physio Posted May 19, 2005 Report Share Posted May 19, 2005 i was told about this site from a couple of mates of mine that ride trials, smithy in oxford and will the taff!, i've been helping them out with recent ankle injuries and after looking at some of the posts on the site, i kinda guessed that this is a common injury, i think i have contacted a few of you recently and chatted about stuff, so this is what i'm prepared to do...... if i offered general injury advice i think i'd get swamped with questions, so for the time being i'm just gonna stick with ankles and go onto other areas later so heres the thing, an ankle is the worst joint in the body to injure, its because when you screw the ligaments in it by spraining it, it stretches the ligaments and causes a structural inbalance, either through hyperextension or tearing the ligament fibres. when the ligament tears, it does heal up again but scars, like a scab when you cut yourself, but this internal scarring is collagen and isn't as elastic as the ligament was, so unless the scar tissue is reduced, you will always have this weakness in the ligament. the ankle is a multi-directional full weight bearing joint and if you screw the structural balance in it, you screw it for life if it doesn heal correctly this then makes the ankle weak and easy to re-sprain and feel like crap afterwards for anything up to 18 months or longer there are very specific reasons for this and as its kinda technical (sorry patronising i know!) i'm not going to go into detail about that now one thing that i will tell you is that you should NEVER EVER disregard or ignore a sprained ankle where the ankle swells like a golf ball on the joint!!!! if this happens then you have screwed the ligaments, if you have then you need professional advice this is where i come in, if you have these sypmtoms then email me straight away and i will tell you exactly what you should do depending on the severity of the injury all ankle injuries are not the same so i cant just post one thing and leave you to it to get on with, the treatment and rehab are very specific to the type of ankle sprain you might have so thats all for a new ankle injury if you have an old ankle injury then you must contact me if you are still getting pain/weakness/instability/stiffness/soreness etc this is because the liigaments in the ankle havent healed correctly and to sort this out i will have to work out what area of the ankle is damaged, which ligaments you have injured and how bad the instability is, you can work on stability by doing proprioception exercises. this is to re-educate your ankle again so that it doesnt get caught out when you're running or walking and it gives way, causing a sprain. its kinda like if you put your hand out in front of you, you can see where it is, if you close your eyes, you can sense where it is. well this is kinda like how the proprioceptive receptors in your ankle work, they kinda know whats going on with your ankle while you are running and walking and you don't have to think about it, they adjust your balance whe you hit dodgy ground etc. but if they've been screwed up after a sprain, then you have to re-educate them again by doing specific exercises so that they give you the right info again. still with me?? at the end of the day almost 99% of ankle injuries can be brought back to as good as new (ish!), some ankles after the right advice, strengthening exercises and rehab actually get better than before as they become stronger than before you injured it!!!!!! ok enough talk email me at silord@hotmail.com or msn messenger if you want any advice, its free so dont worry!!! as long as i have time when i get home from work i will answer your questions and reply to your emails. the reason i did this is that my 2 mates i spoke about had really bad ankles that were gonne give up on them pretty soon, if i can help someone else out before they get to that state then it must be a good thing eh? makes me feel good about myself anyhows laters Quote Link to comment Share on other sites More sharing options...
guineasmithpig Posted May 19, 2005 Report Share Posted May 19, 2005 cheers simon ^^^ as simon has said above, my ankle was gettin pretty bad. so bad it resulted in a fracture and ligament rupture, without even twisting my ankle! by all means, go to A&E after a bad sprain, to check for fractures, but i guarantee they will send u out with a tubigrip support, and tell u to walk on it ASAP. u won't even get crutches if u don't ask! all this is VERY BAD. rest it up and get in touch with simon as soon as u can. he is very good at explaining everything, and i can honestly tell you that he'll give a reliable, understandable analysis, with no bullshitting, and i recommend you take it all on board! i have had 3 bad sprains dealt with by the NHS now, and have ended up in a right mess. even went to the GP (on crutches!) after the last one. all he said was he could refer me to a specialist.... in 2 months time! would like to thank simon again for all his help. and he's been very generous offering advice to people i've referred to him, and i'm on the road to recovery myself. i know its a ball-ache, takin time off the bike. but i'm just 20 now, and wish i'd had mine dealt with properly when i first did it 2 years ago (Y) all you young lads need to look after your bodies. still lots of developing to do, and you don't want it marred by injuries! and i'm sure all the old giffers like me will agree!!! it ain't too late guys, get in the queue! ride safe people!! smithy Quote Link to comment Share on other sites More sharing options...
tank_rider Posted May 20, 2005 Report Share Posted May 20, 2005 Simon, Would it be possible to create some sort of guide to a couple of simple exercises that us trials riders can do (like the rolled up towel one you showed us today) that could help strengthen up our ankles and ward off any future problems for those who haven't already done too much damage. Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Simon, Would it be possible to create some sort of guide to a couple of simple exercises that us trials riders can do (like the rolled up towel one you showed us today) that could help strengthen up our ankles and ward off any future problems for those who haven't already done too much damage. ← yeah thats no problem, let me get to work on it for those that i cant get to cause they live too far away Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 A sprained ankle is one of the most common injuries caused by participation in sports. It refers to soft tissue damage (mainly ligaments) around the ankle, usually caused by an inversion injury (where the ankle is twisted inwards) or an eversion injury (where the ankle is twisted outwards). Because of the position of the bones around the ankle, the inversion injury is far more common. This injury causes damage to the lateral ligaments on the outside of the ankle. The most commonly injured ligament is the anterior talofibular ligament which, as the name suggests, joins the fibular and talus bones together. If the force to the ankle is more severe, the calcaneofibular ligament (between the calcaneus and fibula) is also damaged. The posterior talofibular ligament is very rarely damaged in comparison to the other two ligaments. In the case of an eversion injury the damage occurs on the medial (inside) of the ankle. The ligament on the inside of the ankle is called the deltoid ligament and is very strong. It is so strong in fact that the bone on the inside of the ankle can be pulled off, in what is called an avulsion fracture, before the ligament is damaged. As well as damage to the ligaments, the capsule which surrounds the ankle joint is also damaged. The damage causes bleeding within the tissues and the ankle begins to swell up and can be extremely painful. Ankle sprains can be classified as follows: First degree, where only a few ligament fibres are damaged Second degree sprain refers to more extensive damage to the ligament with associated swelling Third degree sprain refers to a complete rupture of the ligament with swelling and a possible joint dislocation In the more severe injuries there may be associated bone injury and it is wise to get an x-ray to determine whether there is a fracture. SIGNS AND SYMPTOMS With a first degree sprain there is pain when turning the foot in or out and also pain when the damaged area is touched. With a second degree sprain the pain is more severe, there is swelling all around the area and it is painful to walk. With a third degree sprain the pain is excruciating and walking is impossible. There is gross swelling and there may be deformity if the ankle is dislocated. TREATMENT In the first 48-72 hours following the injury it is important the follow the RICE protocol - rest, ice, compression and elevation (never apply ice directly to the skin). Ice packs for a period of twenty minutes every couple of hours may help with the pain but pain-relieving medication may also be necessary. It is important not to put too much weight on the damaged ankle, so walking should be avoided if possible. Where a fracture is suspected an x-ray should be carried out at an accident and emergency department. If a fracture is found or a Grade Three sprain is diagnosed, the advice of the attending doctor should be followed. It should be borne in mind that some hairline fractures do not show up on x-ray until about 10-14 days after the injury, so if the pain persists medical attention should be sought. In the case of a Grade Two sprain, crutches should be used to protect the injured ankle. However, it is important not to be on the crutches for longer than necessary and as soon as the pain allows the patient should begin to gently put weight through the ankle by walking. Ligaments link bones to other bones and provide support to joints. They allow a normal range of movement to occur within a joint, but prevent unwanted movement that would render the joint unstable. In order to fulfill this function ligaments must possess immense mechanical tensile strength. Ligaments are classified as dense connective tissue, and they consist of a protein substance called collagen. The organisation of collagen fibres gives the ligament its tensile strength. Another function of ligaments is to provide proprioceptive input to the brain that allows a person to know what position the joints are in, without having to look. This helps to perform the complex coordinated activities needed for sport. A normal ligament consists of: 90% Type 1 collagen 9% Type 3 collagen 1% fibroblast cells (the cells that produce collagen) Type 1 collagen is mature collagen tissue and has the greatest tensile strength. Type 3 collagen is immature collagen tissue and does not provide a great deal of tensile strength to the ligament. After being laid down by fibroblast cells it takes approximately three months for Type 3 collagen to mature into Type 1 collagen. As with other cells in the body, this process of renewal occurs continually. When ligament tissue is examined under the microscope it can be clearly observed that the collagen fibres are arranged in a longitudinal pattern to resist the stress that is placed upon the ligament. The arrangement of the collagen fibres means that a great deal of force is required to damage ligaments. In a collision sport like football this force is generated by opposition players or when a player catches his foot in the turf and his whole body weight goes over one joint. This force produces structural damage to the joint capsule and ligaments, which is known as a ligament sprain. Once the patient is able walk on the ankle, more active rehabilitation can be started. In ankles that have been repeatedly sprained there is an inherent weakness which may require surgery. This can now be done arthroscopically where a camera is inserted into the ankle and flakes of bone and excess scar tissue can be removed. However. prior to surgery it is advisable to have sought non-invasive treatment from your physio to prevent the need for surgery. PREVENTION The most effective method of preventing ankle sprains is by improving the muscular support around the ankle through plyometric training. These exercises combine speed of movement with strength. The effect of the exercises is to improve the reaction time of the nervous system. This increases the reaction times of the muscles which stabilise the ankle, enabling the muscles to contract quicker to correct a twisted ankle before an injury occurs. However, it is important that these exercises are approached with caution and they should be started gently. After two weeks most of the rehabilitation is achieved through active exercise, although the physiotherapist may help regain range of movement by carrying out passive mobilising techniques. EXERCISE 1 The first exercise is to help restore the ankle's range of movement. Sitting on the floor, the ankle is pumped forward and back. 20 repetitions, 5 times daily. The patient progresses to doing the same exercise while sitting on a high bench or chair, letting the feet hang down. EXERCISE 2 This exercise strengthens the dorsi flexor muscles that pull the toes back towards the knee. Sitting on the floor, a low resistance elastic is tied around the foot, with the other end attached to a fixed object, that is out in front of the foot. Slowly the foot is pulled back towards the knee. 20 repetitions, 5 times daily. As this becomes easier, the elastic is changed to one that provides more resistance. Tip: doubling up the elastic is an easy way to achieve more resistance. EXERCISE 3 This exercise is designed to strengthen the plantar flexor muscles that push the foot down, such as when pushing the peddles of a car. Sitting on the floor, with the legs out straight, a low resistance elastic is tied around the foot, and the other end held in the hand. Slowly, the foot is pushed forward and then relaxed. 20 repetitions, 5 times daily. As this becomes easier, the elastic is changed to one that provides more resistance. EXERCISE 4 This exercise is a progression of the previous plantar flexor strengthening exercises. The patient stands with their hands resting against a wall so that it is taking some of their body weight. With both feet, the patient pushes up on the toes so the heels rise up off the floor. This position is held for 2 seconds and then the heels are slowly lowered. 20 repetitions, 5 times daily. Once this becomes easier, the same exercise is done but without any hands against the wall. Once this has been mastered, the patient progresses to doing the exercise with the toes positioned on a block, so that the heels have to come down lower before pushing up. The final progression to this exercise is to do it on the affected ankle alone. EXERCISE 5 This exercise is designed to strengthen the evertor muscles that enable the foot to turn outwards. Standing up, the base of the foot is turned outwards, held for 2 seconds and then relaxed. 20 repetitions, 5 times daily. Apart from mobilising and strengthening exercises, the rehabilitation for a sprained ankle can be greatly enhanced by practicing what are called proprioceptive exercises. These enhance neuromuscular control around a joint and are very important to the professional sportsperson. These exercises should be started as soon as pain allows. Proprioception refers to the body's ability to sense movement within joints and joint position. This ability enables us to know where our limbs are in space without having to look. It is important in all everyday movements but especially so in complicated sporting movements, where precise coordination is essential. This coordinated movement is a result of the normal functioning of the proprioceptive system. The proprioceptive system is made up of receptor nerves that are positioned in the muscles, joints and ligaments around joints. The receptors can sense tension and stretch and pass this information to the brain where it is processed. The brain then responds by signalling to muscles to contract or relax in order to produce the desired movement. This system is subconscious, and we don't have to think about the movements or the corrections to movement. Sometimes the reactions take place so fast they are termed reflexive. Therefore you can sense your ankle is rolling on uneaven ground before you realise it yourself! Following injury to joints and ligaments the receptors are also damaged, which means the information that is usually sent to the brain is impaired. As a consequence the joint feels odd or just doesn't feel right. Once a joint has been damaged, or a ligament has been torn or partially torn, there will be a deficit in the proprioceptive ability of the individual. This can leave the person prone to re-injury, or decrease their coordination during sport. Proprioceptive ability can be trained through specific exercises and, in the case of the injured athlete, the improvement can compensate for the loss caused by injury. This has the effect of decreasing the chances of re-injury. The exercises should be initiated as soon as possible following injury. The patient balances on the affected leg while partial weight-bearing. This should be done for 1 minute, followed by rest periods to avoid muscular fatigue. Proprioceptive exercises can be done while partial weight-bearing first, then progressed to full weight-bearing. The patient balances on the affected leg for 1 minute, followed by rest periods to avoid muscular fatigue. Advanced proprioceptive exercise. The patient hops then stops and balances for 20 seconds before hopping on again. Once an ankle has been sprained there will always be a slight weakness in the ligament, although this can be compensated by increasing the muscular stability around the ankle by practicing the plyometric exercises for ankle strengthening. Get a towel or wobble board. On this you will be able to increase both proprioception and ankle strength. This can be done either at your gym or at home, if at home you can do this watching TV etc. Stand on the affected foot and gently allow the ankle to lose balance on the rolled up towel (in the shape of a log). You will notice your ankle rocking from side to side and the forces working to prevent this are both increasing proprioception and strength. You will need to do this for a minimum of 20 mins per day twice a day At the end of the day it is always best to contact me first so that we are working on the correct rehab for the specific ankle injury Laters Si Quote Link to comment Share on other sites More sharing options...
Tomm Posted May 21, 2005 Report Share Posted May 21, 2005 Wow, you seem to know your stuff. Did you write all that out just for us? (Y) Quote Link to comment Share on other sites More sharing options...
Trebor Posted May 21, 2005 Report Share Posted May 21, 2005 Perhaps a silly question but: Whenever I rotate my right foot my ankle clicks every time it spins around - it never hurts or anything though, and it's been like this for a while, is this a cause for concern you think? Quote Link to comment Share on other sites More sharing options...
Tomm Posted May 21, 2005 Report Share Posted May 21, 2005 Perhaps a silly question but: Whenever I rotate my right foot my ankle clicks every time it spins around - it never hurts or anything though, and it's been like this for a while, is this a cause for concern you think? ← Ha, mine does that too. Both of them actually. I did a bit of research and basically - Yes. It's not a good thing. I think the fact I read was something like "Joint clicking is never normal and should not be ignored". Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Wow, you seem to know your stuff. Did you write all that out just for us? (Y) ← yep, well most of it, some of it copied and pasted for the explainations etc, but the rest written by me mate Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Perhaps a silly question but: Whenever I rotate my right foot my ankle clicks every time it spins around - it never hurts or anything though, and it's been like this for a while, is this a cause for concern you think? ← thats caused by the hyperextension of your ankle ligaments that SHOULD be holding the joint togther really tight, but arent, this is bad as it makes the ankle much much easier to re-sprain and can wear down the cartilage "type" substance in the ankle joint (although ankles dont technically have cartilage) it needs to be looked out to see if the ankle needs tightening up through whatever is needed, depending on the injury you had in it si Quote Link to comment Share on other sites More sharing options...
SamHolmes Posted May 21, 2005 Report Share Posted May 21, 2005 Both of my wrists seem to click pretty bad when I move my hand round in a circle Any help? (Y) Quote Link to comment Share on other sites More sharing options...
Tomm Posted May 21, 2005 Report Share Posted May 21, 2005 thats caused by the hyperextension of your ankle ligaments that SHOULD be holding the joint togther really tight, but arent, this is bad as it makes the ankle much much easier to re-sprain and can wear down the cartilage "type" substance in the ankle joint (although ankles dont technically have cartilage) it needs to be looked out to see if the ankle needs tightening up through whatever is needed, depending on the injury you had in it si ← OK, so what actually makes the clicking noise? Ligament running over bone or something? I've been wondering for ages. Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Both of my wrists seem to click pretty bad when I move my hand round in a circle Any help? (Y) ← same thing, hyperextension of the ligaments and tendons unless you've had sprains or fratured wrists then its somthing to look at to strengthen them up they get lose and cant hold the joint together as well mate Quote Link to comment Share on other sites More sharing options...
SamHolmes Posted May 21, 2005 Report Share Posted May 21, 2005 same thing, hyperextension of the ligaments and tendons unless you've had sprains or fratured wrists then its somthing to look at to strengthen them up they get lose and cant hold the joint together as well mate ← Do you have any quick advice for stenghtening them up ? Thanks (Y) Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Do you have any quick advice for stenghtening them up ? Thanks (Y) ← hmmmmmm you ever injured it bad? bad sprain/fractured it? Quote Link to comment Share on other sites More sharing options...
Gandalf the Yellow Posted May 21, 2005 Report Share Posted May 21, 2005 wow, that is very helpful im going to do those everyday from now on!! thanks alot! though my wrist has that same clicking problem, and its been sprained before, not TOO badly but it took 2 weeks or soemthing to heal, any advices on that? cheers steve Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 wow, that is very helpful im going to do those everyday from now on!! thanks alot! though my wrist has that same clicking problem, and its been sprained before, not TOO badly but it took 2 weeks or soemthing to heal, any advices on that? cheers steve ← alright steve, im in northampton and work in mk so if you get ny probs gimme a shout on email you had ankle probs before as well? with the wrist, i suggest some strengthening first, try squeezing a tennis ball in the palm of your hand by squeezing all your fingers into it, its bloody hard but will pump your wrists up!! Quote Link to comment Share on other sites More sharing options...
Gandalf the Yellow Posted May 21, 2005 Report Share Posted May 21, 2005 alright steve, im in northampton and work in mk so if you get ny probs gimme a shout on email you had ankle probs before as well? with the wrist, i suggest some strengthening first, try squeezing a tennis ball in the palm of your hand by squeezing all your fingers into it, its bloody hard but will pump your wrists up!! ← erm luckily no injuries on ankle, and hope there won't be in the future from your adviced exercises! (Y) ok i will try that and hope things will get better on the wrist, thanks again you've been very helpful. steve Quote Link to comment Share on other sites More sharing options...
Dai the Socket Posted May 21, 2005 Report Share Posted May 21, 2005 We all know my ankle's f**ked don't we Si (Y) Got my GP appointment on Monday lol. I think i'll be seeing you very soon dependent on the outcome. Quote Link to comment Share on other sites More sharing options...
onza t-bird Posted May 21, 2005 Report Share Posted May 21, 2005 (edited) Hi I know you said it was ankles you were doing but I'm having some problems with my wrist (I think). About three and a half weeks ago i get pushed over playing football and landed with my hand pressed downon the ground, I went to hospital the next night and they said it was just a sprain, Three and a half weeks later and it still hurts and is also quite swollen and hard on the left hand side of the wrist. Is this just the sprain healing or is there actually something wrong with it? Thanks in Advance Joe (Y) EDIT: It also clicks when i twist it around. Edited May 21, 2005 by onza t-bird Quote Link to comment Share on other sites More sharing options...
Will Arnold Posted May 21, 2005 Report Share Posted May 21, 2005 great advice si :wub: im gunna start doing those exerciese pronto... also, it seems to me like nhs doctors dont even care if you hurt a wrist or ancle, the just send you away with a tubigribe or similar and tell you its a sprain! thats what ive heard from alot of people when it actually turns out to be worse (Y) anyway, i know that everyone on here is very appreciative of the time+effort your putting into all this :D cheers Will Quote Link to comment Share on other sites More sharing options...
ScotchDave Posted May 21, 2005 Report Share Posted May 21, 2005 (edited) I'm hyper mobile, any way of dealing with it quickly? (Y) EDIT Grammar Edited May 21, 2005 by div Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Hi I know you said it was ankles you were doing but I'm having some problems with my wrist (I think). About three and a half weeks ago i get pushed over playing football and landed with my hand pressed downon the ground, I went to hospital the next night and they said it was just a sprain, Three and a half weeks later and it still hurts and is also quite swollen and hard on the left hand side of the wrist. Is this just the sprain healing or is there actually something wrong with it? Thanks in Advance Joe :P EDIT: It also clicks when i twist it around. ← joe, more likely a scaphoid fracture that they didnt pick up from the initial xray, its common to miss them, but it easier to fracture your wrist than to sprain it, spraining a wrist is pretty hard! the bones in the wrist dont like being stressed like that and something goes, usually th bone. if its the scaphoid then you have to go back and get ti checked again. the scaphiod can affect the blood circulation to the bone and therefore cause it to shrink and give you major major long term probs i really suggest you go back to your gp, get an xray referral from them and then see if you have a scaphoid fracture, if so then this long after they may be able to cast it up and get it to set straight, if you dont get it sorted then a guy that got referred to me 1 year after a missed scaphoid fracture couldnt move his wrist more than 5deg up and down and has had to have lot and lots of physio to get his wrist going again, itll never be the same again moral go get another xray, if you cant be arsed to do it that way round, go to a&e and say you did it that day and exaggerate the pain, theyll see it looks f**ked, it'll hurt in the right places and they send you off for xray, itll showbetter on this xray as the calcification of the break will show up more on the xray where its been trying to heal dont tell anyone that you did it that long ago as a&e dont see any injuries more than 24 hours old!!! si Quote Link to comment Share on other sites More sharing options...
Tomm Posted May 21, 2005 Report Share Posted May 21, 2005 Stick your thumb up. Press by the circle. If it hurts - good indication of a fractured scaphoid Quote Link to comment Share on other sites More sharing options...
physio Posted May 21, 2005 Author Report Share Posted May 21, 2005 Stick your thumb up. Press by the circle. If it hurts - good indication of a fractured scaphoid ← well hey there mr doc, very impressive from experience? lol yeah the scaphoid is kinda in the central>thump part of the wrist Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.