Almost everyone has twisted their ankle at some in their life; in fact, it is one of the most common reasons for people to visit an emergency department. Technically an ankle sprain has occurred when an ankle twists, causing damage to one of it’s supporting ligaments. The ligaments can be overstretched, partially torn or completely ruptured, depending on the force of the injury. The ligament that is most often involved is the ATFL. ATFL stands for the anterior-talofibular ligament, located on the outside of the ankle.
While there are many ligaments surrounding and supporting the ankle, this ligament is the most vulnerable as it stops the ankle from rolling inwards. This is the way that most ankles are injured. Athletes who jump while moving in different directions, such as basketball players, are actually the most prone to this injury. They often land on their foot when it is not completely flat, twisting it and injuring the ligaments.
What are the signs and symptoms?
Most people won’t have any problem diagnosing that they have a sprained ankle. The symptoms are pain, swelling and tenderness over the area of damage, usually the outside of the ankle. Depending on the severity of the injury, there many be bruising, reduced range of movement, instability and pain with weight bearing. In more severe injuries there may even be a loss of function, where you are unable to walk on the ankle and numbness and/or a feeling of coldness in the foot.
Why should I see a physiotherapist?
Twisted ankles can also cause a fracture of the ankle, not just ligament damage. Oftentimes a bad sprain and a fracture cannot be told apart without proper medical assessment and an X-ray. Your physiotherapist is able to identify if your sprain is severe enough to need further investigation to rule out a fracture. They will also classify the severity of the sprain, providing you with a clear course of treatment. There are many factors that can lead someone to be more prone to fractures, including general hyper flexibility, unsupportive footwear and anatomical structure, however by far the most common reason for an ankle sprain is the existence of a previous sprain without complete rehabilitation.
This is because following an ankle sprain, many people are left with weakness, instability or stiffness, reduced balance and proprioception – which is a sense of where your body is positioned. These things can mean that the next time your ankle is in a vulnerable position you don’t have the strength, awareness of position, balance or structural control to ensure it is in the correct position before putting all your weight through it, causing another injury.
As well as helping you reduce and recover from the pain and swelling of the injury in the early days, your Physiotherapist is trained to identify which issues are likely to affect you in the future and assist you with a personalised rehabilitation programme to ensure your ankle is as strong and stable as possible to prevent future injuries.
None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
Have you ever been to see a physiotherapist for pain in one part of your body and when they treated you, they focused on a completely different area? While this can be a strange experience, it can be even more puzzling when the treatment actually works. So what is going on, shouldn’t pain be treated where it is being felt?
When pain is felt at a different location from where the pain is being caused, this is called ‘referred pain’ and is actually more common than you think. Exactly why this happens is a little complicated, and in fact, we don’t yet understand everything about the way that pain is processed.
Pain is usually felt when something causes damage to the body, sending an electrical impulse to the brain. The brain receives this information and processes it to make sense of which part of the body the signal is coming from and what kind of pain it is. When the brain thinks that the pain is coming from a different area than where the damage or signal is actually coming from, this creates the phenomenon of referred pain.
Sometimes referred pain is easy to explain, such as when a nerve becomes injured or irritated, causing the pain to be felt along the length of the nerve. This often feels like a sharp, burning pain that runs in a strip, along the skin. Other examples of referred pain are more difficult to explain and in some cases seem to defy explanation. Perhaps you have heard about the strange phenomenon of phantom pain where amputees continue to feel pain as though it was in the place where their limbs used to be.
Muscular trigger points can also cause referred pain. The mechanism behind this is a bit trickier to understand, but is thought to be explained by tight bands of muscle tissues that cause pain to be felt in predictable patterns around the body.
Adding to this, we know that other tissues of the body can cause pain to be felt in a different location, including discs of the spine and internal organs. Many times the internal organs can refer pain in peculiar patterns and this can actually lead to serious illnesses being mistaken for muscular aches and pains. Kidney pain can be felt in the lower back and tragically, some people fail to recognize that they are having a heart attack because they feel pain in their neck and arm, not in their chest.
We also know that not understanding or being afraid of pain can make pain feel stronger. In rare cases, people who have pain in one hand can feel pain just by seeing their other hand moving in a mirror. There are many other fascinating aspects to pain, and understanding how it works is an important part of managing your symptoms.
To understand how referred pain may be affecting you, chat to your physiotherapist who can help with any questions.
Lightly grease a grill or pan with olive oil and place on medium-high heat
Cut avocados in half, remove the seed, keeping the skin intact. Place avocados face down on the grill for a few minutes, allowing them to brown slightly. Remove from heat and allow to cool. Cut tomatoes into halves and grill face down for 2 to 3 minutes. Remove from pan and allow them to cool. Cut onions into large rings and place on grill for 2 to 3 minutes, each side. Repeat this process with halved limes, grilling for 1 to 2 minutes.
Once cooled, remove the skins of the avocados. Cut all vegetables into small pieces and mix into a bowl. Mash the ingredients together, adding chopped coriander, seasonings and the juice of the grilled limes, until completely combined.
When the two surfaces of the hip joint move over each other, they usually move freely without any friction. If there is an alteration to either the socket part of the joint (the acetabulum) or the ball (the head of the femur), irritation may occur as the two surfaces move over each other. This is known as Femoroacetabular impingement, a common disorder of the hip, characterized by pain and stiffness.
Femoroacetabular impingement can be classified as cam, pincer or mixed. A cam FAI occurs when the femoral head junction is flattened or a small bump is present. Pincer type of impingement occurs when the acetabular rim extends slightly, causing the femur to be impacted. Cam impingement is more common in men while pincer impingement is more common in women. However, most cases of FAI (about 85%) are mixed, meaning they both have cam and pincer types of impingement.
What are the symptoms?
The most common symptom of FAI is pain located in the hip or groin when resting in certain positions of with specific movements. Some patients also report pain in the back, buttock or thigh. Other symptoms include stiffness, loss of movement range (particularly of the hip), locking, clicking or a feeling that the hip is about to give way.
Activities that cause the incongruous surfaces to move over each other repeatedly are naturally the main culprits for causing symptoms. These can include prolonged sitting, twisting, sitting with crossed legs, squatting and climbing stairs can all aggravate the pain caused by femoroacetabular impingement.
What are the causes?
There are many factors that may cause an individual to develop femoroacetabular impingement including;
Hip dysplasia or malformation during infancy/childhood
Repetitive stress on the hip
A femoral neck fracture that did not heal properly (malunion)
Small bony growths around the joint called osteophytes.
Normal anatomical variation
How can physiotherapy help?
Femoroacetabular impingement is a complex condition and researchers are still determining the best possible treatment. It is thought that untreated FAI can lead to osteoarthritis of the hip down the track and there are both surgical and non-surgical options for treatment. Conservative (non- surgical) management for FAI involves core stability training, strengthening exercises for the lower limb specifically the hip and postural balance exercises. This program aims to improve the hip’s neuromuscular function. A hydrotherapy program can also helpful as it reduces weight through the joint, making movements more comfortable. Lastly, a home exercise program is made for patients, so they can continue treatment at home. For many people, physiotherapy is enough to resolve their symptoms and prevent future problems, however other may require surgery.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
Many people know the value that physiotherapy brings to their life and some have even been visiting their physiotherapist since childhood. However, for those who have never been to see a physiotherapist before, there can be a question mark over exactly what it is that physiotherapists do. In fact, this is one of the most common questions physiotherapists are asked.
What does a physiotherapist do?
The answer is tricky, because physiotherapists do so much. Primarily, we might be described as pain management experts, as we work to reduce the pain of our patients, from those who have suffered a new injury, to those who have had pain for several years. We first identify the cause of the pain and then provide manual therapy techniques, education and management strategies to help our patient understand, manage and reduce their pain.
While pain is usually the first thing that brings patients to see a physiotherapist, this pain has often caused patients to give up activities that they love and can even be getting in the way of everyday tasks. Many of us reduce our activity levels to reduce pain without even realizing it. Physiotherapists are able to identify which areas you are struggling in and why this is occurring. By identifying the cause of your symptoms, we can help to get you back to full function. Physiotherapists are able to do this for everyone including elite athletes and those dealing with serious disabilities.
In fact, physiotherapists have a role to play at practically every stage of life. We can assess infants to monitor their motor skills development and as they grow we help them deal with the pains and vulnerabilities of a growing body. Among other things, we can help improve the function of athletes, assist in preventing injuries, help those with pelvic floor dysfunction and work to prevent falls in the elderly.
Not just exercises and massage.
Physiotherapists offer a range of treatments, from targeted stretches, manual therapies, dry needling, exercises and massage. Physiotherapists are also committed educators and take our role as such seriously.
A huge part of recovering from pain and injury comes from understanding what is happening and how to best manage these issues. Rather than create a dependency on their therapist, we aim to empower our patients to improve their health independently as much as possible.
Physiotherapists aim, to improve your quality of life and remove any barriers to full participation, whether these barriers are due to pain, weakness or stiffness.
Boil some water and soak cashew nuts for 15 minutes until soft. Strain excess water and set nuts aside.
Add the dates to a blender and mix into small pieces and place in a small bowl. Next add almonds and process into a very small meal. Add dates, coconut oil and salt into the almond meal and blend ingredients on high speed until a soft dough is formed.
Grease a muffin tin, and press the cheesecake base into the bottom of the muffin tin. Use a small glass to smooth out the base. Place this tin in the freezer when preparing the filling.
Add cashew nuts, lemon juice, coconut oil, coconut milk and maple syrup to a blender and mix until a smooth paste is created. Pour filling on top of the bases in the muffin tin.
Swirl raspberry coulis on top of the filling and place in a freezer to set, allow 2-3 hours for the cheesecake to set.
Garnish with mint and add extra coulis when ready to serve.
The knee joint is composed of the thigh bone, (femur) and leg bone (tibia) and a small floating bone at the front, commonly known as the kneecap (patella). The interaction between these bones allows for smooth movement of the knee as it bends and straightens.
During movement, the kneecap sits in a groove at the front of the knee and acts as a mechanical see-saw. This protects the knee joint and improves the efficiency of the muscles working to move it. When the patella moves out of this groove it is called a subluxation. If the patella moves far enough out of this groove it becomes a dislocation.
What are the symptoms?
The first time the patella dislocates is usually the most traumatic and painful. The knee may give way, and a visible lump can be noticed where the patella has dislocated. There will often be bruising, swelling and the knee may feel unstable. First time dislocations may also cause a heamarthrosis or bleeding within the knee joint. If there is damage to the ligaments of the knee, subsequent dislocations can happen more easily. They can even happen from everyday activities, causing the knee to give way suddenly.
What are the causes?
First time dislocations often occur due to a traumatic event. The most common cause of patellar dislocation is a non-contact injury to the knee with a twist of the leg (the thigh bone rotates internally on a fixed leg and foot). In addition, a direct blow to the side of the knee can also dislocate the patella.
If there is some instability of the joint, dislocations can occur more regularly and from smaller forces. Dislocations usually occur when the knee is bent and the kneecap slips back into place when the knee is straightened again. While the kneecap can be dislocated in both directions, it usually dislocates towards the outside of the knee.
Certain factors can make dislocation more likely, including overall hyper-flexibility, damage to the ligaments of the knee and muscular imbalance of the quadriceps. The structure and angle of the knee joint itself can also make dislocation more likely. This can be seen in the increased prevalence of dislocations for women as they have a slightly different angle of femur compared to the tibia than men. A traumatic dislocation can cause instability that can lead to future dislocations.
How can physiotherapy help?
An acute patellar dislocation should be treated like any traumatic injury and assessed by a medical professional to reduce pain and swelling, make an accurate diagnosis and check for fractures. While the kneecap may relocate itself quickly, ensuring that it is able to heal correctly to prevent further dislocations may require immobilization for up to six weeks.
Your physiotherapist will be able to identify any factors that may predispose you to further dislocations and provide you with a personalized treatment program to address any stiffness, weakness or instability surrounding the knee. Balance and proprioception (your sense of where your body is in space) are often reduced following an injury and your physiotherapist will help to rehabilitate these. Your therapist may provide you with education and advice regarding bracing or taping. In severe cases of instability, surgery may be recommended to stabilize the knee however this is usually not considered unless there has been a fracture or until a full rehabilitation with physiotherapy has been completed.
None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
When thinking about getting fit and exercising more, our first thoughts are usually that we should join a gym or start jogging. While these are both worthwhile activities, studies show that if you dislike the activity you’re doing, the long-term benefits are usually not enough to keep you committed. There are a few things that are often overlooked when talking about exercising more, particularly the fact that you can often improve your life in more than one way if you find the right activity.
Finding the right activity can boost your confidence an increase your daily activity levels.
We all have different tastes in food and the same is true for exercise. Some of us chase the thrill of learning a new skill; others prefer the challenge of pushing their limits of endurance while others love being surrounded by nature. Exercise is good for everyone, but finding the right activity for you is going to make it much easier to make it a committed part of your lifestyle.
We are also more likely to enjoy doing activities that we are good at. Some people have great balance, while others have great eye hand coordination. Others have great rhythm and someone who is an excellent dancer might be a terrible runner. Consider what you are personally good at and try to choose your activity based on this. Finding something that suits your routine is also an important component to making a new activity a part of your lifestyle.
Sometimes it is simply a lack of imagination that fails to get us off the couch. Jogging is not for everyone, but one of these sports might be. Here’s a quick list of less common activities that you may not have thought of trying:
Rock-climbing
Volleyball
Soccer
Hula-hooping
Slack-lining
Golf
Mountain biking,
Hiking
Stand-up paddle boarding
Roller skating
Skateboarding
Dancing
Pilates
Yoga
Learning new skills can be good for your brain.
Many people think that as they get older, learning new skills becomes too hard. The truth is, with a little patience, you can surprise yourself with your ability to learn new things at any age. The brain is capable of incredible change and adaptation to new stimulus. Learning new things can be a great source of confidence and exercise has been shown to improve your brain function overall.
Many activities can help you meet new people and open you up to new communities.
Even solo sports often have well connected communities of like-minded enthusiasts. Surfers have surf clubs, or often meet each other in the water, rock climbers are always looking for more people to take adventures with and people who wake up at 5 am to do boot camp together become great friends. As we leave high school and university, it can be harder to create new social connections. Using exercise as a way to make new friends can have a significant impact on your overall well-being. In many activities, the communities are extremely supportive of beginners and you might be surprised at how friendly they are to newcomers.
Your physiotherapist is able to give you great advice on which activities might suit your ability level and they can give you some tips to ensure you stay injury free when starting your new hobby. Contact our Physio Direct team today https://physiodirectnz.com/our-team
Preheat your oven to 200°C or 390°F, prepare a baking tray with baking paper or brush a thin layer of olive oil over the bottom.
Sauté oil over medium heat in a large frying pan. Add onions, garlic, chilli, cumin and paprika, salt and pepper and cook until onion and garlic begin to soften.
Add mushrooms to pan and cook for a few more minutes, stirring occasionally until mushrooms begin to brown slightly. Finally, add cooked quinoa and chopped spinach leaves and stir in other ingredients.
Slice capsicums lengthwise, into halves, removing seeds and stems. Fill with quinoa mixture. Set capsicums on the baking tray and cook for 25 minutes.
Garnish with fresh coriander, lime and cracked black pepper.
Most people associate physiotherapy with pain and injury management. While helping you recover from pain is our specialty, physiotherapists are also able to help with many more issues. Here are three things that you may not have thought to visit a physiotherapist for.
Stiffness and Inflexibility
Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears of quickly, and is referred to as DOMS (delayed onset muscles soreness). If however, you find yourself feeling stiff for longer periods, or even most the time – it might be time to see a physiotherapist. There are many different causes of stiffness and inflexibility; by far the most common is lack of movement. Our joints and muscles both lose flexibility if they are not regularly moved all the way through their range. Muscles can feel short and tight with a bouncy feeling of restriction. Joints can also have more of a hard ‘blocked’ feeling when you try to move.
For this kind of stiffness, you may not even notice that you have lost range, as it can be very easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility. They can also help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as Osteoarthritis and Rheumatoid Arthritis can also cause prolonged stiffness and your physiotherapist is well equipped to help you deal with these conditions.
Reduced Strength or Weakness
There are many reasons for weakness in the body, from generalised disuse, weakness in one muscle group following injury, neurological weakness or structural weakness of joint following an injury. Weakness of any kind can predispose you to future injury and can be surprisingly difficult to resolve without targeted exercises. Your physiotherapist is able to determine the cause of your weakness and determine the best treatment to restore your muscle strength.
Reduced Balance
Keeping your balance is a very complicated process. Your body works hard to make sure you stay on your feet. Humans have a very small base of support for our height. Due to this, we use all our senses together to determine which movements we should make to stay upright. This includes our visual, vestibular, muscular and sensory systems. As balance is so important, if one part of our senses begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over.
As a general rule, our balance deteriorates as we age but this does not mean that falls should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all the aspects of your balance and provide effective rehabilitation to help keep you on your feet. Contact Physio Direct on 0800 555 123 or visit us www.physiodirectnz.com
None of the information in this article is a replacement for proper medical advice. Always see a medical professional for an assessment of your individual condition.
Tennis elbow, also known as Lateral Epicondylitis, is a common condition characterised by pain at the outside of the elbow with movements of the wrist and hand. The pain is usually localised to the tendon of a small muscle of the forearm just below the elbow called Extensor Carpi Radialis Brevis (ECRB). This muscle is responsible for extending the wrist back into a “stop” position and is active when gripping and moving objects. While the term ‘tennis elbow’ is used because this is a common injury for tennis players, anyone who performs repetitive tasks with their hands and wrists can be susceptible, including office workers and manual labourers.
What are the signs and symptoms?
The cardinal sign of tennis elbow is pain felt on the outside of the elbow, particularly when making wrist movements or when gripping an object. Symptoms may occur suddenly or appear gradually over time. In the early stages, pain may be present with activity and quickly go away with rest, however, as it progresses the pain may be more constant, lasting for longer and occurring with smaller movements. If pain has persisted for three months then it is considered to be a chronic condition. As with most injuries, the longer an issue has been present, the longer it usually takes to resolve. Other symptoms can include night pain, stiffness in the elbow and forearm, weakness, numbness and pins and needles. As symptoms progress, simple tasks such as lifting a cup can be painful, which can have a significant impact on your lifestyle.
What causes it?
While tennis elbow was originally thought to be due an inflammation process, it appears that this is not the case, rather there is an increased sensitivity to the area along with changes to the blood supply and disorganisation of the collagen fibres that make up the tendon. These changes are an adaptation to excess loading of the tendons attaching to the elbow, particularly the ECRB.
Most of the time, this happens because of small repetitive movements that are done with poor ergonomics or technique. If the health of the tendon tissue is compromised, this can also contribute to the development of tennis elbow. Poor nutrition, disuse, inflammatory diseases and ageing can all mean that the tendon is less able to adapt to forces and are a risk factor for the development of tennis elbow.
How can Physiotherapy help?
Your physiotherapist will first confirm that you are indeed suffering from tennis elbow, which is an important step as some neck conditions can present with similar symptoms. Once the diagnosis has been confirmed, they will determine the severity and causes of your particular condition, likely testing your grip and individual muscle strength.
Your physiotherapist can also identify any muscle tightness, postural or ergonomic flaws
and joints stiffness that may be contributing to your condition. Treatment may include, fitting of a brace, dry needling, strengthening with eccentric exercises and stretching. Depending on the cause of your tennis elbow, your physio may suggest some changes. This could be in the setup of your desk, workplace, or grip technique of your racket or hand-held tool. Eccentric exercises load the muscles in a very specific way and research has shown that these exercises can help strengthen tendon tissues, reducing symptoms of tennis elbow.
It is normal for tennis elbow to take a few weeks or even months to heal. If conservative management is not having a good effect, your physio can help you speak to your doctor about other management techniques. As tennis elbow is a progressive condition that generally does not resolve on its own. Because of this it is recommended to seek treatment sooner rather than later, as recovery is much faster when started early.
None of the information in this article is a replacement for proper medical advice. Always see a medical professional for an assessment of your individual condition.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
400g Fresh Mushrooms, halved
1 bunch Fresh Asparagus
¼ cup Parmesan Cheese, shaved
½ Tbsp. Sesame Seeds
1 Fresh Avocado
1 clove Garlic
2 wedges of Fresh Lime
2 Tbsp. Olive Oil
Salt & Pepper
Heat a medium sized frying pan to high heat cover with 1 Tbsp. of olive oil, sprinkle salt and pepper and add 1 clove of diced garlic.
Cook for 1-2 minutes until garlic is slightly browned and add halved mushrooms and asparagus. Cook on medium heat until both mushrooms and asparagus are browned and slightly soft. Remove from heat and place in a medium sized mixing bowl.
Cut avocado into small pieces and mix gently with mushrooms and avocado. Dress salad with 1 Tbsp. of olive oil and the juice from ½ of a fresh lime.
Sprinkle thin slices of Parmesan cheese and sesame seeds over salad and serve.
If you happen to have an office job, it can’t have escaped your notice that sitting has been shown to be associated with a variety of chronic health conditions. Office jobs are one the most common forms of employment in the developed world, so here are some tips to help you stay healthy when sitting all day.
Move more often:
Sitting itself and the posture you find yourself in isn’t as bad as simply being still for hours on end. An expression in physiotherapy is ‘the best posture is your next posture’. This means that, above all, movement is the best thing for your body and those in office jobs can find themselves becoming very still while focused on the next deadline.
Set a quiet alarm to remind you to move or change positions every 20 minutes. Getting up for phone calls and walking over to see colleagues when you have a question is a great way to break up your sitting time.
Reverse your posture:
While not moving is definitely the worst aspect to prolonged sitting, the postures we often adopt while sitting can also be problematic. Sitting with a flattened lower back, hunched neck and slouched shoulders is the posture that requires the least energy to maintain and is often the one we sink into in a long day. A slouched posture can lead to shortened hamstring, hip flexor and pectoral muscles.
If you are spending large amounts of time sitting, it’s important to take time every day to adopt the opposite postures and keep your body flexible.
This means moving into thoracic and lumbar extension, stretching your shoulders and extending your hips.
Here are a few stretches you can do every day while seated that will help to reverse your posture. Try to do these stretches at your desk every few hours during a working day.
Chest stretch
Sit forward, clasp your hands behind your back and lift your arms towards the ceiling. You should feel a stretch at the front of your chest. Look up slightly to increase the stretch. You should not feel any pain or tingling in your arms. Hold for 30 seconds and repeat.
Seated hamstring stretch
Perch on the edge of your seat and straighten one leg out in front of you. Lean forwards at your hips, keeping your back straight. You should feel a gentle stretch at the back of your thigh. If you feel the stretch behind your knee or into your calf, let your ankle relax, and let your foot drop towards the floor. Hold the stretch for 20 second then swap legs, repeat this stretch with each leg twice.
Chin Tuck
Sit up in your chair so your bottom is at the back of your seat and your lower back is supported. Relax your shoulders and gently tuck your chin in, imagine you are holding a soft ball under your chin and are slowly squashing it. You should feel a gentle stretch at the top of your neck. Hold for 20 seconds, release and repeat.
You should not feel any pain with these stretches. Speak to your physiotherapist or visit physiodirectnz.com to find one near you. They can create a customised stretching routine that you can implement into your day at the office or for more tips on how to perform these stretches to maximum effect. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.
Anterior ankle impingement, also known as anterior impingement syndrome, is a musculoskeletal condition where repetitive forces compress and damage the tissues at the front of the ankle, causing pain and stiffness. It is a common injury that can affect people of all ages, however is usually seen in athletes of sports involving repetitive or forceful upward movements of the ankle, such as sprinting, landing from long jump, uphill and downhill running.
What are the symptoms?
Pain at the front of the ankle is the primary symptom of anterior ankle impingement. This can be felt as an intense, sharp pain occurring with ankle movements or a dull ache in front of the ankle following periods of exercise. Pain can also be felt when putting weight through the ankle while standing, walking or running. Night-time aching, stiffness, swelling and reduced ankle flexibility are also common symptoms of anterior ankle impingement.
How does it happen?
Anterior ankle impingement is caused by traumatic or repetitive compression to the structures at the front of the ankle as the tibia and talus move towards each other during ankle movements. The tissues that are affected become damaged and inflamed, causing the pain typical of ankle impingement. Chronic inflammation can lead to further stiffness, exacerbating the impingement process.
The most common risk factor for ankle impingement is a previous ankle sprain that was not adequately rehabilitated, as this can result in a stiff or unstable ankle. Another cause of impingement is the growth of small osteophytes or bony spurs. These appear around the ankle joint and press against the nearby soft tissues. These can be due to osteoarthritis or grow as a reaction to impingement itself. Training errors, muscle tightness, unsupportive footwear and a hypermobile ankle have also been shown to be risk factors for anterior ankle impingement.
How can physiotherapy help?
Depending on the cause, mild cases of anterior ankle impingement usually recover in one to two weeks with rest and physiotherapy intervention. For more severe impingement, the ankle may require up to six weeks of rest and rehabilitation to recover. In rare cases, surgical intervention will be required to remove any physical causes of impingement. This includes osteophytes to restore impingement free movement of the ankle. Your physiotherapist will first identify the cause of your ankle impingement and help you to choose the best course of action to reduce your symptoms. They are able to advise you on the appropriate amount of rest and provide stretches and exercises to restore strength and flexibility to the ankle.
Mobilisation techniques and range of motion exercises can also reduce stiffness of the ankle, restoring normal joint movement. Moreover, balance and proprioception exercises are included to prevent further ankle injury. Balance exercises challenge the way your body reacts to outside forces. With this, your balance will be improved, and you’ll have a more stable ankle.
Ideally, physiotherapy treatment is the first step before considering surgery. If surgery is required, your physiotherapist can help you to make a full recovery with a post surgical rehabilitation program.
Note: None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual condition.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
