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The other top 3 mistake people make with their Physio Treatment

The other top 3 mistake people make with their Physio Treatment

I recently wrote and article about the top 3 biggest mistakes I see people make when it comes to approaching their pain and injuries. (you can check it out here)

so I thought I’d add the biggest 3 mistakes that I think people make with their physio treatment.

1. Not having a goal or a plan

Let me give you an example. A few months back I saw a lovely 78 year old lady who her GP had referred to us to help with her low back pain. Now she has had quite advanced arthritis and persistent back pain for 30 years. (not that arthritis always means pain, but in this case it was pretty severe). She said to me at the start of the session:

“I don’t know why I’m even here. You aren’t going to be able to fix my back – nothing is”

No she wasn’t exactly wrong. I can’t change her arthritis. But in many cases I believe that’s not the most important thing. I asked her

“In a perfect world – ideally what would you want to achieve out of your treatment with us? How is this impacting your life that you wish you could change?”

Her answer was “I just wish I could wish the dishes or vacuum the floors without having to stop, or sit down for an hour after because my back was hurting. If I could get to a point where I could do that I would be so happy”

This is a completely different goal, and outcome for her than “curing her back”. Realistically in this case it’s unlikely we will be able to get her completely pain free, but now we had a goal and a plan, and this was ABSOLUTELY achievable for her. We worked out a plan for some hand on treatment and a lot of exercise work to be able to build her up to a point where she could do those things. And you know what? she can vacuum the floors without stopping now. Once we had a goal and a plan we were able to work together towards impvoing her quality of life and getting her where she wanted to be.

2. Expecting Miracles

oh-youve-had-this-problem-for-2-years-tell-me-again-how-it-should-magically-disappear-in-1-session

The unfortunate truth is usually the longer you’ve had a problem, the longer it will likely take to resolve. This is because you get neurophysiological changes, more stiffness, more weakness, protective patterns, altered movement patterns, etc, etc.

(Happily the opposite is true too. A study in hamstring injury came out last year which found that if you start treatment within 48 hours of injury then, on average, you would get back to sport 2 weeks quicker than if you started treatment later).

Some problems can get better very quickly, but by and large it takes time and work.

for some reason people often have two conflicting view points. They are very concerned that their problem will never get better, but then they also expect it to be cured immediately. In most cases neither of these are true.

3. Not following through

Another unfortunate truth is that there is often a big difference between feeling “ok” and being actually 100% better. Pain is a warning system (and a very complex one at that) so it is unreliable to base our management entirely on if you have pain or not.

As a good example – we know that following an ankle sprain you are at 50% risk of re-injuring that ankle within the next 12 months. That’s 1 in 2 ankle injuries that are destined for multiple sprains! That’s a terrible outcome. (How would you feel if you got a new battery for your car but 1 in 2 of them would fail?)

BUT – if we ensure you do at least 6 weeks of neuromuscular retraining (that’s strengthening, balance and stability retraining) after the pain resolves then your chance of re-injury is more like 10%. It is actually irresponsible of us to not ensure that your are not only pain free, but back to 100% strength, movement and function AND ensuring the problem is not going to recur or become ongoing. Anything less is, I believe, poor management.

Now you (the public) don’t know these facts and statistics, so once you start to feel “ok” the motivation to continue doing the work can wear off. This unfortunately leave a large percentage of people who are out there only 70-80% better and likely to have further problems down the track. And it’s true that many health professionals don’t necessarily communicate these facts very well to help you understand WHY you need to keep doing the work (or having further treatment) once you are starting to feel ok.

If you were an athlete, and you suffered a hamstring injury – you wouldn’t stop all management once you could move around without pain and run. you need to be able to sprint from a cold start 100 times in a game, and jump, and stretch, and back that up with training every day or two, and keep that up for 6-9 months without a break. This is the difference between many elite athletes and regular people. Everyday people can end up with dodgy hamstrings (or knees, or ankles, etc) because they never get to fully rehabilitating their problem. Elite athletes do the full amount of work to give them the best chance of 100% long term recovery.

Bonus: Not doing your share of the work

The reality of life is people are busy (and a bit lazy) so we find a lot of people don’t get around to doing their homework. We may see you for something like 1/168th of the week, so that’s a very small impact we can have on your life time wise. That’s why you will often get ‘homework’ from your physio. Things you can do for the other 167/168ths of the week that are going to significantly accelerate your progress and mean optimal recovery and avoiding recurrence.

There was some research done over 15 years ago that showed that about 1 in 10 people completed there home rehab exercises! That means 90% of our clients aren’t getting the fastest or best outcomes because they aren’t holding up their end of the bargain.

Everyone who comes into the clinic just wants to lay down on the treatment couch and have someone else “fix”them. Sometimes there are issues that only require this, but usually there is some work to be done to improve capacity, endurance, mobility, strength, etc.

We help those who help themselves :)

(Actually we’ll try and help you even if you don’t help yourself at all… But it would make our job a bit easier if you do a bit too)

 

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

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The Top 3 Mistakes People Make with their Pain and Injury

The Top 3 Mistakes People Make with their Pain and Injury

If there were a few pieces of advice that I would love to give to everybody to help them the most with their pain and injuries – the following would be it. These are big picture things that I end up talking to people about nearly every day.

For the most part these “top 3” mistakes aren’t going to cause anyone any serious harm (unless they miss a bad diagnosis) but these would save a lot of people a lot of time, money and heartache.

So below are the top 3 mistakes I think people make with their pain and injuries:

They don’t do anything at all!

Before I had kids, I would go to parties or gatherings, and nearly every night when people found out I was a physio, someone would ask “hey I’ve been having this pain in my (whatever body part) would you mind having a look at it?” (nowadays it’s more likely to be parents at school)

Normally one of my first questions would be something like “how long have you had it for?” and they would usually say something like “aw like 4 months” (or 2 years!?!)
Then I would say “wow you’ve been putting up with this for quite a while. Have you seen anyone about it?” and they would ALWAYS say “Nope”

And here’s the biggest issue I always see with people and pain. So many people are just walking around in pain and not doing anything about it. Some studies have estimated that 25-30% of people are experiencing musculoskeletal pain at any one point in time! How long do you have to put up with a sore arm before you decide you can’t put up with it anymore? Ow badly does it have to be affecting your quality of life before you get of the couch to do something about it? Or seeing as you’ve had this problem for 2 years it’s now a big, chronic complicated problem when it could have been a quick and easy fix 1 year and 50 weeks ago.

Sure, you don’t have to go running to a health professional with every boo-boo you get, but if it’s negatively affecting your life and not going away (or getting worse) for the love of Odin’s beard go and see someone about it. We usually find that the quicker we get to assess and start correctly managing a problem, the quicker it will get better.

You are making (mostly incorrect) assumptions about it

Now as an example – I’m no mechanic and I only know the basic of maintenance of cars. I can replace a tyre and a battery and that’s about it. If the problem isn’t one of those things I’ve got no idea what to do. What I wouldn’t do is just go along my merry way thinking “it’s just a crank handle sensor (is that a thing in a car?) – it just needs some whatever-I-might-have-read-on-the-internet and it will be fine”. There’s a very good chance my car has a completely different problem and my assumptions are doing nothing to fix it.

But there are so many people we see who have decided they know what their problem is already (and don’t get me wrong a good health IQ and knowledge of your condition is paramount so I think it’s great people nowadays are informed) but if you don’t know what the problem is, how can you do the right thing to fix it.

Regularly people will come in – “I’m pretty sure it’s a pulled muscle, so I’ve been putting heat on it and stretching, but it’s been weeks and it’s not getting better” when once we get down to the actual problem we might find that the heat and stretching weren’t helping because they were actually prolonging the problem. To solve a problem, you first need to

  • Accurately identify what the problem is, then
  • Provide the correct solution for that particular problem.

Pain is a complicated thing (as is the human body). Every week I see someone who has been trying to fix their shoulder pain, when the actual issue was their neck, or their back pain when it was actually a hip issue that was causing all the problems.

I don’t try and fix my car myself, and if your body isn’t progressing how you want it to, maybe you should get more expert help too.

(I’ll record a video soon to tell you the story of my friend Kim who thought for 2 years that she was allergic to chocolate because every tie she ate it she got headaches, only to find after abstaining for two years she had an entirely different problem).

Trusting the internet for everything

Let me tell you a story of a patient I saw many years ago (around the time that Bikram Yoga was just hitting popularity – that’s important for the story).

So this patient (let’s call her Jill) hurt her back. Common story – she bent over and twisted and felt a sudden quite severe pain in her low back on one side. This was really quite sore – she couldn’t straighten up, she was stuck leaning over to one side, the whole deal.

So she limped over to the computer and started googling “what’s good for back pain?”

And she came across a few articles and videos about yoga being good for low back pain.

So she decided (after this expert advice from the internet) to go and book in to a 90 minute Bikram Yoga class (34 degrees and all). Now Jill could hardly move, but she pushed herself through 90 minutes of sweaty smelly pain to try and help her back. After a bit of movement, she did feel a little looser

BUT

The next day she was sooo much worse. She couldn’t get out of bed, and it took quite a few days to just get back to how she was before the yoga session.

Now Yoga certainly can be very helpful for long term and mild low back pain (to improve flexibility, postural endurance and functional capacity) but trying to fold yourself in half is not a good idea when you are in severe pain and can hardly move.

As another example – I looked on WebMD once (out of curiosity) to see what it would say my abdominal strain was. It’s top 2 likely diagnoses were

  1. Pregnant (I’m a guy), or
  2. Ovarian cancer!

The internet is a wonderful place where you can learn just about anything you want. But sometimes it just can’t replace a real person who can think critically, and problem solve according to your specific context.

I estimate that when I see a new client and they say I’ve googled it and I think it’s this – over 80% of the time those people end up being wrong.

One final thing about the internet (and I absolutely understand the irony seeing as you are likely reading this on the internet – unless someone has kindly transcribed the entire blog onto a toilet stall somewhere) is there is no quality control on the internet, and we all tend to assume that all information on the internet is equally valid or accurate. For some reason we as people don’t seem to be very good a critically appraising what we read on the internet.

So what should we do?

If you have a problem and it’s negatively (or severely) impacting your life – please consult a healthcare professional who will be able to tell you

  1. What the problem is, and
  2. What you need to do about it

If you are trying things you think should be helping and they aren’t – go and see someone who can help.

And by all means be informed and aware about your problems, but don’t place the opinion of the internet (or faceless strangers on Facebook who’ve never met you or seen you and your exact problem) above the opinion of highly skilled and trained health professional who literally do this for a living.

And one final (and a little more sobering thought) – very rarely we would see someone who has been putting up with a problem for a long time, or even having other treatments for a long time without benefit, and eventually when we see them we realise something’s not right and it ends up being something more serious (like a kidney infection, or your gall bladder, or sometimes even cancer). This is the worst outcome of trusting the internet and putting up with problems – something that may have been treatable early on becomes something that it’s too late to do anything about.

Now I don’t intend to scare anyone, as this is very very rare, but it never hurts to be mindful of these things (we obviously always have to be).

But just to make sure I finish on a happier note… here a picture of a cat :)
kitten stretching

Happy not-mistake-making

Julian Bowen

Julian is the Director and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors; to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

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The Ultimate Guide to Ankle Sprain Treatment

ankle injury high heelsAnkle injuries are extremely common in sports, particularly netball, basketball, soccer, AFL and volleyball.  (As you can see, they can occur almost anywhere). Studies estimate that 1 sprain occurs in every 10,000 people every day.  In a  town like Perth where we are – that is equivalent to 202 people every day or over 73,000 ankle sprains per year. Ankle sprains also account for up to 25% of all sporting injuries! Studies show that 40% of people can be left with persistent instability of the ankle.  Considering what a big problem this is, it is high time that we provide you with the best, evidence based guidelines for the treatment and management of ankle sprains.

What is an Ankle Sprain?

Ligaments of the ankle

Ligaments of the ankle

Over 90 % of ankle sprains are injuries to the Anterior Talo-fibular Ligament (ATFL for short).  This is due to an inversion injury, where the ankle is twisted inwards.  There are three major ligaments on the outside of the ankle – the ATFL, the Calcaneofibular ligament and the Posterior Talo-fibular Ligament.  Generally – the worse the injury the more of these ligaments are damaged.

We use the term “sprain” to describe an injury of a ligament (remember a ligament connects a bone to another bone).  Sometimes the ankle can twist outwards, injuring the ligament on the inside of the ankle.  This guide will focus on lateral ligament sprains, but the same rules generally apply.

So What Should You Do?

First Aid

So you’ve landed on some defender’s foot at netball and twisted your ankle. It hurts….. bad.  Your team mates help you limp off the court, then what do you do? Good early management can significantly improve recovery times following ankle injury, so looking after it well now will get you back on the court quicker.

This immediate phase is where the good old RICE protocol (rest, ice, compression, elevation) is the most effective. (It has actually been expanded up to SPRICEMM, but we’ll get to that later).  When we say rest, we mean relative rest. Like stop playing netball and go look after your now rapidly swelling ankle.  It doesn’t mean hop around for two weeks being afraid to put your foot down. The S and P stand for support and protect. Support means keep the ankle in a nice neutral position (like the 90 degree position it would be in if you were standing on it).  This keeps the ligament in a shortened range and will help with the initial healing process.  Protect means prevention from further injury (like don’t go back and limp on to the court).ankle bruising 1

Anytime you have a soft tissue injury, you have bleeding. Bruising from a bad ankle sprain is bleeding from the damaged ligament and other tissue into the surrounding space.  You also develop an acute inflammatory response very quickly following the injury. Inflammation is a normal part of healing, as it bring lots of cells and chemicals rushing to the injured area to begin healing. This is normal and helps initiate the healing process. Inflammation also contains lots of chemicals that are irritants to your nerves and pain receptors in the surrounding tissues – this increases your pain levels and makes sure you know that you’ve had an injury.  There is an evolutionary theory that this helps to let you know that you have suffered an injury and to adjust your behaviour accordingly (like don’t fight that mammoth as you might have trouble running away).

Along with all this bleeding comes damage and death of the injured cells of the ligament. Bleeding also means a loss of normal blood supply to the surrounding cells. Ice is very beneficial in the very early stages to reduce secondary injury due to hypoxia (lack of oxygen to the cells) caused by disruption of the normal blood supply.  Secondary injury can also occur due to enzymatic mechanisms – the damaged and dying cells can release enzymes (chemicals) that damage the surrounding cells.

(For a deeper understanding of how inflammation works and the effects of ice, stay tuned for my upcoming article on the use of ice for soft tissue injuries)

If you don't have any icepacks, frozen peas work pretty well

If you don’t have any icepacks, frozen peas work pretty well

Ice reduces this secondary injury by:

Reducing metabolic requirements of the surrounding cells thus increasing the number of cells that survive. This obviously means less injury and quicker recovery. It was originally thought that ice also can reduce bleeding and reduce total inflammation, but the jury now seems to be out on this. It is still wise to use ice in the early stages to not only reduce the metabolic load but also to provide pain relief – you will generally feel better with some ice on your ankle.

Compression is probably the most effective tool we have at reducing excessive inflammation.  Now remember I said that inflammation is normal and important for healing to occur – so we don’t want to completely halt the inflammation process (I don’t actually think it is even possible to completely stop inflammation with these measures). However, excessive inflammation means that too much inflammatory exudate (inflammatory fluid that collects outside of the injured cells) can gather in the interstitial space (between all the other structures). This creates greater pressure within the space between the tissues and can reduce how much other chemicals and cells can get in to the area to help with healing. It’s a bit technical, but changes to the osmotic pressures and perfusion gradients mean that too much pressure from excess inflammation will stop some of the cells and chemicals required for healing even getting to the site of the injury.

Elevation may also be beneficial in reducing swelling, by using gravity to encourage the flow of fluid (and lymph, etc) away from the ankle. The research isn’t strong in this area, but if you’re resting in a neutral ankle position or icing your ankle, it’s not going to hurt to elevate it as well.

The initial bleeding can continue for up to 24 hours, so it is wise to continue icing regularly for at least the first day. There are lots of different protocols out there with varying levels of evidence, so there probably isn’t a perfect amount of time to ice (or have on/off) but keeping ice on regularly will be highly beneficial.

What about anti-inflammatories?

There is conflicting evidence for the use of anti-inflammatory medications in the early stages of injury.  We know that excess inflammation can inhibit optimal healing times and we also know that high pain levels make it hard to move on to the next phases of rehabilitation.  BUT, we also know that inflammation is a necessary part of the healing process. Most over the counter anti-inflammatory medications are aspirin substrates, (aspirin is a low grade blood thinner) so this type of medication could also potentially increase bleeding in that first day or so.

Generally we would take this on a case-by-case basis. We have to weigh up the benefits of pain relief with the potential for increased bleeding. Remember over the counter anti-inflammatory medications aren’t exactly wonder drugs.  I have never come across anyone who has ever sprained their ankle badly, taken 2 nurofen and then their swelling has magically disappeared. Pain relief is usually beneficial (paracetamol, etc) as controlling your pain levels better allows you to complete all your rehabilitation. If in doubt you should always discuss medication with your local pharmacist – they are experts in medications and their advice is completely free!

Anti-inflammatory medication is widely recommended by doctors for acute injuries, so should be considered generally safe to use. In most cases it is probably more helpful than not.

Early Stages

The next step is to work out if there is any serious damage that requires more medical attention. We follow a set of criteria called the Ottawa Rules to determine if you require an x-ray or might have a fracture.  There’s a lot to it, but in general if you:

Can’t walk more than a couple of steps, and

are quite sore to touch on any of the bones of the ankle or lateral foot

it would be wise to see a qualified health professional (such as ourselves) quickly to determine if you need an x-ray or might have broken ankle sprain diagram 1something. Generally I wouldn’t recommend going straight to emergency (unless there is obviously a bone sticking out in the wrong place) as usually you will just sit in a waiting room for 6 hours, get an x-ray then get sent home on crutches without adequate  management advice or treatment. It is usually much easier to get to your physio or GP within the next 24 hours (we usually try to ensure we have same day appointments available). If you need any other immediate treatment we can organise that for you. If you’re not sure, there are always after hours GPs that you won’t have to wait 6 hours in an emergency room to see.

While we’re at it, you should remember that whether you heard a “pop” or “crack” has no bearing on whether you have broken a bone or not – studies show it actually makes no difference at all.

The severity of the injury will dictate how long it will take to get back to full activity (including sport). A grade I injury (minor ligament injury) should be back to sport within a week or two (with proper management). Grade II might be 2-4 weeks.  Grade III (greater than 50% rupture) could be 6 weeks or more. A complete ligament rupture could be looking at 12 weeks on the bench, and might need input from a surgeon if there is persistent instability.

Keeping some sort of compression on at this stage usually helps to reduce excessive inflammation, and may also make it easier to weight bear. Icing may not be as important after the first day or two, but it does provide pain relief and doesn’t do any harm (and might possibly help to reduce inflammation) so if it feels good with ice – you should keep using ice. Assuming there is no fracture, then this brings us to the next important point:

Functional treatment is far superior to prolonged rest and immobilization!

Functional Treatment

While RICE is excellent first aid, it was only ever intended to be first aid.  It is not an effective complete treatment plan. There is a lot of information on the internet that will tell you that RICE doesn’t work at all, and this is because they are using it as a complete treatment. Once you are out of the initial first aid phase  RICE is not enough –  you need functional treatment.

Mobilise

This is actually what the M stood for in SPRICEMM – mobilise! You should start weight bearing (trying to walk on the ankle) as soon as it is comfortable to do so. You will not damage it any further by putting weight on the foot. Sometimes we will tape or brace your ankle to stabilise it better – this usually makes it easier to start walking on it sooner. The sooner you start walking and moving normally, the better you start to regain functional capacity and movement; and the quicker you will get back to sport.

In the old days many people were sent home on crutches and told not to put the foot down for 2 weeks. This is actually terrible advice, and leads to slower recovery, potential secondary complications (like complex regional pain syndrome) and increased risk of recurrence. It also tends to rest the ankle ligaments in a lengthened position, meaning the ligament will heal with more laxity and can suffer from ongoing instability.

We also want to begin some gentle movement of the foot and ankle to restore function and encourage normal healing of the tissues. At this stage we will often start some manual treatment to help restore normal mobility of the foot and ankle. You can also do some mobilisation work yourself at home – particularly working on your dorsiflexion mobility (see below).  Keep your heel down and try and bend your knee towards the wall (increasing the angle at the ankle)

Ankle-Dorsiflexion-Mobilty-             dorsiflexion stretch 1

When you are able it is best to begin exercise to also work on your balance and stability of the ankle. The ankle is critical for good balance and stability of the lower limb, and this is generally impaired following ankle injury.  Rehabilitation and restoration of this stability is critical to avoid persistent “weak ankles” and instability.

Rehabilitation

Appropriate rehabilitation is the key to avoiding persistent ankle pain and instability. We see patients in the clinic all the time who report having a “weak ankle” following a previous ankle injury. This means they continue to suffer from recurrent ankle sprains once they return to sport. It is completely unnecessary to settle for having a weak ankle after injury. All this means is that you never did the right rehabilitation to get the ankle strong again after the initial injury.

There are literally thousands of different exercises that you can do – for the best rehabilitation you should always be assessed by a competent physiotherapist who can identify your exact problems and design the perfect rehabilitation program specifically for you. Here are some safe places to start:

Balance and stability.single-leg-balance-level-one

As simple an exercise as standing on one leg is a very good place to start.  This will train the reactions you use to correct you balance, and all the little muscles around your ankle.  If this is too easy, you can make it harder by closing your eyes (please do it somewhere safe) or by standing on an unstable surface (like a cushion). Strengthening of the eversion muscles (see below) is also important to resist the forces when you twist your ankle inwards.

ankle strength 7

ankle eversion rehab physioadvisor

 

Neuromuscular Rehabilitation

Neuromuscular rehabilitation takes these static balance tasks and integrates them into functional movements and dynamic retraining. This is the real difference between just being ok to do normal daily activities and being 100% recovered for full sport. This end stage rehabilitation phase is also the most commonly skipped step. Being able to jump, hop, side-step while changing direction and throwing, and looking over your shoulder are all things that you would do all the time while playing sport. So it makes sense that you should actually retrain these movements. (Remember one of the top keys to any rehabilitation is SPECIFICITY of training).

Studies show that our balance and stability reactions can be impaired for up to a year following ankle injury, so it is essential to regain and retrain those stability mechanisms. Failure to do so is the number 1 reason 40% of people can end up with persistent instability or “weak ankles”.

There is an infinite combination of possibilities with this kind of rehabilitation (far beyond the scope of this article). Suffice to say, the retraining should be specific to your sport or activity. Do you do a lot of jumping and landing in your sport? Then you should probably include jumping and landing activities in your rehabilitation. Do you do a lot of changing direction? Then this should also be included.

We can design specific rehabilitation programs to get you back to 100% that are uniquely individual to your requirements and chosen sport. Even if you are one of those people that has “weak ankles” from previous injuries, then this type of strengthening and neuromuscular rehabilitation will be invaluable to get those ankles stable again and get you back to playing.

Take Home Messages:

1. Ice and compression as soon as possible will give you the best possible start to recover as quickly as possible.  Try to keep the ankle in a neutral position.

2. Get your ankle assessed to ensure there is no serious damage. Accurate diagnosis will put you on the right path from the beginning.

3. Start weight bearing as soon as you are comfortable to do so. Even partial weight bearing with crutches is better than no weight bearing.  Use tape or a brace if you need to reduce pain and stabilise your ankle.

4. Keep the ankle moving. Normal movement will encourage good healing and get you back to activity quicker.

5. Functional rehabilitation is the best approach to complete recovery.

6. Ensure that you complete your rehabilitation to avoid persistent problems. Most people should not have to put up with ongoing ankle issues – as long as the do the right thing.

 

As always, if you have any questions about this or anything else, we are always happy to hear from you.

Happy Rehab.

Julian Bowen

Julian is the owner and Principal Physiotherapist at EMC Physiotherapy.  He has spent  over a decade working exclusively in private physiotherapy practice, and estimates he would have performed over 40,000 individual treatments in that time. He has worked with everyone from Paralympians, elite athletes, WAFL Footballers, the Defence Forces and weekend warriors, to thousands of everyday people with all manner of issues.  He is passionate about injury prevention and has a special interest in the treatment of headaches, shoulder issues, hypermobility management and exercise rehabilitation for the prevention and treatment of injuries. 

 

References:

Petersen W, et al. (2013) Treatment of acute ankle ligament injuries: a systematic review. Archives of Orthopaedic and TRauma Surgery, Volume 133, Issue 8, pp 1129-1141

Kerkhoffs G, et al. (2012) Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med 2012;46:854-860 doi:10.1136/bjsports-2011-090490

Michel P.J. van den Bekerom, Peter A.A. Struijs, Leendert Blankevoort, Lieke Welling, C. Niek van Dijk, and Gino M.M.J. Kerkhoffs (2012) What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?. Journal of Athletic Training: Jul/Aug 2012, Vol. 47, No. 4, pp. 435-443

Bleakley C, et al. (2004) The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. Am J Sports Med January 2004 vol. 32 no. 1 251-261

Grey J & Rawlinson G (2013) The Physiotherapy Management of Inflammation, Healing and Repair. in S Porter (Eds) Tidy’s Physiotherapy. Elsevier Health Sciences pp 253-271

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Referred Pain

Pain is complicated, and complex.  Many times where you are feeling your pain, and where it is coming from are two very different things.

Is your headache a problem with your head? Or is it referred from your neck? OR your sinuses? Or your TMJ (jaw)?

That sore toe you have could be a problem with your low back….. or it could be a sore toe. That ‘shoulder’ pain you’ve had for weeks could be an issue with your neck. (Below is a diagram showing common pain referral patterns from different areas of the neck).

 

 

 

 

 

At EMC Physiotherapy, we are highly trained in identifying and treating the source of your problem, rather than just treating your symptoms. On top of this, we can accurately identify the underlying reasons why you have developed this pain.   Is there injury, or inflammation? Do you have underlying muscle weakness, or tightness? Is your posture and activity contributing to your problem? At EMC Physiotherapy, we can answer all these questions and more.

So if massaging your shoulder just isn’t getting rid of your shoulder pain, Feel free to call us on 9297 2555.  We can help.

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