Quite often we hear of patients who repeatedly sprain their ankles. Weeks, months or even years may pass between episodes, but there is a definite pattern of inversion ankle sprain (or “rolling your ankle”) on a specific side. Often times this can be attributed to what we call a functional ankle instability.

Rolled Ankle – What is it?

Quite often, patients tell us they keep “rolling their ankles”.  In this case, they more than likely have functional ankle instability.  With functional ankle instability, our body controls the muscles around the affected joint in an altered fashion due to repeated episodes of injury. So what can we do to fix this?

Physiotherapy for Ankle Sprains

The specific approach a physiotherapist or chiropractor might use to treat an ankle sprain can vary.  Often times, it depends on the stage of the injury.  To combat chronic, repeated ankle sprains it is essential to retrain and strengthen certain muscles and movement patterns in the ankle.  This is not appropriate immediately after an acute ankle sprain however.  In the case of a swollen, recent ankle sprain the treatment approach is different. 

Treatment for Acute Ankle Sprains

The physiotherapists in our Burlington sports injury clinic often use a combination of laser therapy and acupuncture in the initial stages of ankle sprain recovery.  Laser therapy has a reputation for reducing swelling and eliminating pain quickly.   For further information about laser therapy, please visit our laser page.

Active Release for Ankle Sprains

In our Burlington clinic, Active Release Technique is performed by our chiropractors.  Active release has a great reputation for assisting with tissue mechanics in chronic ankle sprains.  Again, if you just sprained your ankle it is not likely to be appropriate.  In the later stages of healing it may be more helpful.

Graston Technique for Ankle Sprains

The Graston Technique is another technique that can be helpful for ankle sprains.  Similar to active release, Graston is more appropriate in the later stages of healing.  It assists in the breakdown of dysfunctional scar tissue that occurs as a result of the initial injury.  Again, in the early stages of recovery from an ankle sprain a treatment like laser therapy is more beneficial.

Exercises for Ankle Sprains

According to some recent research, the peroneus longus muscle has been found to be dysfunctional in many patients who have experienced repeated ankle sprains. Although the specific cause is unknown, this altered muscular activity can be expected to reduce protection against ankle sprain.  Consulting with one of our practitioners is recommended to assist you in finding the appropriate management strategy for your ankle sprain.  For more information about our Chiropractors, please visit our Chiropractic Page.  For information about our Physiotherapist, please visit our Physiotherapy page.  Burlington Sports Therapy – 905.220.7858  info@burlingtonsportstherapy.com

References
Santilli V, Frascarelli MA, Paoloni M. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability. The Journal of American Sports Medicine 2005; 33(8): 1183-1187.

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Since the World Cup is on everyone’s mind these days, we thought it would be only fitting to make you aware of a crucial paper published in the American Journal of Sports Medicine which analyzed score-celebration injuries among soccer players.

The authors of the study observed professional and amateur soccer players over the course of two seasons, looking at the incidence and nature of injuries sustained by players during their goal celebrations. Over the study period, 152 players were evaluated for injuries sustained in matches. Of these, 6% (9 players) sustained injuries during their goal celebrations. The pertinent findings were as follows…

7 of the 9 players were male and their average age was between 17 and 29.
The injuries happened on real grass in 8 of the 9 cases.
Most injuries occurred in the second half.
Sliding injuries (on the stomach, back or knees) accounted for 5 cases.
Piling up or over-excited teammates were the other major cause.
Injuries included fractures to the ankle, clavicle and rib. Other injuries included knee ligament sprain, lower back strain, and lower limb muscular strains.
Perhaps the most interesting statistic is that the average recovery time for these injuries was 6.2 weeks! Perhaps enough reason to take it easy when celebrating a goal!

References

Zeren B, Oztekin HH. Score-celebration injuries among soccer players. The American Journal of Sports Medicine 2005; 33(8): 1237-1240.

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Have you been injured in a car accident?  Quite often patients come to our clinic with a sore, stiff neck after being involved in a car accident.  We can help.  This blog will outline for you some of the more commonly asked questions by our patients about whiplash and whiplash treatment.

What is Whiplash?

Whiplash injury is a condition that involves damage to both the muscles and joints in the neck after it has been “whipped” backwards.  Most commonly associated with rear-end motor vehicle collisions, whiplash is a common yet sometimes complicated condition to resolve.  Due to this, a great deal of literature has been published on whiplash injury and different pieces of the puzzle are slowly being put together.

Whiplash – What is Injured?

One of the common areas of the neck injured in a motor vehicle accident is the cervical facet joint.  The cervical facet joint is located at the back of the neck.  It is compressed together when the head is extended (like the motion of looking up).  To challenge the right facet joints, we turn the head to the right and extend the neck backward.  Likewise, to challenge the left facet joints, we would turn the head to the left and extend the neck backward.  A recent study published in the journal Spine investigated the affect of having your head turned when rear-ended and whether or not that made injury to the facet joints (whiplash) worse.  Perhaps predictable, this study indeed found that a head-turned posture increases the facet joint injury associated with whiplash.  Unfortunately, it is common for drivers to turn their head to the right and look out the rear-view mirror a split second before an impending collision.  Of course, we hope that none of us are ever in this situation, but in the unfortunate event of a rear-end collision remember to keep your head straight!

What is WAD I, WAD II or WAD III?

Whiplash injury is now often referred to as Whiplash Associated Disorder, or “WAD”.  WAD injuries are graded between one and four. WAD I is a whiplash injury from a motor vehicle accident in which the patient has a sore neck.  WAD II is a whiplash injury from a car accident in which the patient has a sore neck and a decreased range of movement (stiff neck).

What if I have a “pinched nerve in neck”?

WAD III is more serious than WAD I or WAD II. WAD III is a whiplash injury that is characterized by a sore neck, a decreased range of movement (stiff neck) and numbness and tingling in the arms.  Often described as a pinched nerve in neck, the involvement of neurological structures makes this injury a little more severe and consequently, a little more difficult to resolve.  If you have been in an accident and are experiencing these symptoms (like a “pinched nerve in neck”) please contact our clinic or your medical doctor; x-rays are more than likely necessary.

Whiplash Treatment

Treatment for whiplash injury can vary, depending on the individual characteristics of each person’s condition.  In the past, treatment for whiplash included the use of a soft cervical neck collar.  Unfortunately, this seemed to prolong recovery.  We’ve now learned that early return to normal activity is helpful for recovery from Whiplash and whiplash associative disorder, depending on the case.  The first priority is to have your injury diagnosed by a qualified practitioner.  Our clinic has these practitioners.

Whiplash Diagnosis

It’s important that your neck injury is diagnosed properly before choosing a management strategy; there are some neck injuries that should not be moved.  Sometimes X-rays are required.  Once deemed safe and a diagnosis of WAD I or WAD 2 is made, it is usually recommended that the neck is moved within a relatively pain free range of motion.  Again, diagnosis is paramount with WAD injury before any movement or treatment is attempted.  Our clinic often uses the expression “hurt vs. harm” for our whiplash patients.  This means that although it may be a little painful to move your neck, it likely won’t harm you.  Diagnosis for your injury and referral for appropriate x-rays can be performed by our Chiropractor.

Physiotherapy or Chiropractic for Whiplash?

Our Burlington Physiotherapy and Chiropractic Clinic sees many patients with whiplash injury.  We adapt the treatment toward the needs and comfort level of each patient; for some patients, active release technique and Graston are a great way to treat these injuries.  This is performed by our Chiropractor.  For others, laser therapy and exercise is the best starting point…this is performed by both our Chiropractors and our Physiotherapist.  Whatever the case, we offer our whiplash patients many treatment options depending on their specific needs.  If you’ve been in a car accident and need treatment for your injuries, please call our clinic today!  905.220.7858 info@burlingtonsportstherapy.com

References
Lord SM, Barnsley L, Wallis BJ et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo controlled prevalence study. Spine 1996; 21: 1737-44.
Siegmund GP, Davis MB, Quinn KP et al. Head turned postures increase the risk of cervical facet capsule injury during whiplash. Spine 2008; 33(15): 1643-1649.
Sturzenegger M, Radanov BP, Distefano G. The effect of accident mechanisms and initial findings on the long term course of whiplash injury. Neurology. 1995; 242:443-9.

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Laser therapy has been used in clinical practice for the treatment of musculoskeletal injuries for over 26 years.  As with other healthcare applications utilizing laser technology, knowledge of this modality has grown considerably since its inception.  A recent study published in the American Journal of Sports Medicine examined the usefulness of low intensity laser therapy for the treatment of achilles tendon injury.  A significant difference was found between the treatment group and the placebo group, with the laser patients healing much faster.  Specifically, the laser group achieved the same level of healing in 4 weeks that the placebo group achieved in 12 weeks.  (Eccentric strengthening of the tendon was given to both study groups since this has been established in the literature as beneficial for overuse tendon injuries).  For those readers seeking a viable treatment approach for their Achilles tendon injury, this recent research supports an approach combining low intensity laser therapy and eccentric exercise.

Laser for the Achilles Tendon

From a practitioner standpoint, this paper provides some other useful information.  The success of laser therapy for various injuries largely depends on the settings chosen by the practitioner.  A longer, more intense setting is not necessarily better.  Through clinical trials like this one, it has been discovered that the use of certain lower settings for tendon injuries will benefit the patient more.  Perhaps another example of how scientific evidence can guide practitioners and patients in choosing the best treatments available.

Achilles Tendon Injuries

The Achilles tendon is located just above our heel, below the calf muscle.  It is actually a continuation of the calf muscles (the gastrocnemius and the soleus) and inserts on the bone in our heel.  This tendon allows us to stand up on our toes. Injury to this tendon is common.  Achilles Tendon injuries can range from rupture to a mild tendinosis.  Obviously, the appropriate treatment approach depends on the specific diagnosis.

Physiotherapy for Achilles Tendon Injury

If you have an achilles injury (such as achilles tendinopathy, achilles tendinosis, achilles tendonitis, achilles rupture or simple achilles tendon pain) there are various treatment options available.  As mentioned above, laser therapy has a great track record for effectively treating this area, especially in acute cases.  Laser therapy is also commonly called cold laser therapy or low intensity laser therapy; for more information please visit our laser page.  For chronic, stubborn tendon complaints more aggressive treatments like active release technique or graston technique are perhaps more effective.  Again, please look around on our site to get an idea of what these treatments entail.  For active release technique click here.  For more information on graston technique, please click here.  For more information about our clinic, please call us at 905.220.7858. or email at info@burlingtonsportstherapy.com.

References
Stergioulas A, Stergioula M, Aarskog R et al. Effects of low-level laser therapy and eccentric exercise in the treatment of recreational athletes with chronic achilles tendinopathy. The American Journal of Sports Medicine 2008: 36(5); 881-887.
World Association for Laser Therapy (WALT). Laser dosage recommendations. Available at http://www.walt.nu/dosage-recommendations.html

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The Q-angle (quadricep angle) is a measurement used by many health care practitioners to assess patello-femoral alignment. It is often mentioned in running magazines and on different websites because of its apparent ability to identify those persons at risk of certain knee injuries. Some of these knee injuries include patellofemoral syndrome, patellofemoral maltracking, chondromalacia patella, patellar tendinosis, patellar tendinitis, osteoarthritis and “runners knee”.  But is it a valid measurement tool?

Patellofemoral Syndrome – Diagnosis

The basic premise of the Q-Angle is that a higher angle (such as what might be expected in people with a wider pelvis) would affect the way that the patella (knee-cap) lines up with the lower limb.  Some practitioners use it to identify those patients at risk of patellofemoral syndrome. According to the scientific literature though, the Q-Angle is a measurement which over-simplifies knee biomechanics. It only examines a person in one plane of reference (like a two-dimensional object) and does not take into account the complex forces that occur during running, walking and jumping. Numerous publications in very reputable journals have scrutinized its ability to accurately identify those people at risk of knee pain and patellofemoral syndrome.

Patellofemoral Syndrome – Treatment

The treatment for patellofemoral syndrome varies, depending on the specific nuances of each individual case.  At our physiotherapy and chiropractic clinic in Burlington, we try to use good science to guide our decisions and our advice. Commonly, the treatment for patellofemoral syndrome involves soft tissue therapy and strengthening exercises.  Obviously, the best course of action is to give our clinic a call and speak with one of our practitioners.  In the meantime you may want to take a look at our services page; specifically our active release technique and our graston page.  Curious about who will be helping you with your injury?  Check out our practitioners page!  905.220.7858  info@burlingtonsportstherapy.com

References
Duffey MJ, Martin DF, Cannon DW et al. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc. 2000; 32: 1825-1832.
Nguyen AD, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clinical Journal of Sports Medicine. 2009; 19(3): 201-206.
Thomee R, Renstrom P, Karlsson J et al. Patellofemoral pain syndrome in young women. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports. 1995; 5: 237-244.
Witvrouw E, Lysens R, Bellemans J et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. American Journal of Sports Medicine 2000; 28: 480-489.

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