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]

Is the Empty Can Test A Good Rehab Exercise?

Over the past couple of weeks, I have been seeing a few more shoulder injuries, all which have started for many different reasons. There have been falls, sports injuries and others which have been there for a long period of time. However, with some of the presentations there has been a common factor and that has been a particular exercise or rehab that has been prescribed.


After spending some time with the clients going through their medical history and working out actions that may aggravate or relieve their pain, we are able to come to a clinical impression, which gives us an ability to determine a personalised rehab plan to the shoulder joint. The shoulder can be a complicated joint as there are lots of different muscles which attach around the area and influence its movement.
While I don’t like to call out another practitioner or say that one exercise shouldn’t be performed, I do believe that there are exercises that are better for people so that we are to strengthen an area while limiting pain.

The empty can/ full can exercise involves taking your arms out to the side (abduction) on about a 45-degree angle and turning your thumbs down (pronation) or as if you are pouring a can out and then turning the can upwards (supination) this exercise is done with weights being held and repeating the pronation and supination action.

This exercise has been proven to target the supraspinatus muscle, which is one of the four rotator cuff muscles. When you pronate your wrist, we decrease the amount of space our shoulder joint has to move and this is one of the many reasons that people may get shoulder pain. So you can imagine that if you have been given this exercise from a healthcare practitioner and you are getting a sharp pain in the front of your shoulder, your desire to perform the exercise is not going to be very good. So how do we target the muscle without placing our shoulder in a painful position?

There are a number of different ways, but to keep it simple, standing external rotations and lateral raises, should be sufficient enough to train the muscles. Each person is different and require slightly different instructions or cues to help them feel the activation of a muscle, but as a general sense these 2 exercises can activate the muscle correctly without putting the shoulder into a position which may cause more impingement pain.

If you think that this could be beneficial for yourself, please don’t hesitate to contact us at the clinic

Written By: Brendan Ashman

Ice or Heat

Heat v Ice to Treat a Sports Injury

Most patients ask ‘do I use heat or ice?’ Now the answer to this question generally is if it’s acute or chronic.

An acute injury, being one that happened suddenly, will show signs and symptoms of pain (usually intense), local tenderness, redness, warm to touch and swelling. These signs and symptoms are mostly the result of internal bleeding and inflammation, which is the body’s response to an injury occurring suddenly and usually the inflammatory process should last 48 hours. The best therapy for an acute injury in these initial stages is rest and iceIce is a vasoconstrictor (it causes the blood vessels to narrow) and limits internal bleeding at the injury site and would therefore reduce the swelling and pain. Apply ice (wrapped in a thin towel) to the affected area for 10-15 minutes at a time and generally repeat every hour (if needed). The main goal during these initial stages is that you want to isolate, decrease and prevent the inflammation from spreading further.

Chronic injuries, on the other hand, can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal. Chronic injuries generally do not have inflammation or swelling and that is when heat a good form of therapy. Heat is best to stimulate blood flow, increase the elasticity of joint connective tissues and help relax tight muscles or muscle spasms. Safely apply heat (i.e. wheat pack) to an injury 15-20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Because heat increases circulation and raises the skin temperature, you should not apply heat to acute injuries or injuries that show signs of inflammation, as this will generally make them worse. This is a common mistake made by a lot of people with acute injuries, so please use cold in the initial stages of injury.

Some exemptions to the rule are:

Heat is recommended in an acute injury once the inflammation has settled down (usually after 48 hours). This will encourage the blood flow to the injury site and promote the healing process.

If you have a chronic injury, but suddenly aggravate the injury and the pain greatly increases in severity, ice would be recommended for the next 2 days. This type of injury is also known as acute on chronic.

If you are unsure or the injury does not show signs of improvement within 48 hours please consult with your local doctor or osteopath.

 

Written by: Daniel Stasiuk

Ankle Sprains

The ankle is made up of 3 bones: The Tibia (the shin bone), Fibula (runs on the outside of the shin bone) and Talus (connects our foot to the shin bone). The bony bumps found on the inside and outside of the foot are called the medial and lateral malleolus.

The way the ankle is designed, its primary movement is dorsi and plantar flexion (up and down), while it is subtalar joint which produces eversion and inversion movements (turning foot in and out).

 

The ankle has a number of ligaments which holds the bones together and allow the ankle and foot to move. The two main sets of ligaments which originate from the malleolus are the Medial and Lateral Ligaments.

The Medial Ligament, or the Deltoid ligament is a strong, flat and triangular band which consist of four ligaments and fans out from the medial malleolus to the talus, calcaneus and navicular bones. The primary action of this ligament is to resist over-eversion of the foot or rolling the foot inwards. This particular type of rolling motion which may cause an ankle sprain is rare and is normally associated with a fibula fracture known as a Pott’s fracture.

The lateral Ligament has 3 parts to it, which we separate into 3 different names. The Anterior talofibular, Posterior talofibular and Calcaneofibular ligaments. They all originate from the lateral malleolus and attach onto other bones of the foot. These ligaments all resist over-inversion of the foot. This type of ankle sprain is the most common.

So how do we treat a sprained ankle?

As osteopaths, we have a number of special test that we can do to make sure that we are able to identify the exact ligament that is involved and rule out a fracture. If we are unable to rule out a fracture we may advise an x-ray to identify a break and possibly a cast if needed.

If no break is suspected, the first goal of treatment is to assist in getting the swelling down while keeping as much range of motion throughout the foot and ankle bones. Rehabilitation is extremely important with a ankle sprain and vital for getting the person back to their sport or daily task. We would start off with some advice which would include rest, ice, compression and elevation (RICE). Then followed by basic ankle and foot range of motion exercises such as the ABC’s (which is just moving the foot to the letters of the alphabet).

Once the person’s pain and swelling has decreased and their range of motion is better, we can start to add in some harder exercises like balance exercises, theraband ankle work and increasing their range of motion exercises. The very last step is to make the persons rehab a little more sport specific to them, such as hopping, jumping and changing directions. Whether it is basketball, running or just getting back to playing with the kids.

 

Written By: Brendan Ashman

Concussions and Our Kids In Sports

After a conversation with one of the Beach Integrated Health Clinics patients, the topic of concussions with kids in sports came up. It prompted me to write a little bit about concussions, what to look out for and how as Osteopaths we can help.

So what is a concussion? A concussion is an injury to the brain that results in temporary loss of normal brain function. It is usually caused by a bump, blow or jolt to the head or body. This force to the body or head may or may not involve a loss of consciousness. Often there are no specific signs of head trauma like bleeding or even a bump.
A person who has suffered a concussion often cannot remember what happened immediately before or after the injury and may act confused. Which is why it is important to know the type of questions to ask someone if you suspect a concussion has occurred. A concussion can manifest in different ways such as altered memory, judgment, reflexes, speech, balance and muscle coordination.

Who can suffer from a concussion?
Everyone has the potential to get a concussion at some point in their life. Studies have shown that concussions seem to effect women more than men. Which could be for a number of reasons, though researchers seem to think the main reason for that is because women are more likely to report it or at least mention it to their healthcare professionals. A person who has had a previous history of concussions, especially a history of 2 or more concussions, are more at risk for increase in symptoms.

Symptoms of a concussion may include:
• Prolonged headache
• Vision disturbances
• Dizziness
• Nausea or vomiting
• Impaired balance
• Confusion
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
There are also some post Concussions symptoms to be aware of, as some symptoms may not show immediately.
• Mental fog
• Mental slowness
• Memory loss
• Confusion
• Irritability (especially in children)
• More emotional
• Nervous
• Sad
• Difficulty falling asleep
• Sleep changes
There are ways to decrease the risk of a player getting a concussion in many sports like encouraging kids to wear a helmet in sports such as hockey and rugby if it isn’t already compulsory, however, this will not 100% stop a concussion from occurring.
The treatment for a concussion is rest. However, we must take into consideration the severity of the concussion and other factors that might be inhibiting the individual to heal. For example: after a tackle in football a player may hit their head and get a concussion. After 72 hours they may still have some neck pain and a dull headache. Although the concussion may have settled down, the player may have some neck stiffness or pain, which is causing the headache to be persistent. This is where our Osteopaths can help. Having spent time as an Australian Football league Trainer 1 have seen my fair share of concussions and it is important to treat all concussions as a serious injury. While taking a medical history and we decide on techniques that are a little gentler, so we don’t expose the individual to a jolting sensation through the body, neck or head to our treatment.
If you come across a person who you suspect does have a concussion the rule that I like to follow is if in doubt sit them out. While they may be unhappy that they cannot return to the sport, it is always better to be cautious. If they subject their body or head to another heavy blow, it may increase the persons symptoms exponentially.

By Brendan Ashman
Manual Osteopathic Practitioner

Getting your bike setup correctly

Over the last three weeks, the Tour De France has been running. The Tour consists of 21-day stages over a 23-day period, and the riders will cover around 3,500 kilometres (2,200 mi). While not all of us are elite athletes, there has certainly been an increase in cyclist on the road with the nice weather.

Cycling can be a great form of exercise. We get a great cardiovascular workout and it helps improve the strength of the leg muscles. There are, however, many common injuries that can occur when we start to ride or with high volume riding without the correct recovery methods.

Some of the most common sites of pain in cyclists are the neck, shoulder, knee, lower back and sacroiliac joints (SIJs). There are many reasons in which a person might be experiencing pain. It could be related to a new hobby, a predisposing injury, muscle tightness, or it could even be the set-up of your bike. Just like a work desk, our bike set up can be incredibly important to ergonomics, decrease injury, aid in decreasing pain and keep you riding for a longer period of time.

Getting the correct set up on your bike will depend on what kind of bike you have, how tall you are, shoulder reach, as well as what feels comfortable.

Here are a couple of quick tests you can do:

To check your seat height get onto your bike with one leg straight and place the heel of your foot on the pedal at the lowest point, which should make your leg straight. If this does occur then your saddle should be at the correct height for you.

To find the best saddle position, you should sit on the bike with the pedal at 3 o’clock. Place your foot with the joint of the toes on the pedal spindle. In the perfect scenario an imagery perpendicular line should run from your knee-cap through the spindle of the pedal. If the line runs behind the spindle, then the saddle needs to be pushed forward. If the line runs in front of the spindle then the saddle needs to be pushed backwards.

There are a lot of measurements and angles to take into consideration when setting up your bike with an ergonomics assessment. My best advice is that if you are experiencing any pain before, during or after riding your bike, it might be worth a visit to your local bike shop or your local specialized practitioner and ask for an ergonomic bike set up. This will allow to can for longer with the correct posture and decrease your chances of dealing with some of the getting some of the common cyclist pain.

If you would like more information on ergonomic set ups on bikes. Please ask us for a bike set up hand out.

 

Written by Brendan Ashman

 

Did you know that Brendan recently did a certification course for bike fitting and setup. For more information please ask Brendan at brendan@beachealth.com or call (416) 546 4887