Sports Injury Focus- Ankle Sprains

We’ve seen lots of people with ankle injuries over the years. The common story we hear when clients come in, is that they have sprained the ankle ages ago and started to notice pain in the knee, hip or back on the same side as the ankle injury. There is always a knock on effect, and what most people don’t realise is lack of range of ankle movement( particularly what we call dorsiflexion) and loss of balance and strength and control at the ankle are the number one reasons why these problems persist.

Most people rest, take painkillers, wear a support and just assume that when the pain goes that the foot and ankle has fully recovered. Read on to get the correct information about how to properly manage a foot and ankle injury….

Ankle Sprains – Signs and symptoms:

Likely to have landed awkwardly, twisted, or fallen causing pain, stiffness and immediate swelling, mainly on the outside of the ankle joint, below the ankle bone. A ball of swelling will be noted or tracking of bruising down the lateral border of the foot. This is what we call ecchymosis. In my experience the worse this is my more likelihood you have a more serious ligament injury or a fracture. Injuries are classed in different grades, and upon diagnosis we will advise you to either wear a brace, get some crutches to offload the area, or we may advise an x-ray to exclude any bony injuries.

Please be mindful that the info below is a very basic guide. Please consult a health professional in order to get a proper idea of the severity of your injury before proceeding with anything we have provided below.

* Week 1 

We use the regime called P.O.L.I.C.E. Protection, Optimum Load, Immediate ice, compression and elevation. Strapping the joint will also help.

Begin gentle walking ASAP. Often 3-4 days post injury. Note it is expected (and okay) to be painful. However, straight line walking only.

None whatsoever twisting or turning of the ankle joint can be tolerated in week 1. Swimming is encouraged when possible and if pain allows.

From a Physio point of view – deep friction massage and very gentle massage of calf and Achilles would begin after just 4-5 days. We also use ultrasound and interferential at this stage. Strapping can also help.

* Week 2 

Very gentle (but prolonged) walking on the flat, is vital and to be encouraged. Towards the end of week 2, the goal will be for gentle jogging on a treadmill.

Swimming continues, cycling and cross trainers are all ok.

From a Physio point of view – massage continues of ankle ligaments and of the calf and Achilles tendon to prevent tightness and future problems. Stretching of all muscle groups is a must and balance work is now added to both ankles. Ankle mobility is important too.

* Week 3 

Exercise and CV work is increased.

Straight line running is picked up and athlete will aim to be at three quarter pace by the end of this phase.

Slowly, but surely, uneven surfaces are introduced and twisting and turning begins to be allowed.

From a Physio point of view – all deep massage work continues, muscles and ankle joint are stretched to the max and proprioception exercises are now top priority along with full movement of the ankle joint.

* Week 4 

Athlete returns to training and possibly performance. CV work increase and continues.

From a Physio point of view – all treatment and stretching continues for approximately 3-4 weeks and athlete pays attention to proprioception exercises. Lots and lots of balance work. We will also have a look higher up the chain and make sure that the calf muscles, hamstrings, gluteals and quads are doing what they should be doing.

Review of recovery: 

Take it very easy early on. But in the case of nearly all ankle sprains, too much rest will be harmful.

Stretch and mobilize the injury at just the right time and no ankle injury can ever fully recover with prolonged rest.

Secret Tip(s): 

Too much rest in the first few weeks will increase the likelihood of re-injury and a plateau. Do not be fooled by lack of pain when walking straight – Twisting and turning “pain free” must be achievable.

Note: It’s not uncommon for ankle sprains to feel not much better even 6 weeks down the line. And it’s often because of too much rest in the first few weeks.

Stay off the beach and avoid uneven woods/hilly areas when running, for at least 3 months post-injury. Don’t be fooled by the lack of pain after two weeks either.

It does not mean you are fit to play or run and if you haven’t followed all of the Protocols listed above, you will damage the ligament again sometime soon.

If you’d like more info on this, and some further easy, actionable tips on other sports injuries too. We have a free guide that we can send you. Connect with us on 01344 489398 or email us on bracknell@applephysio.com and tell us what’s going on. 

A member of the team can take your details and we can email you a copy.

About the Author: Leslie Abrahams and the Apple Physio team


fullsizeoutput_39a3

Leslie is a Physio, Pilates Educator and Rehab Specialist who has a special interest in Spinal Treatments, lower limb injuries, and has vast experience dealing with patients post injury or surgery. Every week, for over 20 years, 100’s of people aged 30-64+ have consulted the Apple Physio team looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.

 Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the Director of Apple Physio Clinics situated in Bracknell and Windsor. Berkshire’s Specialist Private Physiotherapy Practice for People in their 30’s. 40’s, 50’s and 60’s and above, who want to keep healthy and active.

Sports Injury Focus – Achilles Tendon Problems

Here at Apple Physio, we have worked with people with achilles issues for many years and truly have a great knowledge of how to diagnose and manage this issue. We see people with minor strains to complete rupture, and the recovery plans and treatment process varies. 

Truth is, without knowing you or your medical history intimately, I cannot tell you which of these will work best for you. And even if I did know the root cause of your sports injury, there are no guarantees that any one single strategy will work. As a disclaimer please do seek professional help and get a proper assessment of your injury.

Achilles Injury – Signs and symptoms: 

Immediate sharp pain in the back and bottom of your leg. Right above the ankle joint. Often happens when running or jumping and gets worse/comes on gradually as you run.  Sometimes this can build up over a period of time and is aggravated by movement, especially walking up hill or stairs. Calms down with rest and sometimes you can feel crepitus ( creaking) of the tendon.

* Week 1 

Complete rest. 

Apply lots of ice. Swap footwear to soft, comfy, high-heeled shoes. No need for strapping or supports other than to apply ice. 

Every hour for 10 minutes is recommend. 

Typically, a pro athlete suffering with an Achilles tendon issue would be advised to go swimming, take one or two gentle walks (on the flat) and when possible, work on core stability exercises with a balance ball. 

The right selection of footwear is important – avoid plimsoles or sandals. Find and wear a pair of trainers with a nice thick “heel” to prevent any tension on the tendon. 

From a Physio point of view – after about days 2-3, I’d begin some deep massage and very gentle stretching and work on the ankle joint to prevent any stiffness or get rid of any swelling. 

I’d also massage the calf muscle and check the lower back for any stiffness to rule out any nerve problems that could create more long-term problems. 

* Week 2 

Ice continues – often until day 10 depending upon how much bleeding has taken place and how badly damaged the muscle tear is. 

Typically, one of my players would now be exercising on a bike, swimming would continue and towards the end of week 2, I’d be aiming to have the athlete doing some very gentle jogging. 

The player or athlete can expect to feel some form of burning sensation, but as long as it isn’t “cramping” or “biting” this is fine – and a good thing. 

From a Physio point of view – massage is now vital.
It’s now that the scar tissue build up is “dangerous” and if the massage isn’t done, it’s the number 1 reason for an Achilles tearing again in the first two weeks back to running or playing. 

* Week 3 

Ice has stopped. Now, heat is being used rather than ice in this stage. 

Stretching is now vital. I’d be recommending the athlete to attend Yoga classes, increase the amount of Pilates exercises and that he or she be working on their balance (using a ball). 

Fitness levels are increased significantly. Swimming, cycling, gentle jogging is stepped up (still on the flat). And by the end of this phase, the athlete may or may not be asked to be doing three quarter pace running by now. 

From a Physio point of view – hands-on treatment is vital, massage continues and work on the Achilles, calf, hamstrings, gluteal muscles and lower back is essential to prevent future reoccurrence. 

Ankle joint and balance work is important too. PNF stretching is also introduced. Static, Isometric exercises to the calf and achilles tendon is initiated.

* Week 4 

Athlete 90% fit. 

CV work increases and a return to practice and full drills are possible and the goal, by the end of week 4. 

Athlete is put through drills that will include sprints, shuttles and plyometric work, including running backwards. 

Note: Hill running and sand is disqualified for at least 3 more months for this type of injury.


From a Physio point of view – hands-on massage continues, PNF stretching is vital and passive and active eccentric stretching and strength work is stepped up. 

* Week 5 

Athlete returns to sport.
Fitness and performance work increases. 

From a Physio point of view – massage continues to prevent scar tissue build up and stretching is continued before, during and after training sessions. 

Note: Daily hands-on massage will be needed for approximately another 2-3 weeks to prevent scar tissue (collagen) tightening the muscles. 

*Week 6

Review Of Recovery: 

Take it very easy early on, stretch and mobilize the injury at just the right time and no Achilies injury can every recover fully without deep massage or the right amount of rehabilitative work. Especially strength starting with static/isometric to a more dynamic eccentric type exercise.

*Week 7

Secret Tip(s): 

Too much rest in the first few weeks will increase the likelihood on re-injury. 

Stay off the beach when running for at least 3 months post injury. 

Don’t be fooled by the lack of pain after two weeks either. It does not mean you are fit to play or run and if you haven’t followed all of the protocol listed above, you will damage the tendon again sometime soon. If you are able to do plyometrics comfortably – i.e. run jump and push off the affected leg. Then you have a good chance of prevrnting the issue from returning again in future.

If you’d like to talk to an experienced Specialist Physio about the possibilities if you currently struggling with an Achilles problem and you decide for yourself that Physio will add value to your health, like it does so many other people, then please connect with us. 

If you’d like more info on this, and some further easy, actionable tips on other sports injuries too. We have a free guide that we can send you. Connect with us on 01753 866 274 or email us on windsor@applephysio.com and tell us what’s going on.  A member of the team can take your details and we can email you a copy.

About the Author: Leslie Abrahams and the Apple Physio team


fullsizeoutput_39a3

Leslie is a Physio, Pilates Educator and Rehab Specialist who has a special interest in Spinal Treatments, lower limb injuries, and has vast experience dealing with patients post injury or surgery. Every week, for over 20 years, 100’s of people aged 30-64+ have consulted the Apple Physio team looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.

 Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the Director of Apple Physio Clinics situated in Bracknell and Windsor. Berkshire’s Specialist Private Physiotherapy Practice for People in their 30’s. 40’s, 50’s and 60’s and above, who want to keep healthy and active.

Sports Injury Focus – Calf Muscle Injuries

The calf muscle. Muscle and achilles tendon issues. Pain on the side or front of the lower leg. We truly have a great knowledge of how to diagnose and manage this.  We see people with minor strains to complete muscle rupture, and the recovery plans and treatment process varies. The injuries (and the recovery plans) are in no particular order of importance and they all have one thing in common – they all work. There’s a great saying that goes: Small hinges swing big doors. And it’s often the simplest advice that wins in the end.

Truth is, without knowing you or your medical history intimately, I cannot tell you which of these will work best for you. And even if I did know the root cause of your sports injury, there are no guarantees that any one single strategy will work. As a disclaimer please do seek professional help and get a proper assessment of your injury.

Calf Injury – Signs and symptoms:

Immediate sharp pain in the muscle at the bottom of the leg, just below the knee. OR in the middle of the muscle belly. Often people describe the pain as having felt like they’d been “shot” in the back of the leg. These are injuries of a more acute nature. Some people describe a niggle that tends to get worse with activity and calms down when they not using the muscle. The persistent niggle is a little more difficult to deal with as there are many factors to consider. Training regime and biomechanics for example.

* Week 1

This is always about P.O.L.I.C.E Protection, Optimal Loading, Ice, Compression and Elevation
Ice is best applied little and often. 10 minutes every hour, should be enough.

Typically, a pro athlete would be advised to go swimming, take one or two gentle walks and when possible, work on core stability exercises with a balance ball.

The right selection of footwear is important – avoid plimsoles or sandals. Find and wear a pair of trainers with a nice thick heel to prevent any tension on the muscle.

From a Physio point of view – after about day 5, I’d begin some deep massage and very gentle stretching and work on the ankle joint to prevent any stiffness or get rid of any swelling.

* Week 2

Ice continues – often until day 10 depending upon how much bleeding has taken place and how badly damaged the muscle tear is.

Typically, one of my athletes would now be exercising on a bike and swimming would continue.

The athlete can expect to begin on a bike or start on the rowing machine to keep up with CV fitness but running should be avoided for now.

From a Physio point of view – deep massage is now vital. We’ll also review and correct biomechanics and start to work on improving ankle range of movement.

It’s now that the scar tissue build up is “dangerous” and if the deep massage isn’t done, it’s the number 1 reason for calf muscles tearing again in the first two weeks back to running or playing.

* Week 3

Ice has stopped. Now, heat is being used rather than ice in this stage.

Stretching is now vital. I’d be recommending the athlete to attend Yoga classes, increase the amount of Pilates exercises and that he or she be working on their balance (using a ball).

Fitness levels are increased significantly. Swimming, cycling, gentle jogging is stepped up. And by the end, the athlete may or may not be asked to be doing pace running by now.

From a Physio point of view – hands-on treatment is vital, massage continues and work on the Achilles, hamstrings, gluteal muscles and lower back is essential to prevent future reoccurrence.

PNF stretching is also introduced.

* Week 4

Athlete 90% fit. CV work increases and a return to practice and full drills is possible and the goal, by the end of week 4.

Athlete is put through drills that will include sprints, shuttles and plyometric work.

From a Physio point of view – hands-on massage continues, PNF stretching is vital and passive and active stretching is stepped up. We’ll also start to add in jumping and plyometrics.

* Week 5

Athlete returns to sport. Fitness and performance work increases.

From a Physio point of view– massage continues to prevent scar tissue build up and stretching is continued before, during and after training sessions.

Note: Hands-on massage will be need for approximately another 2-3 weeks to prevent scar tissue (collagen) tightening up the muscles.

Review of Recovery:

Take it very easy early on, stretch and mobilise the injury at just the right time and no calf injury can ever recover fully without deep massage, stretching and proper plyometric strength work.

Secret Tip:

Too much rest in the first few weeks will increase the likelihood of re-injury.

Don’t be fooled by the lack of pain after two weeks either. It does not mean you are fit to play or run and if you haven’t followed all of the protocol listed above, you will damage the muscle again sometime soon

If you’d like to talk to an experienced Specialist Physio about the possibilities if you currently struggling with a calf strain and you decide for yourself that Physio will add value to your health, like it does so many other people, then please connect with us.

If you’d like more info on this, and some easy, actionable tips you can use now to start easing your sports injury. Connect with us on 01344 489398 (Bracknell) , 01753 866274 (Windsor) or email us on windsor@applephysio.com and tell us what’s going on. A member of the team can take your details and we can email you a copy.

About the Author: Leslie Abrahams and the Apple Physio team


fullsizeoutput_39a3

Leslie is a Physio, Pilates Educator and Rehab Specialist who has a special interest in Spinal Treatments, lower limb injuries, and has vast experience dealing with patients post injury or surgery. Every week, for over 20 years, 100’s of people aged 30-64+ have consulted the Apple Physio team looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.

 Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the Director of Apple Physio Clinics situated in Bracknell and Windsor. Berkshire’s Specialist Private Physiotherapy Practice for People in their 30’s. 40’s, 50’s and 60’s and above, who want to keep healthy and active.



Sports Injury Focus – Hamstring and Groin Injury

Here at Apple Physio we have worked with people with Hamstring and Groin injuries for many years and truly have a great knowledge of how to diagnose and manage this issue. We see people with minor strains to complete rupture, and the recovery plans and treatment process varies. We may be able to diagnose the area of the strain via Physical Assessment or we may request you get a scan of the area to ascertain the severity or grade of the tear. The hamstring/groin is divided into 4-6 different muscles, so it is important to determine which muscle belly is affected.  The injuries (and the recovery plans) provided in the weeks below are in no particular order of importance and they all have one thing in common – they all work. There’s a great saying that goes: Small hinges swing big doors. And it’s often the simplest advice that wins in the end.

Signs and symptoms:

Immediate sharp pain in the back of the thigh or inner thigh. Often when sprinting, or a challenge that stretches the muscles of the hamstring or groin forcefully and it’s not uncommon for bruising and swelling to appear and sometimes track to behind and side of the knee. Can be very disabling in the first few days and very painful to walk.

Tip 1

This is always about Ice and rest. Compression. Not much else.

Typically, I’d advise an athlete to go swimming, take one or two gentle walks and when possible, work on core stability exercises with a balance ball.

From a Physio point of view – after about day 5 I’d begin some deep massage and very gentle stretching. It’s here where we’ll determine if you need some additional investigations and may refer you to get an ultrasound scan in order to confirm the severity of the injury. Sports Taping and compression(via a thigh support or tubigrip) may help as well. Be careful if you have a flight soon after an injury like this. Consult your doctor or speak to your Physiotherapist if you are unsure.

Tip 2

Ice continues – often up to day 10 depending upon how much bleeding has taken place and how badly damaged the muscle tear is.

Typically, an athlete would now be exercising on a bike, swimming would continue and towards the end of week 2, I’d be aiming to have the athlete doing some very gentle jogging. The player or athlete can expect to feel some form of burning sensation, but as long as it isn’t “cramping” or “biting” this is fine – and a good thing.

From a Physio point of view – massage is now vital. It’s now that the scar tissue builds up is “dangerous” and if the massage isn’t done, it’s the number 1 reason for hamstrings or groin muscles tearing again in the first two weeks back to running or playing. Massage will be applied as the athlete can tolerate. Flushing is the term we would use.

Tip 3

Ice has stopped. More heat is being used rather than ice in this stage.

Stretching is now vital. I’d be recommending the athlete to attend Yoga classes, increase the amount of Pilates exercises and that he or she be working on their balance (using an exercise/ gym ball). However, stretch to the point of tolerance being careful not to hurt the healing tissue further.

Fitness levels are increased significantly. Swimming, cycling, long distance running is stepped up. And the athlete may or may not be asked to be doing three quarter paces running by now.

From a Physio point of view – hands-on treatment is vital; massage continues and work on the gluteal muscles and lower back is essential to prevent future reoccurrence.

PNF stretching is also introduced. (This simply means a contract relax technique to increase tensile strength of the muscle fibre and also increased the range of movement. PNF stretching can also modulate pain.)

Tip 4

Athlete 90% fit. CV work increases and a return to practice and full drills is possible and the goal, by the end of week 4.

Athlete is put through drills that will include sprints, shuttles and plyometric work.

From a Physio point of view – hands-on massage continues, PNF stretching is vital and passive and active/functional stretching is stepped up. Isolated hamstring strength and inner thigh work is included through a good full range of movement.

Tip 5

Athlete returns to sport, fitness and performance work increases.

From a Physio point of view – massage continues to prevent scar tissue build up and stretching is continued before, during and after training sessions. Isolated hamstring strength work is included through a good full range of movement. Here we include my favourite – Nordic hamstring curls and the squashed frog and side lunge for the inner thighs. The aim to make the hamstring and groin even more robust and strong to prevent re-injury.

Note: Hands-on massage will be needed for approximately another 2-3 weeks to prevent scar tissue (collagen) tightening the muscles.

Review of recovery:

Take it very easy early on, stretch and mobilize the injury at just the right time and no hamstring or groin muscle can ever recover fully without deep massage, stretching and the right amount of strength work vs the functional activity requirements.

Secret Tip:

When jogging or running for the first time… a *burning* sensation is to be expected and is OKAY. There’s no need to stop. But you must stop if it cramps or feels as though the muscle is “biting” sharply…

Too much rest in the first few weeks will increase the likelihood of re-injury.

Don’t be fooled by the lack of pain after two weeks. It does not mean you are fit to play or run and if you haven’t followed the rules listed above, you will damage the muscle again sometime soon.

Conclusion:

Truth is, without knowing you or your medical history intimately, I cannot tell you which of these will work best for you or if your recovery will follow the plan above. And even if I did know the root cause of your sports injury, there are no guarantees that any one single strategy will work. As a disclaimer please do seek professional help and get a proper assessment of your injury in order to tailor your treatment plan.

But imagine this… how great it would be if you try just one of the strategies below every day…within a few weeks you could have gotten some way towards winning back your active, healthy “sporty” lifestyle.

If you’d like to talk to an experienced Specialist Physio about the possibilities if you currently struggling with a hamstring or groin strain and you decide for yourself that Physio will add value to your health, like it does so many other people, then please connect with us.

If you’d like more info on this, and some easy, actionable tips you can use now to start easing your sports injury. Connect with us on 01344 489398 (Bracknell) , 01753 866274 (Windsor) or email us on windsor@applephysio.com and tell us what’s going on. A member of the team can take your details and we can email you a copy.

About the Author: Leslie Abrahams and the Apple Physio team


fullsizeoutput_39a3

Leslie is a Physio, Pilates Educator and Rehab Specialist who has a special interest in Spinal Treatments, lower limb injuries, and has vast experience dealing with patients post injury or surgery. Every week, for over 20 years, 100’s of people aged 30-64+ have consulted the Apple Physio team looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.

 Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the Director of Apple Physio Clinics situated in Bracknell and Windsor. Berkshire’s Specialist Private Physiotherapy Practice for People in their 30’s. 40’s, 50’s and 60’s, who want to keep healthy and active.