Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards - could the patient walk or did they go to hospital? Was there an x-ray?
The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn't settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the physiotherapist later.
Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed.
How Physiotherapists examine a sprained ankle
The physiotherapist will note any oedema, change of colour or abnormality of circulation. Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation.
Depending on pain the physio may manually test the strength of the ankle muscles. This can occur on the plinth or up on their feet if the injury permits it. Once the active movements have been recorded, the physiotherapist performs passive movemenst of the joint, pushing carefully with their hands to explore stretch of the joint structures in each direction. The physio may manually palpate the area to test which structure is at fault, noting swelling or tenderness
Treatment protocols for Physiotherapy
Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.
A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio's hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support.
In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.
Monday, November 1, 2010
Ankle Sprain Physiotherapy Treatment
Try Physiotherapy for Golfer’s Elbow
How Physiotherapists Treat Golfer's Elbow
by Jonathan Blood-Smyth
Golfer's elbow (medial epicondylitis) is not confined to golfers, but occurs in many sportsmen and women, with racquet sports the most common causes. Other sports where golfer's elbow occurs are in bowlers in cricket, archers and weightlifters. This and the more common tennis elbow are tendinopathies, overuse syndromes where there is no significant inflammation but a pathological alteration in the body of the tendon at the painful site.
The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs but no inflammatory process, rather a degenerative one. As the elbow is stresses by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur.
High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.
The medial epicondyle is the bone prominence on the inside of the elbow where the forearm and rotatory muscle originate from. The muscles become tendinous near the bone and the tendon inserts into the bone to anchor the muscles. This area is where the pain occurs.and scientific work has not shown an inflammatory process but degenerative one. As the elbow is stresses by forces which would tend to push the elbow out into "knock elbow", the tendon takes a lot of stress and changes occur. High stresses occur in the cocking phase of a throw and during the subsequent acceleration, and in the golf swing from high backswing down to near the ball strike. Golfers are more likely to have their dominant hand affected and tennis players who use heavy topspin in their forehands are also more at risk.
Pain and ache over the front of the medial epicondyle is the typical symptom, worse with repeated flexion of the wrist and improved with resting. Shoulder, elbow, forearm or hand pain can occur, with weakness or pins and needles in the lower arm. Physiotherapy examination includes the bony tendon insertions, the elbow joints and the muscles, with palpation of the "funny bone" area behind the elbow where the ulnar nerve lies. Nerve involvement can give weakness in the forearm muscles and sensory symptoms, so an exclusion neurological examination is performed by the physio.
The main treatment of golfer's elbow is conservative, including anti-inflammatories, wrist and forearm splinting, corticosteroid injection and physiotherapy. Modifying the provoking activity is a first line of management, making patient education about the condition and the eliciting factors vital. An example is modifying the golf swing mechanics to avoid setting the problem off continually. The patient is taught to avoid aggravating positions and activities, such as leaning on the elbow if there is nerve involvement.
Non-steroidal anti-inflammatory drugs are used in the initial acute phase to reduce pain and inflammation along with avoiding painful movements, use of ice, gentle stretches, friction massage and ultrasound. As the problem settles and becomes sub acute the aims change to improving flexibility by stretching, increasing strength and normal activities. A forearm brace may also be used or a wrist brace to rest the wrist muscles. Once the problem is chronic the programme continues with reduced use of the splint and re-introduction of sporting activities.
Correction of sporting technique, such as the golf swing, is best achieved by engaging a professional instructor who can also advise on stretches, fitness work and muscle strengthening. Athletes should warm up well before sport and stretch effectively afterwards, choosing good technique and selection of appropriate equipment. Doctors and therapists may need to monitor patients, especially athletes, very carefully as they tend to continue to perform through the pain.
Physiotherapy and Back Exercises
The cost of low back pain to society is very great, with high financial costs in terms of lost income, lost production and time off work and the costs of medical and physiotherapy and other treatments. This is apart from the personal consequences of the loss of one's work or job role, loss of the ability to do normal activities and the pain itself. Many back pain treatments have been developed, most of which do not have high levels of effectiveness, and much is down to self management. An exercise programme has been shown to be an important aspect of this and this includes stability work, gym or aerobic exercise and lumbar and pelvic ranges of movement.
Joint ranges of movement are not obvious to most of us but are vital to our ability to perform day to day activities. The shoulder is an important example of a highly functional joint which allows us to place our hands in front of our vision so we can perform precise actions. To do this it has a very large range of movement, allowing us to put our arms behind the back, behind the neck and right above the head. A joint can change due to illness or injury with various effects from loss of joint movement, looseness of the ligaments or damage to the joint surfaces themselves.
Injured joints go through the inflammatory process with a gradual formation of scar tissue over six weeks, the maturing scar beginning to contract around two to three weeks after injury. At this stage stretching and movement are important to maintain the length of the healing tissues and stimulate remodeling in these healing tissues closer towards the original type for the structure. Restriction of joint mobility can cause pain and limit everyday actions and functions we want to perform. If we lose movement in our shoulder or in our hand we have a problem as it gets in the way, but spinal loss of motion is less evident and we are more likely to accept it by default.
Abnormal joint movement and muscle activation can result from, amongst other things, stiff joints, muscles and other soft tissues. The complex movements and stability function of the lumbar spine allows controlled movement under load but is interrupted and changed for the worse by the dysfunction of the injured area. Pain and increased movement loss can develop as time goes on. With the stiff area reaching its limit more quickly than surrounding joints when a movement is performed, there is a risk of re-injuring this joint when forces are put upon it. It is worthwhile to work on pushing back these restrictions of joint movement.
Stiff joints cause alteration in muscle activation and joint movements, changing the way the complex interplay between muscle patterning and stability work in the spine. The coordinated weight bearing and movement functions of the spinal system are altered by the dysfunctional patterns of joint activity, leading to difficulties with pain and loss of function over time. If the joint stiffness remains there is a risk that the next time a movement is attempted the joint will be stretched to or beyond its stiff limit and could be re-injured. This is a good reason to try and loosen up these restrictions.
A physiotherapy approach to having a fit and fully functional lumbar spine has to include working at different aspects of spinal fitness which includes developing a good level of muscle endurance and power, lumbar stability and a full joint range of motion. Physiotherapists or other treatment professionals are qualified to treat patients with endurance and strength exercises, pain reduction techniques, spinal stability work, joint mobilising exercises and functional work. Daily performance of joint mobility work is encouraged to stretch out tight structures.
Sunday, October 31, 2010
Physiotherapy Services At Don Mills Health Care
Don Mills Health Care is committed to providing high quality physiotherapy treatment in order to help you manage many physical problems in the body.
Headed by our caring Registered Physiotherapist, our advanced Physiotherapy Department can assist you in overcoming a variety of physical conditions including joint and muscle pain, chronic conditions, neurological issues and weight management.
At Don Mills Heath Care, our physiotherapy treatment is considered advanced because we use a combination of skilled hands on therapy, along with state-of-the art rehabilitation equipment such as Vibrational Wave, MEDEX Core Strengthening, Shockwave Therapy, Traction, etc.
Although you may seek physiotherapy treatment for a specific reason, the Don Mills Health Care team strives to provide everyone with the following benefits and outcomes:
Benefits of advanced physiotherapy:
Decreased pain in a shorter amount of time
Improved joint mobility and range of motion
Improved strength and flexibility
Improved cardiovascular status
Outcomes of advanced physiotherapy:
More quickly regain function and the freedom to do activities in your home, workplace, school, and community
Restore and increase ability to participate in sports, hobbies, and leisure activities
Restore your independence faster!
Our dedicated Physiotherapy Department looks forward to helping you achieve an improved level of health and wellness.
Physiotherapists in Toronto, Toronto Health Care, Walk in Clinic Toronto, Toronto Orthotics, Toronto physiotherapy
At Don Mills Heath Care, our physiotherapy treatment is considered advanced because we use a combination of skilled hands on therapy, along with state-of-the art rehabilitation equipment such as Vibrational Wave, MEDEX Core Strengthening, Shockwave Therapy, Traction, etc.
Although you may seek physiotherapy treatment for a specific reason, the Don Mills Health Care team strives to provide everyone with the following benefits and outcomes: