, aerobic and balance exercises will guarantee better health outcomes. The following includes important benefits that exercise can provide to us as we age.
WHAT ARE THE BENEFITS OF EXERCISE?Reduced risk of developing chronic diseases or managing the ones you may already have Physical activity lowers the risk of many chronic conditions such as dementia, diabetes, obesity, heart disease, osteoporosis, and cancers, to name a few. As well as this, physical activity also assists in managing the symptoms of any chronic diseases you may have e.g., blood sugar control for diabetics or pain management for those with osteoarthritis. Memory and brain function improve Keeping a healthy body is essential to keeping a healthy mind. Regular exercise boosts oxygen to the brain and in turn can improve cognitive processing, memory recall and reaction times. These notable benefits effectively reduce the risk of dementia and cognitive decline in later life. Studies have consistently shown that exercise stimulates the human brain’s ability to maintain old and create new network connections that are vital to cognitive health. Other studies have shown that exercise increases the size of a brain structure important to memory and learning, improving spatial memory. Reduced risk of falls Every year, 1 in 3 people aged 65 years and over will have a fall, and falls are the most common cause of injury among older people. Physical activity improves balance and coordination and in turn can minimise the risk of falls. Increased bone strength As we age, the focus is addressing risk factors for frailty and falls. Bone strength effectively can be addressed through different types of exercise. Ultimately, bones become stronger when a certain amount of load is placed on them. We improve our physical function and independence With exercise improving muscle strength and muscle function, and reducing the risk of falls, this in turn then improves our physical function and independence as we age. Maintaining functional independence is important as we age as it provides older adults with the choice to stay at home and enjoy all aspects of their daily lives at their own pace which then has positive effects on their mental health. We recover from illness more quickly Just like a healthy diet, exercise can contribute to general good health and therefore to a healthy immune system. It may contribute even more directly by promoting good circulation, which allows the cells and substances of the immune system to move through the body freely and do their job efficiently. We stay socially connected Our ability to maintain social connections is often compromised as we age. This is mainly due to our decline in functional abilities and independence, which in turn makes it difficult to get out and maintain our social connections, often leading to feelings of loneliness and poor mental health. Group based exercise programs are a great solution to social isolation and prolonging independence, as they effectively provide a safe, supportive, and motivational environment to build self-confidence and maintain relationships with others. If you have not exercised regularly for a long time or at all, you should consult with an accredited exercise professional or your GP. To get you started on your exercise journey you can book a consult with our Accredited Exercise Physiologist Sammy here Sources: ESSA Australia
Summer is on its way, which means so is the emergence of the iconic Aussie summer sport cricket. You will even see our Senior Physio / resident athlete Kai Allison playing for the Pottsville cricket club this summer! The demands of the sport of cricket can be variable depending on whether the player involved is a speed or spin bowler, and whether they field infield or outfield. For those who are bowling fast or consistently throwing from the boundary, the forces needed from their shoulders to generate speed on the ball are very high and with repetition this can lead to injury if the players shoulder musculature isn’t ready for the task. That is common sense, right?! To do difficult tasks with your shoulders they need to be strong. What is not common sense is the impact that the players ability to create forces through their lower body and trunk will have on their ability to bowl or throw with speed. With specific training of stepping patterns and trunk rotation patterning and strength, we can significantly reduce the risks of shoulder injuries in the overhead throwing athlete as well as improve performance. Studies published by Oyama et. al (2009) and Richardson et. al (2015) showed that with poor control of stepping patterns and trunk rotation sequences there is an increase in electromyographic activity in the muscles of the rotator cuff and all of the stabilisers of the shoulder blade, as well as an increased external rotation range of motion in the cocking phase of the throw. That is technical talk to say that the amount of force going through your shoulder muscles is increased and the positions that your have to get into to achieve force in the throw are more precarious if you don’t have good control of your trunk and stepping patterns. The other way to look at the information from the studies above is that we are able to reduce the forces through our rotator cuff (deep shoulder muscles) by adding rotation and stepping patterns which is great for injury prevention and performance, but it also suggests that if we are trying to specifically drive rotator cuff and scapular adaptation from our training, then we need to train them in isolation. So the take away from the above info is that for building strong and resilient shoulders in the overhead athlete we need to be training both isolated rotator cuff / scapular muscle strengthening AND full body stepping + trunk rotation + shoulder rotation strength and patterning. The other major aspect of maintaining shoulder health is throwing athletes is the ability to control acceleration and deceleration of our upper limb at the start/end of the throw. This wont just happen by itself with regular strength exercises, we need to be specific with our training. That’s a lot of information about WHAT to do, so lets go through some examples of HOW to go about it. The following exercises are a non-exhaustive example program of some ways to target the goals above (I will put a video of these on our Instagram and Facebook in case the photos and explanation don’t make sense).
- Band / Cable shoulder internal & external rotations
- Weighted Ball accelerations/ decelerations
- Single and double hand Palloff press
- Swiss Ball DeadBug
- Cable weighted step & rotate
Why everyone needs a foam roller! What is Fascia?
- Fascia is a layer of connective tissue that surrounds the outer surface of muscles , individual muscle fibres, vessels, nerves and organs binding them together
- Fascia connects our skin to our muscles and our muscles to each other forming chains that help to redistribute stress throughout the body
- The connection between the muscles and fascia is the myofascial system
- For various reasons including inactivity, repetitive motion, injuries and poor posture the fascia and underlying muscles can become stuck together of bind causing ‘knots’ or trigger points. This restricts movement, decreases flexibility, causes muscles to fire improperly during exercise and causes pain.
- It increases range of motion and decreases pain by sending information to the brain to enhance muscle activation and relaxation via the nerves and therefore breaking down adhesions. The elastic fibres are also directly manipulated from a knotted position into a straight position which is the correct orientation for the fibres
- Tension is released via stimulation of the golgi tendon organ(GTO) (the nerve receptor where the muscle and tendon meet). When excited the GTO causes the muscle to relax
- Increased blood flow / circulation and therefore improved vitality
- Allows muscle relax and to fire efficiently
- Reduces pain
- Assists injury prevention
- Acts as an indicator of when muscles are tightening even though you may not feel pain with activity
- Alternative to a massage
- Reduce cellulite
- Identify the problem area
- Hold on the tender spot for 30-60 sec or until the discomfort decreases by 50-75%
- Roll over the whole muscle looking for other tender spots
- Roll the entire length of the muscle to stimulate the GTO
- Remember muscles are 3 dimensional so you may need to roll in multiple directions
- Do not roll on 1 area for longer than 1-2 minutes.
- If there are no tender spots you can you long sweeping rolls over the long muscles such as the hamstrings
- Start with gentle pressure and gradually increase as your tolerance allows
- Stay on soft tissue and avoid bones, joints and tendons
- Also roll the areas above and below the problem area
- You should expect mild to moderate discomfort when rolling but NOT pain especially sharp pain
- While rolling focus on your breath: in through the nose for 4 sec and out through the nose for 6 sec. The longer exhalation helps to activate the para-sympathetic nervous system which allows the body to relax. You must not hold your breath
- It is good idea to do some core exercises prior to rolling
- Pre workout: roll quickly for 15 sec to
- Increase blood flow
- Optimise length / tension relationship of a muscle
- Improve movement efficiency
- Psychological ramp up for activity
- Post workout: roll slowly for 30 sec to
- Flush the tissue,
- Create elasticity of the tissue,
- Begin recovery process
- Any time for the benefits already discussed, primarily getting rid of any niggles and bringing tight muscles back toward a normal state
- High blood pressure
- Varicose veins
- Taking anti-coagulant therapy
Feeling The Pinch?
The Stubborn Shoulder Impingement SyndromeDo you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering? During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards. These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles that stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space. Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the padding under the shoulder bone) can lead to injury and pain. Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury. You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time. The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.
What Causes Shoulder Impingement?Generally, SIS is caused by repeated, overhead movement of your arm into the “impingement zone,” causing the rotator cuff to contact the outer tip of the shoulder blade (acromion). When this repeatedly occurs, the swollen tendon is trapped and pinched under the acromion. The condition is frequently called Swimmer’s Shoulder or Thrower’s Shoulder, since the injury occurs from repetitive overhead activities. Injury could also stem from simple home chores, like hanging washing on the line or a repetitive activity at work. In other cases, it can be caused by traumatic injury, like a fall. Shoulder impingement has primary (structural) and secondary (posture & movement related) causes: Primary Rotator Cuff Impingement is due to a structural narrowing in the space where the tendons glide. Osteoarthritis, for example, can cause the growth of bony spurs, which narrow the space. With a smaller space, you are more likely to squash and irritate the underlying soft tissues (tendons and bursa). Secondary Rotator Cuff Impingement is due to an instability in the shoulder girdle. This means that there is a combination of excessive joint movement, ligament laxity and muscle weakness around the shoulder joint. Poor stabilisation of the shoulder blade by the surrounding muscles changes the physical position of the bones in the shoulder, which in turn increases the risk of tendon impingement. Other causes can include weakening of the rotator cuff tendons due to overuse, for example in throwing and swimming, or muscle imbalances between the shoulder muscles. In summary, impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the shoulder space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries. Over time pain can cause further dysfunction by altering your shoulder movement patterns which may lead to a frozen shoulder. For this reason, it is vitally important that shoulder impingement syndrome is rested and treated as soon as possible to avoid longer term damage and joint deterioration.
What are the Symptoms of Shoulder Impingement?Commonly rotator cuff impingement has the following symptoms:
- An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead
- Shoulder pain that can extend from the top of the shoulder down the arm to the elbow
- Pain when lying on the sore shoulder, night pain and disturbed sleep
- Shoulder pain at rest as your condition worsens
- Muscle weakness or pain when attempting to reach or lift
- Pain when putting your hand behind your back or head
- Pain reaching for the seat-belt, or out of the car window for a parking ticket
Who Suffers Shoulder Impingement?Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.
How is Shoulder Impingement Diagnosed?Shoulder impingement can be diagnosed by your physical therapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.
What does the Treatment Involve?There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle.
To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist.These stages may include:
- Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
- Regain Full Shoulder Range of Motion
- Restore Scapular Control and Scapulohumeral Rhythm
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception and Agility Exercises
- Return to Sport or Work
WHAT IS AN ANKLE SPRAIN?An ankle sprain is a stretch or tear in one or more of the lateral (outside) ligaments of the ankle. Ankle ligaments are slightly elastic bands of tissue that keep the ankle bones in place. Because the ankle is responsible for both weight-bearing and mobility, it is particularly susceptible to injury. The relatively small joint has to withstand large forces exerted when walking, running and jumping, especially if the surface is uneven. Most ankle sprains happen when the ankle twists or rolls suddenly, usually a rapid and uncontrolled movement. The most common injuries happen when the foot rolls onto the outside of the ankle, straining the outside ligaments of the ankle joint. Symptoms of a sprained ankle include; pain, tenderness and swelling, bruising, trouble moving the ankle, and sometimes an inability to put your full weight on the ankle.
HOW LONG DOES IT TAKE TO HEAL?Most people recover completely from mild sprains within two to six weeks. More severe sprains can take up to six months before you can return to full activity, or sport. Once a significant sprain occurs, without good rehabilitation the joint may never be as strong as it was before the injury. It is not surprising therefore that many people have a history of repeated ankle sprains. With the correct rehabilitation however, you can help your ankle become even stronger than it was before the injury.
WHAT CAN BE DONE?Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to inflammation, part of the natural healing process. However, the body tends to overreact to sudden traumatic injury and as a result excess inflammatory fluid accumulates which can result in ‘scar’ tissue production. Too much scar tissue may prevent normal function with reduced flexibility and increased risk of re-injury. It is important to get medical advice to gain a positive diagnosis and
ADVICE HANDOUTFollow the PRICE guidelines immediately after injury and for at least 3 days afterwards before doing anything else. Your local physio therapist as well as most massage therapists can assist you with this: PROTECT - Protect the injured tissue from undue stress and avoid ALL movements in the same direction as when the injury occurred. REST – Unload the joint (take the weight off it) as much as you can in the first 72 hours after injury. Try and avoid walking on the joint as much as possible. ICE – Ice is an amazing natural healer and a great short-term pain reducer. It is also believed to have a beneficial effect in reducing swelling and promoting healing. The optimal amount of time to apply ice is around 10-15 minutes in bony areas such as the ankle. It can be applied as often as desired to achieve pain relief, ideally every 1-2 hours. COMPRESSION - This is advised for the first 72 hours, but only while your foot isn’t elevated. The compression can be firm if it doesn’t cause pins and needles or any loss of feeling around the joint. ELEVATION - Reduces the flow of blood to the area which helps reduce swelling. Elevation is recommended in the first 72 hours after injury. However, remove any compression while your foot is elevated unless you are wearing just a light compression bandage. When following PRICE it is also important to avoid HARM, hence the saying: ‘Give PRICE and avoid HARM’. HARM is an acronym for Heat, Alcohol, Running, Massage. Following this acute management phase, your physical therapist will start some ‘hands-on’ treatment to mobilise and strengthen the joint. This phase of treatment is crucial to ensure you return to full function and prevent future injury. Adequate preparation for activity is key and weight-bearing should progress gently. Drastic changes in activity level and performing unpractised skills expose your ankle to re-injury. Gradually build up your fitness level. Your ankle, and the rest of your body, will thank you for it! WHY IMMEDIATE TREATMENT IS IMPORTANT The success of injury healing can be boosted by appropriate, effective and timely action particularly in the early stages of an injury (ie. the first 72 hours). Any ‘soft-tissue’ is subject to injury including ligaments (which join bones to bones), tendons (which join muscles to bones) and to muscles themselves. The immediate reaction of the body to injury is similar irrespective of the soft tissue structure and is known as an inflammatory reaction. Injuries can be caused by overstretching, bruising or crushing. A strain describes overstretching of a muscle, while a sprain describes overstretching of a ligament or tendon. THE INFLAMMATORY REACTION Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the four main signs of inflammation:
- Heat – chemicals released from the damaged tissue causes dilation of surrounding blood vessels to bring healing agents to the area. The result is more blood and therefore heat
- Redness – is due to the increase in blood to the area
- Pain – is caused by the chemicals released from the injured tissues as well as the increased tissue pressure from the fluid acting on nearby nerve endings
- Swelling – is the result of this accumulation of extra fluid.