Month: September 2014

Ankle sprains can occur when a person rolls over on their ankle (often on an uneven surface) or when landing down from a height or a step. Symptoms may include immediate pain, swelling (most commonly on the outside of the ankle), bruising and difficulty walking due to pain. These symptoms can be quite similar to that of an ankle fracture, so assessment by a doctor or a chartered physiotherapist to determine if an X-ray is indicated is important. With an ankle sprain, the ligaments of the ankle (ligaments connect bone to bone) may be stretched or torn.

At IONA Physiotherapy, a comprehensive assessment to determine which structures have been injured will be undertaken and will guide your management programme. Treatment is likely to include advice regarding control of swelling, manual therapy to restore movement and exercises to improve strength and proprioception. Proprioception, or joint position sense, is your ability to tell where a joint is in space without looking at it.

When you hear someone say they “have a weak ankle”- they probably mean that they keep rolling over on their ankle, and one of the reasons for that is likely to be poor prioprioception.

Proprioceptive retraining has been shown in research to reduce the rate of recurrence of ankle injuries and will therefore be a crucial part of your rehabilitation.

The wrist is most commonly fractured by falling on an outstretched hand (FOOSH). You can fracture one of the long forearm bones (most commonly the radius) or one of the smaller wrist bones (carpal bones) such as the scaphoid. If you do sustain a FOOSH and have immediate wrist pain and an inability to put weight through the hand or move the wrist, along with immediate swelling, it’s likely that you may have a wrist fracture and you should seek medical assessment.

A Colles (radius) fracture is the most common wrist fracture and often displays a ‘dinner fork’ deformity meaning that the back of your wrist resembles a fork turned downwards. This may treated by immobilisation or surgical repair. Physiotherapy will commence after your orthopaedic surgeon has told you that the fracture has united and rehabilitation can begin.

A fracture of the scaphoid bone is less symptomatically severe as a Colles fracture. This bone is found at the base of the thumb. The reason a fracture of this bone is somewhat infamous is because not all scaphoid bones heal well after fracture. The blood supply to this bone can be compromised by fracture, leading to crumbling of the bone over time (avascular necrosis) which leads to longer term problems with the wrist. For this reason, it’s extremely important that this fracture is identified early and treated effectively.

Top tips for wrist fracture

• It is very important to keep your fingers, elbow and shoulder joints moving while you are immobilised for your wrist fracture. This means moving at least 3 times a day throw full available range of movement.
• Once your orthopaedic surgeon has confirmed that your fracture has united, rehabilitation will begin in earnest. At IONA Physiotherapy we will give you the appropriate exercise programme and help your regain movement at the wrist as soon as possible.

There are many useful resources online to provide you with more information about how to treat different types of neck pain. We can discuss these in detail at your initial consultation with us, when we will work out together what treatment best suits you.

NHS Choices – Neck Pain and Stiff Neck
NHS Choices – Osteoarthritis of the Neck (Cervical Spondylosis)
NHS Choices – Whiplash Associated Disorders
University of Queensland’s Consumer Guide to Researched Treatments for Whiplash

When you present for your physiotherapy assessment, the first step of the clinical exam is to triage the seriousness of the cause of neck pain. This means that by taking a detailed history and undertaking a specialised manual exam, we can categorise your neck pain as mechanical neck pain, radiculopathy (a trapped nerve in the neck leading to sharp shooting arm pain) or likely due to a serious spinal pathology that requires further medical assessment. Less than one out of a hundred people presenting with neck pain have a serious spinal pathology but we are always on the lookout for such a presentation.

Once your triage reveals a more straightforward musculoskeletal source of your neck pain, a specialised manual exam of your neck and upper back will reveal where the symptoms are coming from and also the consequences to your joint movement and muscle function. This detailed examination will form the basis of your treatment plan.

Current research suggests that the most effective treatment for neck pain is an approach that combines manual therapy (joint mobilisation, manipulation or soft tissue massage) and exercise. On their own, manual therapy or exercise do not have as good an effect as when they are combined so you can expect your treatment session at IONA Physiotherapy to include both elements.

Manual therapy leads to short to medium term improvements in pain and disability i.e. helping you to get back to doing your daily activities comfortably and exercise seems to lead to longer term improvements. Each exercise programme is based on individualised assessment and will vary for each patient. For example, some people with neck pain are tight in certain muscles and weak in others around the neck and shoulder, so their programme will feature a range of exercises to correct this muscle imbalance.

Advice is also important for treating neck pain, for example if your neck pain is postural in nature, your work station may need to be analysed to ensure it is set up correctly so that better work posture can be achieved.

The most important advice to someone who has Whiplash is to manage your pain well, so that you can go about your everyday activities without disruption. This may mean taking prescribed medication to keep pain levels down, to enable you to go to work, do your exercises etc. We now know from research that if you rest for too long after a whiplash injury, your recovery can be slowed down so the focus to your treatment will be towards active recovery.