All About Quadricep Strains
This month we find ourselves fascinated by quadricep strains and hope to share a little information and advice with you. If that interests you, read on. But if another injury or ache or pain is your priority right now, please give us a call. We are here to help with hamstring strains, bicep strains, triceps strains, calf strains… and even aches and pains that have nothing to do with strains!
So, you’ve strained one of your quadriceps… Firstly, ouch – we know that can be a real pain. But we want to reassure you that with the right knowledge and some help from an Osteopath, you’ll be back on your feet in no time.
What Is It Exactly?
First things first, let’s understand the anatomy. The quadriceps muscle group is a powerhouse located at the front of your thigh. It’s responsible for extending your knee and helping you to kick, jump, and run. Maybe you don’t run like an Olympian, but your body’s movement potential and power is amazing when you start to really consider its mechanics! The quadriceps are so named because there are four of them. You’ve got the Rectus Femoris running down the centre of your thigh, the Vastus Lateralis on the outer side of your thigh, the Vastus Medialis on the inner side of the thigh and the Vastus Intermedius deep between the vastus lateralis and vastus medialis. Sometimes, these muscles can get overstretched or overloaded, leading to those unwelcome strains.
How Bad is It your quadricep strain?
There are three grades of quadriceps muscle strain, and each one brings its own set of challenges:
Grade 1 – The Mild One:
A Grade 1 strain is the least severe of the bunch. It happens when only a small number of muscle fibers get torn. You might feel some mild discomfort and tenderness in the affected area, but it won’t stop you from going about your daily activities. It can be tempting to ignore it and just get on with things, but this might be detrimental to your healing in the long-term. So challenge yourself to take proper care of this injury.
Grade 2 – The Moderate Trouble-Maker:
A Grade 2 strain is a bit more intense. This time, a more significant number of muscle fibers get torn. Ouch! You’ll likely experience pain, swelling, and maybe even some bruising around the thigh. Moving your leg could be tricky, and walking might not be as smooth as it used to be. The challenge here is to care for your leg, but not fall into a poor movement pattern while you work around the injury. This can create more problems throughout the rest of your body – which is the last thing you need!
Grade 3 – The Severe One (Or the Great Escape):
A Grade 3 strain is the big kahuna, and it’s no joke. In this scenario, the muscle suffers a complete rupture. Yep, you heard that right – it tears all the way through! The pain will be intense, and you may even notice a divot or dent in your thigh where the muscle used to be. This one might take you off your feet for a while, and you’ll need some serious TLC to get back on track.
How Did This Happen?
So, how does all this quad strain mayhem happen? Well, it can come about in a variety of ways:
- Overexertion: Pushing yourself too hard during exercise or physical activities, like sprinting or weightlifting, can put a strain on those quads.
- Sudden Movements: Abrupt changes in direction, especially when running or playing sports, can cause the muscle fibers to go “uh-oh!” and decide to take a break.
- Weak Muscles: If your quadriceps muscles are weak or imbalanced compared to other leg muscles, they might not handle the workload and could get strained.
- Lack of Warm-up: Skipping the warm-up routine before getting into the action can leave your muscles unprepared and vulnerable to injury.
- Fatigue: Tired muscles are more prone to strains, so it’s essential to listen to your body and not push it beyond its limits.
Bad luck plays into these things too of course. But it’s a good reminder that warming up, listening to your body, using proper form and cooling down properly are essential.
How Can My Osteopath Help?
Alright, now that we’ve got the lowdown on quadriceps muscle strains and how they happen, let’s talk about what an osteopath can do to lend a helping hand during the healing process.
Osteopaths are like the masters of the musculoskeletal system. They understand how the body works and can work their magic to help you recover from that quad strain:
- Assessment and Diagnosis:
First things first, our Osteopath will give you a thorough evaluation. They’ll ask about your symptoms and examine the affected area. This will help them determine the grade of your strain and tailor a treatment plan just for you. - Manual Therapy:
Osteopaths are experts in manual therapy techniques, and they’ll use their hands to gently manipulate and mobilize the affected area. This can improve blood flow, reduce muscle tension, and speed up the healing process. - Rehabilitation Plan:
As you move through the recovery stages, our Osteopath will develop a tailored rehabilitation plan for you. This might include specific exercises and activities to progressively challenge your quads and get them back in top-notch shape. - Prevention Tips:
To avoid future quad strains, our Osteopath will share some valuable prevention tips. These could include additions to your warm-up routine, muscle-strengthening exercises, guidance on how to pace yourself during physical activities and other lifestyle tips like gait adjustment and postural advice.
Remember, every quad strain is unique, and the healing process can vary from person to person. So, don’t rush it! Listen to your body, follow your Osteopath’s advice, and give those quads the TLC they deserve.
In no time, you’ll be back on your feet, enjoying life to the fullest, and saying goodbye to those quad strain blues. So, take care, be patient, and let us guide you to a full and speedy recovery!
Your First Osteopathy Appointment
So, you’ve got your first appointment with an osteopath coming up and you’re filled with anticipation and curiosity. Let’s walk you through what to expect before, during, and after your first visit here at BeacHealth.
Before the Appointment:
Before you head to your Osteopath’s clinic, take a moment to gather some essential information. Make sure you have your medical history handy, including any past injuries or conditions you’ve dealt with. Jot down any current symptoms or discomfort you’re experiencing, so you don’t forget to mention anything during your visit.
During this time, you might also want to write down any questions or concerns you have about your health. Your Osteopath is there to help you, so don’t be shy about asking anything that’s on your mind.
It’s best to wear comfortable clothes to the appointment. You’ll probably be asked to move around a bit so we can see how your muscles are working. Restrictive, uncomfortable clothes just get in the way.
During the Appointment:
Expect a warm and friendly atmosphere. Osteopathy is a holistic discipline – we treat the whole person not a muscle in isolation – so we’ll work to put you at ease.
Your Osteopath will start by having a chat with you about your medical history and any specific issues you’re facing. They’ll listen attentively and ask questions to get a comprehensive picture of your health.
Next comes the physical examination. Don’t worry; it won’t be anything invasive or uncomfortable. Your Osteopath will gently assess your body’s mobility, posture, and movement. They might ask you to perform certain movements to better understand how your muscles and joints are doing.
Based on their assessment, your Osteopath will create a personalized treatment plan just for you. They’ll explain their findings and what they believe could be causing your discomfort. Remember, your Osteopath is here to work with you and find the best approach for your unique needs.
If any hands-on treatment is necessary, your Osteopath will explain each step before proceeding. Manual therapy techniques are common in osteopathy, and your Osteopath might use gentle manipulations, stretches, or other techniques to address your specific concerns. Rest assured that it’s non-invasive. If anything hurts let your Osteopath know. Communication is key.
After the Appointment:
Congratulations, you’ve completed your first visit with an Osteopath! Now, let’s talk about what comes next.
After your session, you might experience some immediate relief from your symptoms (and that is just the most amazing feeling for you and for us!). However, keep in mind that healing takes time, and your body might need a bit of adjustment. Don’t be discouraged if you don’t feel 100% right away; gradual progress is normal. It’s even possible that the aches and pains might feel even more pronounced for a day or two while the healing happens.
Your Osteopath might provide you with some helpful advice on how to manage your symptoms at home. This could include exercises, stretches, or lifestyle modifications that will support your recovery. Follow their recommendations diligently to maximize the benefits of your treatment. We cannot stress the importance of this enough. While we love repeat business, we prefer that our patients keep coming back because we’re just that good – not because they keep hurting themselves in the same old ways over and over again!
In some cases, your Osteopath might recommend follow-up appointments to continue monitoring your progress and adjusting the treatment plan as needed. It all depends on the injury/condition/ache – it’s severity and causes. The important thing to know is that we’re here for you to provide ongoing support if it’s needed for long-term healing and well-being.
Remember, open communication with your Osteopath is key. If you have any questions or concerns after your first visit or throughout your treatment journey, don’t hesitate to reach out. They are here to guide you and ensure you feel comfortable every step of the way.
Before, during, and after your first visit with an Osteopath, you can expect a caring and personalized experience. The team at BeacHealth will take the time to listen to your concerns, conduct a thorough examination, and design a treatment plan tailored to your needs. With gentle hands-on techniques and expert guidance, they’ll help you on your journey to improved health and well-being.
So, take a deep breath and call us to book your first appointment and embark on a path of healing and vitality. You’ve got this! We hope you found this informative. If you’re curious about osteopathy, human movement or human anatomy check out other blogs on our web site at www.beachealth.com, or follow us on Instagram at beachintegrated. We should warn you that the occasional osteopathy joke may make its way to our posts! We look forward to seeing you at the clinic.
Medial Ankle Sprain
Ouch! So, you missed your footing on the stairs and fell. You landed badly, twisting your ankle in a funny direction. It could have been worse of course, but it’s still not great. It’s time to call your Osteopath.
What Is a Medial Ankle Sprain?
When your foot rolled, it stretched or even tore the ligaments holding your ankle together. A medial ankle sprain is an injury to the ligaments on the inside of the ankle. Ligaments, by the way, are tough bands of tissue that connect bones to each other. They help to stabilize joints and prevent them from moving too far out of place. Medial ankle sprains are less common than lateral ankle sprains, which occur on the outside. This is because the deltoid ligament which runs along the inside is particularly strong. Not only does the strength of the deltoid ligament make a roll outward (called an eversion) less likely than an inward roll (called an inversion), but it makes injury less likely. However, if the twist, trip, or direct blow is bad enough, even the deltoid ligament can tear.
Symptoms of a medial ankle sprain may include:
- Pain on the inside of the ankle
- Swelling
- Bruising
- Tenderness
- Difficulty walking or putting weight on the affected foot.
How Do I Treat It?
The treatment for a medial ankle sprain will depend on the severity of the injury. At first, you must apply the RICE protocol: Rest, Ice, Compression, and Elevation. We know you’ve heard it before, but it bears repeating. You must keep your weight off the injured foot for a time – skipping this step or attempting to fast-forward through it could seriously impact your healing. What does Ice mean – it means ice it for twenty minutes every two to three hours (and yes to all the smartie-pants out there – you can have a break while you sleep!) Wrap your ankle in a compression bandage and prop it up above your heart level. RICE is generally considered effective for up to three days, but don’t hang about. Remember to get in and visit your Osteopath early in the injury. We will work with you to promote healing, reduce pain, reclaim your ankle’s range of motion (preventing it from stiffening up as it heals) and strengthen the muscles around the ankle to stabilize and support it. It’s essential that we do this as, left untreated, your injury could lead to chronic pain, instability and recurring injuries.
The good news is that ligaments can heal. They just heal a little slower than muscles. Crucially, they need to bear a little weight to do that and exercise stimulates growth and healing. Your Osteopath will be able to prescribe the right exercises for you along with performing manual manipulations to make those exercises more possible.
Every injury is different, but your exercise regime will likely include stretches and strength training for the leg muscles, ankle mobility exercises, and progressive balance exercises.
Getting Back to Normal
The bad news is that a history of ankle sprains is one of the greatest predictors of future ankle sprains. The good news is that your Osteopath can advise you on ways to make that less likely – from exercises for strength, balance and proprioception to advice on strapping your ankle and footwear. Our Osteopaths are here to help!
Calf Muscle Strain
You may not give them much thought, but your calf muscles are constantly working hard day-to-day when you’re walking around or exercising. This makes it really inconvenient – not to mention painful – when you strain a calf muscle. Muscle strains are a common reason our patients seek out osteopathic treatment. Read on to find out about the different causes and treatment options for calf injuries.
Calf anatomy facts
Before we dive into the injury, let’s take a moment to unpack the anatomy of the calf. Did you know that it is actually made up of three muscles? They are called the gastrocnemius, soleus, and plantaris (we know… what a mouthful!). The gastrocnemius is a two-pronged muscle that runs from just above your knee down to your heel. It is the largest of the three and is vital to movement of the knee and the ankle. It is more commonly injured than the soleus, which lies underneath the gastrocnemius.
What are the common causes of calf tightness and strain?
Our muscles lose flexibility as we age, making them more prone to injury. Short or tight calf muscles make you more susceptible to a strain, especially if you skip the warm-up before you start exercising. Participating in sports and activities like tennis, basketball, and football that involve sudden movements or changes in direction are common ways to strain a calf.
What are the symptoms of a strained calf muscle?
Calf strains are graded as mild (a minor strain), moderate (a partial muscle tear), or severe (a complete muscle tear).
Common symptoms of a strained calf muscle include:
- Tenderness and pain in the area
- Tightness and aching after exercise
- Swelling and bruising of the muscle
- Sharp pain or ‘popping’ during exercise
- Pain when stretching the calf
- With a severe tear, it will be very difficult to walk or stand on the affected leg
Symptoms will generally be more intense for a severe strain.
How to treat a strained calf muscle
Depending on the severity of the strain, your recovery could range from a few weeks for a mild strain, to several weeks or months for a moderate to severe strain.
What you can do to help
There are some steps you can take at home to treat a strained calf muscle.
For the first 2 – 3 days, RICER protocol is suggested:
- Rest your leg as much as possible.
- Ice therapy (apply ice packs for 20 minutes every two hours for the first 24 hours).
- Compress the injured leg using a bandage wrapped firmly around the calf to minimize swelling.
- Elevate the leg using a pillow for support, as much as possible.
- Refer – if you are unable to walk, you should seek medical attention to determine if medical imaging is required.
How can osteopathic treatment help?
Muscle strains are one of the most common injuries we treat in the clinic. Our hands-on treatment takes a holistic approach to healing and recovery. If you have tight calf muscles or are experiencing a strain, we may use a range of soft tissue techniques, including massage therapy, joint manipulation and stretching. This helps by increasing blood flow to the area and reducing tightness. As part of your treatment, we may also develop a program of exercises and stretches for you to do at home, as well as getting you to follow a clean diet and adequate water intake. This is all to help with your recovery and to strengthen the muscles – and hopefully prevent the injury from reoccurring in the future!
If you are experiencing pain or tightness in the calf muscles, come and see us. We are here to help! We will assess your symptoms and come up with a treatment plan to get you back to your best. Call us on (416) 546-4887 or email [email protected] to make an appointment.
References:
- St Johns Ambulance Australia. (2020). First aid fact sheet. Sprain and strain. [Online]. Available at: https://stjohn.org.au/assets/uploads/fact%20sheets/english/Fact%20sheets_sprain%20and%20strain.pdf (Accessed 14 June 2022).
- Physiopedia (2021). Calf Strain. [Online]. Available at: https://www.physio-pedia.com/Calf_Strain (Accessed 14 June 2022).
- Cleveland Clinic (2021). Torn Calf Muscle. [Online]. Available at: https://my.clevelandclinic.org/health/diseases/21696-torn-calf-muscle (Accessed 14 June 2022).
- Healthline (2019). How to heal, protect, and strengthen a strained calf muscle. [Online]. Available at: https://www.healthline.com/health/pulled-calf-muscle (Accessed 14 June 2022).
Sacroiliac Joint Pain
Many of us have experienced lower back pain at some point in our lives. Whether that is after a fall, running or simply sitting down for too long most days. SIJ is short for ‘sacroiliac joint’, and SIJ pain contributes to around 15-30% of back pain. But most of us don’t know much about it, so today we are delving into SIJ pain and how we can help!
What is the SIJ?
The SI joints are located either side of the lower spine, in between your pelvis, specifically, they connect the sacrum to the iliac bones — hence the name sacroiliac! The joints themselves are pretty immobile and only allow for a few degrees of movement, BUT they serve an important purpose as shock absorbers. They also help reduce the pressure on your spine by distributing weight across your pelvis, so it’s important that your back pain is diagnosed correctly!
What causes SIJ pain?
SIJ pain or SIJ dysfunction occurs when the SI joints are inflamed and are either restricted or moving too much. If they are restricted, they may be stuck in a slight rotation from their ideal position, which can wreak havoc on your pelvis and the rest of your body. SIJ pain could be triggered from:
- Injury or trauma, such as a fall or car accident.
- Persistent impact from running or climbing stairs.
- Loose ligaments due to hormones in pregnancy.
- Abnormal walking patterns.
- Certain medical conditions such as arthritis.
- One leg being shorter than the other.
Symptoms
SIJ pain is typically felt in the lower back and buttocks, but can also present around the hip, groin and extend down the leg to the knee. It usually feels like a sharp, dull or a stabbing pain. In most cases, SIJ pain is typically felt on one side of the body but may present itself in both joints as well (but this is much less common).
Other common symptoms are:
- Difficulty sitting for long periods of time.
- Feeling of instability in the pelvis.
- Difficulty sleeping on the affected side of the body.
- Increased pain when walking or running.
- Pain with certain movements e.g. sitting to standing, bending, twisting.
We can help!
Sacroiliac pain is often misdiagnosed as another back injury, so we will perform a thorough examination to ensure we correctly diagnose and treat your body. This may involve checking where your pain is located, your posture, how you walk and even muscle strength.
Once correctly diagnosed, we can use a range of soft tissue massage and manipulation (if needed) to help release tight muscles and realign the pelvis. This will also be accompanied by some stretches and strengthening exercises for your glutes and core muscles.
In some instances, we may recommend a sacroiliac belt to help stabilize the area, especially when the joint is moving too much and is very painful (commonly seen in pregnant women when their ligaments begin to relax).
If you are currently experiencing SIJ pain, we recommend avoiding running and limiting movements that inflame the joints, such as lifting and jumping. Even sports such as cycling and golf may cause pain and discomfort.
Below are a couple exercises to try at home to strengthen your core and glutes:
Bridge: Lie down on the ground with your knees bent and feet on the floor. Place your palms either side of your body and slowly raise your hips. Hold for 5 seconds, then slowly lower your hips. Repeat 8-10 times.
The bird dog: Start on your hands and knees, make sure your hips and shoulders are square and you are looking towards the floor. Slowly extend one arm and the opposite leg. Hold for 5 seconds before releasing down and changing to the other arm and leg. Repeat 8-10 times.
If you think you may be suffering from SIJ or lower back pain and want to avoid experiencing it in the future then give us a call on (416) 546-4887to book your appointment!
References
- Dydyk, AM., Forro, SD., Hanna A. 2021. Sacroiliac Joint Injury, StatPearls, Treasure Island (FL). Available from: https://www.ncbi.nlm.nih.gov/books/NBK557881/
- Yeomans, S. 2018. Sacroiliac Joint Dysfunction (SI Joint Pain). [Online]. Available from: https://www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain [Accessed 24 Nov 2021]
- 2013. 6 Best Sacroiliac Joint Pain Exercises, and 5 to Avoid. [Online]. Available from: https://www.braceability.com/blogs/articles/sacroiliac-joint-pain-exercises [Accessed 24 Nov 2021]
- Danisa, O. 2018. Exercise for Sacroiliac Joint Pain Relief. [Online]. Available from: https://www.spine-health.com/wellness/exercise/exercise-sacroiliac-joint-pain-relief [Accessed 24 Nov 2021]
- York Morris, S. 2018. Is Your SI Joint Causing Your Lower Back Pain?. [Online]. Available from: https://www.healthline.com/health/si-joint-pain#treatment [Accessed 24 Nov 2021]
Lateral Ankle Sprain
How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Approximately 2 million ankle ‘sprains’ (the word used to describe a ligament that has been over-stretched or torn) occur in the US every year alone, which gives you an idea of how many happen worldwide! Whilst many of these sprains occur in the sporting world, there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!
What is a ligament sprain?
Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorized into the following grades:
- Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
- Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
- Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.
Why is a sprain of the outside of the ankle so common?
The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.
Risk factors
One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:
- Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
- Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
- Being taller and heavier in weight
- Having wider feet
Signs and symptoms
Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):
- Pain (possibly preceded by an audible click or pop) over and around the affected ligament
- Swelling
- Bruising
- Limping on the affected side when walking
- Reduced movement of the affected ankle
- Instability of the ankle joint (i.e. excessive movement) if severe enough
After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).
Treatment
Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.
The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.
When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.
If you have sprained your ankle and need some help, look no further than your trusty osteopath. Call us today on (416) 546-4887 or book online to book your appointment and begin treatment immediately.
References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf
Lateral Ankle Sprain
How many of us have rolled our ankle and damaged a ligament at some point in our life?! The answer is many of us. Many sprains occur in the sporting world, but there are surprising amounts that occur in the general population. This shows us that we don’t have to be an elite sportsperson to be at risk of rolling our ankles. It’s an injury that can literally happen to any one of us… Picture Joe Bloggs walking down the street and slipping unexpectedly off the curb. Ouch!
What is a ligament sprain?
Let’s start at the beginning… Ligaments hold bone to bone. Two bones held together become a joint. Ligaments are responsible for providing a joint with stability (along with the muscles and tendons surrounding it), ensuring the bones of a joint do not move away from each other and dislocate. Ligaments are thick, strong bands of tissue that can withstand the majority of the large forces that run through our bodies when we move. Sometimes the force placed upon a ligament is too great for it to withstand, and this is when damage (or a sprain) occurs. Ligament sprains are generally categorised into the following grades:
- Grade 1: A mild sprain with only damage seen at a microscopic level and no joint instability.
- Grade 2: A moderate sprain where some, but not all, of the ligament fibres are torn. There may be very mild joint instability (or none) associated with this grade.
- Grade 3: A severe sprain where all of the ligament fibres are torn leaving the joint unstable.
Why is a sprain of the outside of the ankle so common?
The outside (or lateral aspect) of the ankle joint is one of the most commonly sprained regions of the body. The two leg bones (the tibia and fibula) run down the leg from the knee and slot in with the ankle bone, or ‘talus’ (pronounced ‘tay-luss’). The fibula bone runs down the outside of the leg and the tibia runs down the middle/inside of the leg. The very ends of these bones are enlarged lumps (known as malleoli… ‘mal-ee-oh-lie’). You can feel these lumps either side of the ankle. Where the malleoli meet the talus is where the outside (lateral) and inside (medial) ligaments are found. The medial ligaments are much stronger than the lateral ligaments which result in the lateral ligaments being injured more commonly. A simple roll of the ankle can cause an over-stretching or tearing of the ligaments here, depending on the force being placed on the ankle as it rolls outwards. In a normal healthy ankle, the ability to roll the ankle outwards is greater than that of rolling inwards… Another reason why lateral ankle sprains tend to occur more often.
Risk factors
One of the biggest risk factors for a lateral ankle sprain is having a history of ankle sprains. If you have done it previously, you are more likely to sprain it again! Other risk factors include:
- Being hyper-mobile or having excessive range of motion at the ankle joint due to naturally looser ligaments.
- Playing sports where turning, twisting and pivoting at high speed are a large part of the game (i.e. netball, basketball, football (any form), and racket sports)
- Being taller and heavier in weight
- Having wider feet
Signs and symptoms
Sometimes when you roll your ankle, the force placed on the ligament is not great enough to damage it. In these instances, you may experience no symptoms at all. For instances where the force is great enough to damage the ligament, you can expect to experience any or all of the following (depending on the severity of the injury):
- Pain (possibly preceded by an audible click or pop) over and around the affected ligament
- Swelling
- Bruising
- Limping on the affected side when walking
- Reduced movement of the affected ankle
- Instability of the ankle joint (i.e. excessive movement) if severe enough
After a severe injury you may not be able to walk immediately. The more severe the sprain, the more likely other structures in and around the ankle may be affected, including the possibility of fracture and/or dislocation (if the force is great enough).
Treatment
Most cases of lateral ankle sprains that enter our clinic are mild to moderate in nature. More severe injuries are often dealt with initially at an emergency department (i.e. if it has been necessary to rule out a fracture/dislocation), but may present to our clinic for ongoing management once the acute injury has begun to heal.
The first goal of treatment for lateral ankle sprains is to regain a normal walking pattern, whilst reducing the risk of further injury. This is likely to mean zero participation in your chosen sport to begin with, especially if pivoting and turning play a large part. We will work on reducing pain by massaging the muscles of the leg and foot. We may also need to work on muscles higher up the body, such as your back, glutes, hamstring and quad muscles. Any stiffened joints will be mobilized gently to restore range of motion. Any swelling can be dealt with using drainage techniques of the lower limb.
When normal walking has resumed, you can progressively load the ankle by adding in strengthening, balance, and more multi-directional agility exercises. The end goal for a sportsperson is to return to training followed by full match play. A non-sportsperson will look to return to their normal daily life without pain or dysfunction. A mild to moderate ankle sprain will take approximately 6-8 weeks to heal. More severe injuries can take months.
If you have sprained your ankle and need some help, look no further, our team can help you get back and running. Our osteopaths can help with treatment and rehab, whilst our chiropodist can help out with alignment corrections and shoe recommendations. Call us today on (416) 546-4887 or book online at beachealth.janeapp.com to book your appointment and begin treatment immediately.
References
1. Mackenzie, MH. et al. 2019. Epidemiology of Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training. 54 (6). 603-610. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602402/pdf/i1062-6050-54-6-603.pdf
2. Physiopedia. 2021. Ligament sprains. [Online]. Available from: https://www.physio-pedia.com/Ligament_Sprain. [Accessed 08 March 2021]
3. Beynnon, BD. et al. 2002. Predictive Factors for Lateral Ankle Sprains: A Literature Review. Journal of Athletic Training. 37 (4). 376-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164368/pdf/attr_37_04_0376.pdf
Gluteal Tendinopathy
Have you recently started to experience pain at the side of your hip? With the turn of the new year now behind us, maybe you’re embracing your new healthy lifestyle and have been going for a solid run several times a week to shift some of those festive kilos… Or it might just be that you’re getting a bit older, hitting the middle decades of life, and you’ve had a nagging hip for a while. There are a few structures in and around the hip that can lead to pain felt at the very outer aspect of it. Problems in the low back, the hip joint itself, and soft tissues that surround the joint can all be viable culprits.
Common culprits in the running and middle-aged populations are the tendons of the gluteal muscles. These muscles are responsible for movement at the hip (outwards, backwards and forwards) and stability of the pelvis and hip during movement. There are three gluteal muscles or ‘glutes’. The deepest muscle is the gluteus minimus, followed by gluteus medius, and finally gluteus maximus (which is the largest and most superficial of all three). Where the gluteus medius and minimus tendons wrap around the bony outer part of the hip and insert into the bone, are the areas most commonly associated with disease leading to pain in the outer hip.
Tendon disease
There are a few terms that can describe a diseased tendon. An acutely inflamed tendon is known as ‘tendinitis’, where ‘itis‘ means inflammation occurring at the tissue. A tendon which is chronically diseased (i.e. long-standing pain that may have been present for several weeks, months or years without the presence of inflammation), is known as ‘tendinopathy’. Historically the term ‘tendinosis’ was used to describe a chronic tendon problem, but tendinopathy is now the favoured term. The important thing is to think of a tendon problem sitting somewhere on a continuum between acutely inflamed and chronically degenerated and/or torn.
Let’s take our aforementioned population, a middle-aged female (females are more affected by this issue than males), who runs. What typically happens is they will start to run with the full intent of bettering themselves. Due to poor running technique, the tendon becomes overloaded and after a few weeks or months… Bang! Inflammation, pain, can barely walk! Once the initial pain settles and movement resumes, they start to run again. If they haven’t corrected the problem that underlies the initial acute episode, the problem compounds itself. The body will compensate, and further excessive load and compression are placed on the tendons and other surrounding structures. This might go on for a while with the hip grumbling from time to time. Eventually, the changes that have occurred to the tendon tissue result in widespread degeneration and derangement of the tendon fibres and you are left with a tendon incapable of dealing with the high loads required to do something like running. If left untreated, the tendon eventually tears and leaves you with a very unhappy and less mobile hip.
Signs and symptoms
The signs and symptoms of a gluteus medius and/or gluteus minimus tendinopathy include any or all of the following:
• Pain felt on the outside of your hip
• Pain that radiates down the thigh to the knee
• Pain that is worse before and after exercise
• Pain that improves initially with exercise (depending where on the disease process you are)
• Pain when lying on the affected side
• Difficulty walking up stairs or hills
• Difficulty standing on one leg (on the affected side)
Treatment
Your first port of call is to temporarily cease the activity that is aggravating your hip, and ring your osteo (ahem… 416-546-4887). This will help to de-load the injured tendon, and give you relief knowing soon you will be in the hands of an expert who is going to guide you through your recovery journey. We will assess your movement from top to bottom and work out where the root cause of your problem is. This is what osteopaths are great at doing. We look beyond the pain, take a picture of your whole life (occupation, hobbies, family life, etc…) and work out all of the contributing factors, so we can put a comprehensive plan in place to rid you of your problem forever.
For a gluteal tendon problem to occur in the first place, there will likely be mechanical issues to correct in the spine and/or lower limb (from the foot up). We do this with a combination of:
• Hands-on therapy to soothe your pain and improve muscle and joint health
• Re-training of poor movements into more efficient movements
• Strengthening exercises for the muscles / tendons
• Alterations to your daily life which may be contributing to your issue (i.e. increasing particular activities, decreasing aggravating activities, changing a work posture)
Over time, treatment will aim to progressively strengthen the gluteal tendons, so they are capable of withstanding greater loads again. Combined with correction of poor, inefficient movements, this will also decrease the compressive forces acting on the tissues in and around the hip, leaving you with greater strength and more flexibility.
We will be with you every step of the way. A gluteal tendinopathy doesn’t mean you have to give up running. We might need to change focus for a short period during rehab, but our goal will be to get you back to your pre-injury state… with a little extra in the tank so you’re not back with us for the same issue within two months.
Hip pain, was it? No problem. We got this! Contact us
Plantar Fasciitis
It’s morning, and the alarm clock has just told you it’s time to get out of bed. Another few minutes won’t hurt. You check your emails, social media sites, and you even ring your mom to see how the dog slept last night… basically anything to delay putting your feet on the ground and taking those first steps to get the day started. And it’s because of this pain you’ve been getting on the bottom of your heel every morning for the last few weeks. And it’s getting worse… Time to see your osteopath!
There are a few things that can cause pain on the bottom of the heel, but the most common cause is a condition named plantar fasciitis (also known as plantar fasciopathy).
What is plantar fasciitis?
Plantar fasciitis is an overuse condition affecting the plantar fascia. The plantar fascia is a layer of soft tissue that stretches along the bottom of the foot, from the heel bone to the metatarsal bones in the front of the foot. It helps to provide stability to the arch of the foot and is similar in make-up to a tendon (the things that attach muscle to bone). If too much stress is placed on this structure, over time the tissue can degenerate, weaken, and start to give you pain. The pain is commonly felt where the plantar fascia attaches into the heel bone.
Risk factors
Scientific research suggests there are a few groups of people who are more prone to developing plantar fasciitis. These include:
- Runners
- People who are over-weight and lead a sedentary lifestyle and/or spend long periods standing for work (e.g. a factory worker)
Important things to consider with these at-risk groups include:
- Foot alignment and arch height: Having a very low or high arch or having excessive or not enough movement in the foot joints can lead to the development of this problem.
- Amount of training: Increased levels of training can place greater stress on the plantar fascia more regularly.
- Footwear: Wearing certain types of footwear when training can lead to an increased risk of plantar fasciitis (i.e. wearing athletics spikes, or the wrong footwear for your foot type).
- Muscle strength and flexibility: Decreased strength in the muscles that control toe movement, as well as weakened and tight calf, hamstring and gluteal muscles are all associated with higher rates of plantar fasciitis.
Signs and symptoms
The signs and symptoms of plantar fasciitis include:
- Pain at the bottom of the heel
- Pain that appears as a gradual onset
- Pain felt first thing in the morning (i.e. taking those first steps out of bed in the morning is classic!)
- Pain that decreases with activity, but increases again afterwards (early stages)
- Pain that increases with activity and pain felt at night (latter stages)
- Pain felt after periods of prolonged rest during the day (i.e. being sat at your desk for 2-3 hours and then getting up again)
- Tight calf, hamstring and gluteal muscles
- Weak muscles that help to support the arch of the foot
- Stiff or over-flexible foot and ankle joints
Diagnosis and treatment
First things first, if you have heel pain that sounds similar to the picture we have painted above, make an appointment with us now (you know what to do call us on (416) 546-4887). Once we have asked the relevant questions, performed the necessary tests, and are convinced that the issue stems from the plantar fascia, we will formulate a plan with you with short and long-term goals to reach within a set time.
Initial hands-on treatment will include a combination of massage, joint mobilisation and manipulation, and dry needling of the lower limb muscles with the aim of correcting any mechanical issues that are playing a role in this issue. Depending on the presentation, we may also use tape around the foot and ankle to provide support and reduce the stress being placed on the tissues. Other treatment will include advice on weight loss (if required), training regimen, footwear, and exercise prescription that helps to lengthen and strengthen tight and weak muscles. Some cases of plantar fasciitis may require a foot orthotic or in-sole to provide extra support to the foot whilst wearing shoes. This would be best recommended and assessed by our Chiropodist (foot specialist) at Beachealth.
Plantar fasciitis is a tricky condition to treat which may require ongoing treatment for several months. We will endeavour to get you pain-free in the shortest time possible, so we recommend following all advice to a T, which may include a reduction in the amount of training you are doing at present. When you start to hit goals and we see improvements being made, we’ll have you back up to your full training program before you can say “plantar fasciitis”.
Imaging?
People regularly ask if they need imaging for such an issue, but the majority of cases of plantar fasciitis can be diagnosed with a thorough case history and physical assessment. This is where we excel! Imaging is there for cases that do not respond to treatment and for those instances where we need to rule out a more serious problem.
If you need help with heel pain, please call us today on (416) 546-4887 to book your appointment. Let’s have you putting your best foot forward, ASAP! 👌
References
1. Thompson, JV. et al. 2014. Diagnosis and management of plantar fasciitis. Journal of American Osteopathic Association. 114 (12). Available from: https://jaoa.org/aoa/content_public/journal/jaoa/933660/900.pdf
2. Brukner, P. et al. 2017. Clinical Sports Medicine. 5th ed. Australia: McGraw Hill Education
3. Harvard Health Publishing. 2007. Easing the pain of plantar fasciitis. [Online]. Available from: https://www.health.harvard.edu/newsletter_article/Easing_the_pain_of_plantar_fasciitis. [Accessed 15 Jul 2020]
4. Orthoinfo. 2010. Plantar fasciitis and bone spurs. [Online]. Available from: https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs. [Accessed 15 Jul 2020]