“It’s just a rolled ankle”

We, as physiotherapists, hear this all the time; Ankle sprains are one of the most common injuries amongst the sporting and general populations.  Because of the common presentation and often quick resolution of symptoms, many people think of ankle sprains as a relatively minor injury.

However, ankle sprains can leave people with increased laxity of the ankle ligaments, pain, and instability of the joint.  In fact, up to 70% of people who sprain their ankles will do it again.

The good news is that rehabilitation programs have been shown to significantly reduce the recurrence of ankle sprains.

The term “ankle sprain” means that a ligament (or ligaments) in the ankle has been injured.  Ligaments are dense fibrous tissue that connects bone-to-bone providing strength and stability to the joint.  When the ligaments are injured, the stability and strength of the joint are compromised leaving the surrounding muscles to provide stability.

This is where physiotherapy and rehabilitation comes in. After a detailed assessment, your physio will provide you with advice for the management of your acute ankle injury, as well as a rehabilitation program aimed at restoring the stability of your ankle joint through strength, coordination, and proprioception training.

With the winter sport season well underway and ankle sprains being such a common injury on the sporting field, don’t leave this type of injury unattended.

To book an appointment, call 08 9335 7733

Written by: Keri Meyers, Physiotherapist

References:

Gribble PA, Bleakley CM, Caufield BM, Docherty CL, et al. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016;50:1493–1495.

Brukner, P., Clarsen, B., Cook, J., Cools, A., Crossley, K., & Hutchinson, M. et al. Brukner & Khan's clinical sports medicine (1st ed.).

Is Taping the way to go?

With the local winter sports season well and truly underway, we as physiotherapists often get asked the question, should I use tape?

The use of tape has been part of a physiotherapist's toolkit for a number of years. Throughout this time there have been a number of changes to the materials, techniques and even 'styles' involved in taping, and with elite athletes often wearing tape that is clearly visible to the weekend warrior's amongst us, the question of whether to use tape or not, has only increased.

So, should we be taping?

The question of whether to tape an area or not comes down to consideration of a few key principles.

Tape will not prevent an injury. This point is key. A lot of people expect that if they tape an injured or susceptible area, it will rid them of the risk of injury. This is not the case. Tape may reduce the severity of an injury, but does not eliminate the risk. So for example, a taped ankle can still sprain, but it may reduce the severity of the sprain. This is evident in elite sport. A lot of elite athletes, such as AFL footballers, will prophylactically tape. Meaning they tape a body part, ankles being a common example, despite never having a serious ankle injury. There are still ankle sprains in the AFL, so the tape doesn't stop injury. But the tape is there to attempt to reduce the severity of the injury and hopefully reduce the number of matches missed.

Another important point is that tape should never be substituted for a proper rehabilitation program. If you know you have a weakness in a certain area that makes you susceptible to an injury, taping is fine, but do yourself a favour and consider seeking the advice and guidance from a health care professional, to address the weakness.  An exercise program that helps reduce the risk of injury is often of benefit and can be used in conjunction with taping. But rarely do we recommend the use of tape in isolation.

This flows into the next question that we get asked. Will taping make my joint weak? My advice. Regular taping is fine, as long as there is the counterbalance of some other strength, balance or conditioning work. To understand this point further we need to understand what tape does.

Amongst other things, taping helps provide proprioception to a joint. What this means is that tape helps enhance the feedback loop that naturally occurs in our body. When we walk or run, the tissues within out lower limb give feedback to our brain on what they are doing. To take the ankle for example again, when we step on an uneven surface the tissues in our ankle send messages to the brain saying where they are. The brain then interprets the information and sends signals back down to muscles and tendons around the ankle, instructing what to do, so that we don't lose our balance. Tape gives more sensation around the ankle, so helps provide more feedback to the brain and can enhance our proprioception. If we were to tape our ankle all the time and didn't exercise it without tape on, the feedback loop can become reliant on the tape itself. We could then feel 'weak' in everyday activities.

This applies for taping of all joints and isn't ideal. So, if you do tape regularly for matches or training, it's best that you do something that works on the tissues around the joint, without tape on and help maintain the natural feedback loop within the body. This could be specific physiotherapy exercises or simply doing some sports specific training without tape on.

The last point to consider is tissue healing and the risk of re-injury. If you have had an injury to an area but by taping the joint, you feel you can return to play quicker, make sure you seek professional advice before simply doing so. It's important that you know the risks before stepping out onto the playing field and a health professional will be able to give you guidance on whether it's a good idea or not. There are some circumstances where a physiotherapists will allow a person to return to play, if taping allows them to function better, but this decision is made with careful, professional consideration to how well the tissue has healed and what the risk of further injury is. 

So should we tape? Of course! But make sure it's done in consideration of the principles mentioned above. Realise that it won't prevent an injury from occurring, you do need to do something else to help with your recovery or injury prevention and that seeking advice when you are unsure is probably the best thing to do.

Tape is a wonderful tool and there's a place for it in all levels of sport and recreation. Be sensible about when you use it and it certainly can be the way to go.

The old fashion cork

Recent injury to Brownlow favourite Nat Fyfe, has reminded me of the importance of managing an old fashion cork. It’s been widely reported that Fyfe received a knee to the quad in a controversial incident with Sam Mitchell when the Dockers played the reigning premier three weeks ago. Fyfe, soldiered on for two weeks before missing Freo’s most recent clash with GWS due to a documented groin injury. We can only speculate whether there is a relationship between the two injuries but nevertheless it’s reminds me of the common perception that, ‘it’s a corkie… it’ll be alright’.

Most people know that a cork is the result of direct contact to the muscle by an external force. Whether this is an errant elbow or knee or landing awkwardly on the ground, a lot of us can relate to that numbing moment when you’ve received a cork. As a result of the trauma, the muscle bleeds and a haematoma develops within the tissue. (For ease, I will refer to the haematoma as a cork for the rest of this blog.) Bruising develops, often within the hours and days following and the feeling of a very stiff muscle to touch is there for days and sometimes weeks.

I’m sure many of us have heard the stories of how corks used to be managed. Heck I’m sure there are many of you that as your reading this, are getting flashbacks to the time when you were on the bench, digging your fingernails into the rickety old physio table, as the trainer did their best to inflict as much pain as physically possible, lathering the decorub and stripping the muscle to within an inch of it’s life, attempting to rid you of the dreaded ‘corkie’. I’ve been told many a time in the past to ‘run it out’ and push through, but my more recent experiences with corks, have made me realise the management of these type of injuries has changed and for the better.

I’ve seen some horror stories. Players that have thought it would be best to self manage their cork, failing to report to me until they have already returned to the training track. I remember on one occasion a footballer reported feeling a strain after they went back to training too soon without consulting anyone first. Even after a strain was diagnosed they failed to follow instruction. A week later I was sending them for an ultrasound of their quad, which revealed a cavity a cool 22cm long. The cork had bled again after the strain, essentially splitting the muscle, leaving a long cavity full of fluid to collect. In the case of corks this is a train wreck and extremely rare. And although my aim is not to scare readers, it highlights the importance of at least getting it checked by a trainer or health care professional.

So how is a cork best managed? Should we be continuing to run? In some cases this is ok but in the interest of preventing further injury, always get an opinion first. In general, ice should be applied immediately and can be repeated every two hours, for 20 mins. How long you use ice for is still under conjecture, but using ice for 72 hours post injury is generally accepted. Compression can be applied but be sure to remove it overnight.  Elevate the leg when possible to help remove swelling and keep the area moving in the most pain free way. Avoid stretching the muscle until you’ve sought the advice of a trainer or physiotherapist and have a confirmed diagnosis. Avoid massage in the early stage as this will make the muscle bleed more and hold yourself back from heading out on the town and getting on the drink.

Returning to training or playing depends on many factors such as your strength and muscle length, so have these tested before getting back into it. If you come back too early, running around with a muscle that is not functioning properly, could predispose you to overload in other areas and muscles. Is this the case with Fyfe? Unfortunately we can’t say it is because we don’t have the inside word and the reality is he would have received the best standard of care, so there is every chance his groin injury is completely separate. But it has reminded me of times when it has been the case so again make sure the muscle is working well before returning to play.

As always, my advice would be to seek professional advice and treatment to make sure your dealing with a ‘cork’ and not something else such as an intermuscular haemotoma, which is a little different to a cork, whereby the bleed happens between the layers of muscles instead of within the muscle itself. Remember good management in the early stage will help prevent further injury.

The battle against concussion

It seems the more we learn about concussion, the more questions are raised. Should we be wearing helmets? Should we be playing contact sports? I often wonder what runs through the head of those that are on the frontline in regards to researching head injuries. Surely amongst them there has to be someone that loves to watch a cheeky game of football from time to time. Do they too fear that we will one-day lose contact sport to concussion?

In recent times there has been an increase in the amount of information available regarding the long-term effects of multiple concussions. Post-concussion syndrome has been identified as a possible long-term effect of a severe or concurrent head injury and comes with various undesirable symptoms. But could the way we handle a concussion also affect the likelihood of longer-term problems?

In our profession, we are passionate about handling injuries with the upmost care. For me, the way you manage a concussion is the most important. Remember, concussion is a brain injury, an injury to our most vital organ.

We saw on the weekend a sickening head-clash between two Sydney Swans. We saw one of them, Buddy Franklin, lose consciousness from a knock to his cheek. He’s out cold well before he hits the ground. You wouldn’t be silly to be surprised that the result was a concussion rather than a fractured cheekbone. But it’s what we don’t see, which explains why Buddy was left laying there the way he was.

Buddy’s brain, had rattled within his head, hitting his skull, most likely once at the front and once at the back, much like how a pin ball bounces quickly from a nearby barricade and then ricochets back to where it came. The brain suffers trauma and Buddy loses consciousness.

The way we manage someone like this is important. Obviously professional sports people have professional support, but in the general community we don’t necessarily have this on hand. So what should we do?

Anyone that loses consciousness, no matter how short a time that may be, should be removed from the ground and should not be allowed to return to play. This topic is well debated amongst those in professional sport and still to this day many players return later in the match. The AFL introduced the concussion rule a few years back to allow the highly trained staff extra time to assess a player thoroughly and ensure they were not at risk of returning to play. This is still being debated as best practice within media circles. But I think it’s safe to say that if people are still discussing it at the highest level with the highest professional support, we can say it’s best to keep people off the ground at community level.

Allow the player to rest. Just like when you tear a hamstring, that initial stage requires a level of relative rest to allow tissue healing. This means avoid vigorous exercise and anything that stimulates the mind. So put away the Suduko’s and cross words for a while and let the mind recover.

Avoid alcohol; it is a vasodilator of your blood vessels, which means it will increase your blood vessels diameter. When you suffer a concussion the body is already pumping blood to the brain to help with healing. This is normal and healthy. If you add alcohol to the equation, more blood will be pumped to the brain then is required for healing and it will ultimately impede recovery.

Importantly keep the patient safe and monitor their symptoms. Make sure they don’t drive, they have someone that can stay with them at home and look for signs that they maybe deteriorating. Any headache, dizziness, nausea or vomiting and vision impairments that are becoming gradually worse should all be taken as a sign to be checked out immediately. Remember if they fall asleep you can’t monitor this so don’t allow them to go to bed until around their usual bedtime. Don’t be cruel and keep them awake all night, remember the brain needs rest. And as always, the safest bet is to have them checked by a healthcare professional.

In regards to returning to play, most local competitions these days have imposed a policy of having a concussed player assessed by a GP and obtaining a medical clearance before returning to sport and I think this is a fantastic initiative.

Please treat brain injuries the right way. Hopefully the better we become at managing concussion, the more often a patient will completely recover, the fewer the incidence of long-term symptoms will occur and the less likely we will lose contact sport to concussion.