Massive congratulations to all SPL teams for coming to the end of the season! ✨
We are also very thankful and happy to have provided our rehabiliation services to Lion City Sailors Football Club, Geylang International FC, Tanjong Pagar United F.C. (Official), Balestier Khalsa Football Club, & Tampines Rovers Football Club this year. We look forward to working with all of you again.
Meanwhile, stay safe and healthy! 💙
The ankle joint is made up of 3 bones, the tibia and fibula (shin bones) and the talus (ankle bone). The 2 bony prominences of the ankle are known as the lateral malleolus (distal fibula) and the medial malleolus (distal tibia). Apart from a bad sprain or high ankle sprain, fractures can also happen here.🦶
The biggest group affected are teenagers as a high percentage of them take part in contact sports. Similar to an ankle sprain, the mechanism of injury is mostly rotational, but can also occur from an external blow or trauma.
The symptoms of a fracture are:
💢 Immediate severe pain
💢 Swelling, bruising, tenderness
💢 Obvious deformity
💢 Inability to walk
If the fracture is severe and displaced, meaning that the bones are out of alignment, surgery is recommended.🦴 If the fracture is deemed as stable, meaning it is either a mild fracture and/or the bones are still aligned, a cast or airboot may be preferred. Either way, the leg is immobilized for 4-6 weeks to allow the bones to heal.
Due to this period of immobilization, muscle wasting and stiffness is normal due to the lack of active muscle use. Swelling can occur also due to the lack of movement and gravity, causing blood to pool in the ankle. Cartilage degeneration within the joints may occur. In some cases, the bones don’t heal properly or not at all, resulting in malalignment or non-union of the broken pieces. 🤕
Physiotherapy is important to help identify and treat some of these issues. For example, swelling, pain, stiffness, and tightness can be reduced via electrophysical agents⚡, manual therapy👐, and simple appropriate exercises. Subsequently, the exercises will be progressed accordingly to regain mobility and prepare the individual to return to sports and activities. ⛹️
Whilst fractures may not be entirely prevented, there are some ways to reduce the risk of fracture. This includes:
☑️ Gradually increasing the exercise intensity
☑️ Wearing appropriate footwear
☑️ Regular ankle strengthening exercises
☑️ Eating a healthy diet
Send us a DM or contact us at 82182905 / 62620970 to find out more!📱
📝1. Scheer, R. C., Newman, J. M., Zhou, J. J., Oommen, A. J., Naziri, Q., Shah, N. V., … Uribe, J. A. (2020). Ankle Fracture Epidemiology in the United States: Patient-Related Trends and Mechanisms of Injury. The Journal of Foot and Ankle Surgery, 59(3), 479–483.
📝2. Larsen, P., Rathleff, M. S., & Elsoe, R. (2018). Surgical versus conservative treatment for ankle fractures in adults – A systematic review and meta-analysis of the benefits and harms. Foot and Ankle Surgery.
📝3. Ankle Fracture. (2021, March 21). [Illustration]. https://www.orthopaedicsurgeon.com.sg/ankle-fracture/
📝4. Crocker, B. (2018, July 25). Tibia Fracture - Broken Tibia. PhysioAdvisor. https://www.physioadvisor.com.au/injuries/lower-leg/tibia-fracture/
#fracture #anklefracture #distaltibiafracture #shin #anklesprain #ankle #rehab #anklerehab #strain #injury #sprain #joint #muscle #rehabilitation #strengthening #exercise #health #physiotherapy #physio #physiosports #fitnessSingapore #fitnessSG
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Regardless an ankle sprain or high ankle sprain, a comprehensive rehabilitation programme or protocol is needed. Although ankle sprains are the most common injury in sports, less than 50% of individuals seek medical treatment. As such, 1/3 of them can go on to experience chronic ankle instability and recurring sprains. 🦶
Once the acute phase has settled, a physiotherapist can prescribe some isolated ankle strengthening exercises. This should also be followed by single leg dynamic exercises that work to improve proprioception and control/balance that is often affected after an ankle sprain.
Here are some exercises you can try:
1️⃣Single leg hops on the spot
2️⃣Single leg hop and stick (forwards)
3️⃣Single leg hop fast (forwards)
This is essential especially for athletes and people looking to return to sports.🏀⚽🎾 A study recently published a return to sport criteria to help guide the rehabilitation process and recommendations. They came up with the PAASS framework, which refers to:
▪️Pain severity during sport participation & over last 24 hours
▪️Athlete perception of their own ankle & how ready they feel
Your physiotherapist will assess these factors before progressing your exercises and help to plan when you can return to sport. ☑️
If you or anyone you know is interested to start your rehab journey with us, do drop us a DM or call us at 82182905🤳 / 62620970📞 to arrange an appointment!
📝1. Smith, M. D., Vicenzino, B., Bahr, R., Bandholm, T., Cooke, R., Mendonça, L. D. M., ... & Delahunt, E. (2021). Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus. British Journal of Sports Medicine.
📝2. Chinn, L., & Hertel, J. (2010). Rehabilitation of ankle and foot injuries in athletes. Clinics in sports medicine, 29(1), 157.
#anklesprain #ankle #rehab #anklerehab #strain #injury #sprain #joint #muscle #rehabilitation #strengthening #exercise #health #physiotherapy #physio #physiosports #fitnessSingapore #fitnessSG #balance #agility #footwork #hopping
Less commonly seen is the high ankle sprain. It involves separation of the ligaments that bind the 2 long shin bones (tibia and fibula). The area of the ankle where this separation occurs is called the syndesmosis. The syndesmosis consists of the interosseous membrane (IM), anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and the transverse tibiofibular ligament and interosseous ligament which are not pictured in the video. The IM spans the entire length between the tibia and fibula, while the AITFL and PITFL are the primary stabilizers of the distal shin joint, limiting external rotation of the foot. 🦶
As such, a high ankle sprain usually occurs from a twisting or rotational injury. For example, pivoting inwards with the foot planted, OR experiencing an external blow to the outside of the knee while the foot is planted and flexed. This position creates shearing forces within the ligaments and interosseus membrane, causing them to split apart. In more serious cases, it can be accompanied with fracture. Common sports involved include basketball🏀, soccer⚽, rugby (or American football)🏈, and lacrosse🥍.
There is normally point tenderness over the syndesmosis, with perhaps less swelling than common ankle sprain, but difficulty to weight bear. Thus, the initial management is to offload weight, and surgery if there is frank instability, confirmed via imaging. 🦴
For physiotherapy, the primary goal of the initial phase is to protect the joint while managing the swelling, inflammation, and pain. This is done through modalities such as current therapy, manual therapy, and cryotherapy. Appropriate exercises and gait retraining are slowly introduced to regain motion, function and strength. The recovery time for a high ankle sprain typically takes longer than a common ankle sprain, and can take several months. Eventually, return to sports and activities are introduced. ⛹️🤾
Send us a DM or contact us at 82182905 / 62620970 to learn how to manage a high ankle sprain! 📱
📝1. Williams, G. N., & Allen, E. J. (2010). Rehabilitation of Syndesmotic (High) Ankle Sprains. Sports Health: A Multidisciplinary Approach, 2(6), 460–470. doi:10.1177/1941738110384573
📝2. Syndesmotic Ankle Sprains. (n.d.). Physiopedia. Retrieved September 20, 2021, from https://www.physio-pedia.com/Syndesmotic_Ankle_Sprains
📝3. Porter, D. (n.d.). High Ankle Sprain (Syndesmotic Injury). AOFAS FootCareMD. Foot Care MD. Retrieved September 20, 2021, from https://www.footcaremd.org/conditions-treatments/ankle/high-ankle-sprain
📝4. Lee, E. (n.d.). High Ankle Sprain: A Difficult Athletic Injury | OAK Orthopedics. OAK Orthopedics. Retrieved September 20, 2021, from https://www.oakortho.com/news/high-ankle-sprain-difficult-athletic-injury
#physiosports #physiotherapy #physio #covid19 #health #exercise #strengthening #rehab #rehabilitation #fitnessSG #anklesprain #highanklesprain #muscle #joint #injury #sprain #strain
Around the ankle joint are many ligaments that act to support and stabilize the joint. An easy way to remember is to divide it into the lateral ligaments complex on the outside of the ankle, and the medial ligaments complex on the inside of the ankle. 🦶
The lateral ligaments are: the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL) and the calcaneofibular ligament (CFL). Apart from the anatomical structure of our bones that allow the ankle to roll inwards more easily, the ATFL is also the weakest ligament and most commonly injured, followed by the CFL. The medial ligaments, namely the deltoid ligament, is a much stronger structure consisting of superficial and deep layers, and thus rarely injured.
During an ankle sprain, the ligaments, muscles and soft tissue are stretched. If the ligaments are stretched beyond their limit, they tear. The anterior drawer of the ankle is the most commonly used test to assess ligament laxity, specifically of the ATFL.
To test, the subject can be sitting or lying down, with the knee relaxed. The examiner stabilizes the lower shin and cups the heel, exerting a forwards direction force to the heel. The test is positive if there is excessive translation of the talus (or foot). A translation of more than 5mm 📏 would indicate an ATFL tear. Do remember to compare the findings on both legs and correlate with the patient history. 📋
Not to worry if findings do indicate a tear either, as it has been shown that ankle sprains and ankle ligament tears can be managed well conservatively, without surgery. A comprehensive rehabilitation programme however, is needed. Surgery is only recommended for those with persistent symptoms and determined on individual basis. 🤸
Send us a DM or contact us at 82182905 / 62620970 to learn how to manage an ankle sprain!📱
📝1. Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British journal of sports medicine, 51(2), 113-125.
📝2. Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle Sprains. Current Sports Medicine Reports, 18(6), 217–223.
📝3. Stress tests for Ankle ligaments. (n.d.). Physiopedia. Retrieved August 30, 2021, from https://www.physio-pedia.com/Stress_tests_for_Ankle_ligaments
📝4. ANKLE STRESS EXAMINATION TESTS. (n.d.). The University of West Alabama. Retrieved August 30, 2021, from http://at.uwa.edu/Special%20Tests/SpecialTests/LowerBody/ankle.htm
#physiosports #physiotherapy #physio #covid19 #health #exercise #strengthening #rehab #rehabilitation #fitnessSG #anniversary #muscle #joint #injury #ankle #sprain #anklesprain #fitfamSG #SGfitfam
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