Ah, beautiful day, isn’t it? And what lovely scenery/pavement in Glasgow. Do watch that kerb tho… Oh. Are you ok? Just going to walk it off? No? No.
That looks sore, and it’s starting to swell already. Oh dear.
Sound familiar? One of our previous blogs (here) covers the anatomy and first aid for twisted or sprained ankles (and defines what damage has actually been done), but here we’re going to go through what a physiotherapist will do.
First of all, you’ll have carried out your PRICE first aid (of course): protect, rest, ice, compress and elevate for the first 48 hours or so. You’ve got some lovely sensible shoes on and you’ve made your physiotherapy appointment, good stuff.
So what are we going to do?
Well, first, we’ll have a look at you. Really, we’re checking for bruising, swelling, obvious limps or even more obvious sobbing etc (tissues will be available).We’ll have a look at the position of your foot (both sides) and ankle, as some people’s natural foot positions make them more susceptible to injuries.
Then we’ll look at you standing, to see if you can weight bear on your affected side. If you can, we might ask you to stand on one leg (I know, a lot of people struggle with this at the best of times, but we’ll look at both sides for a comparison.) If you’re able, we’ll also have a look at your balance with your eyes closed to test something called proprioception, which is your body’s own balance correcting mechanism when you don’t have visual input.
Active Range of Movement
Next, we want to know how much you’re able to move your ankle yourself (in other words: are you muscles and joints still working ok, or is pain or stiffness limiting movement?) NB It’s ok to take your normal painkillers or anti-inflammatories before your physio appointment – we’ll still be able to tell how sore you are! We’ll take a look at your other joints as well, as a sore ankle can affect all sorts of movement and cause you to tighten in your hamstrings, or give you an achy lower back for example.
Passive Range of Movement
We’ll be gentle, we promise. This is to see how far your joint will move without relying on your own muscles. We’ll also do specific ligament stress tests. To put it simply, a ligament’s job is to hold bones together, and if you’ve ruptured a ligament completely, the bones will move like they shouldn’t. This calls for a plaster cast I’m afraid.
This is where your joints move by gliding or sliding, rather than your conscious flexing and extending. We can test this in lots of different ways, most of which shouldn’t be too painful.
Now let’s see if your muscles are working at all or if they’ve been inhibited by your injury or pain. We’ll test all your ankle movements, both sides, and probably have a quick look further up the chain too.
Sounds fun. Quite often we see lots of swelling and oedema, and sometimes (if we’re really lucky) pitting oedema. That’s where your thumb mark stays put after you’ve pressed the swollen part. Physiotherapists know the anatomy underneath the skin and we’ll palpate the area to feel for anything untoward (like a “dent” where a ligament should be intact, or for areas of heat.)
Ok, by now you’re probably feeling a little poked and prodded, but that’s the general assessment over with. Now onto treatments. There is a vast range of modalities available, and our physiotherapists will find out what suits you best (for instance, ultrasound won’t be used if you already have metalwork around your ankle) and what will work for your particular injury. Here are a few:
exercise – sounds obvious (we are physios after all), but you’d be amazed at how small, regular (easy!) movements of your toes, foot and ankle can improve the swelling. We’ll teach you appropriate stretches (especially for the calf) to help regain your flexibility. Then we’d progress your exercises to build strength and improve your balance and proprioception, to help you avoid future injuries like this
massage – veeeerrryy gentle at first, don’t worry, and we won’t be massaging within the first 72 hours of your injury, as this may increase the blood flow, and therefore the swelling. After that though, massage can help shift any excess fluid which has gathered at your ankle through gravity, returning it to your lymph vessels for drainage
acupuncture – brilliant for helping ease pain, but also good with encouraging healing on older injuries (so swelling that’s been hanging around a while)
ultrasound – (other electrotherapies are available) This is a pain free, swelling-reducing, scar tissue-organising treatment that takes just a few minutes (and no, unfortunately you won’t be able to see your ankle on a screen)
taping – different tapes for different dates (sorry). Kinesiotape is wonderful for helping reduce swelling and bruising appearance, and can help those inhibited muscles get back into action. More restrictive zinc oxide taping, or elastic adhesive tape can be used for your return to sport, but we prefer a strengthening program rather than relying on tape for restricting excess movement for a too-early return
advice and education – sounds obvious to us, but we can give you lots of information to help you better understand what’s going on in your body, so that you can do more of the right things and fewer of the wrong things
Pretty soon, you’ll be back out enjoying the nice weather (pavements), pain free and maybe even in heels.
If you’d like to speak to a physiotherapist, or make an appointment please call us on 0141 2372 721 or book online at www.tm2online.co.uk/firstclassphysio