Blog Injuries

Ankle pain and how to treat it

What causes ankle pain?

There are many reasons someone may suffer from ankle pain. For the purpose of this article, we will
focus on one of the most common ankle injuries, namely a lateral ankle sprain.
Injury to one or more of the lateral ankle ligaments typically happen when you ‘roll your ankle’. This is
when the foot rolls inwards suddenly, maybe over a curb or from an uneven surface. This can sprain or
tear the supportive ligaments on the outer ankle and cause pain, swelling and difficulty walking.

Ankle Pain

How to treat ankle pain?

If your ankle is swollen then it is recommended to adopt the PRICE protocol for the first 48 hours.
PRICE stands for: Protect, Rest, Ice, Compression, and Elevation. This can be done by wearing a
bandage or an ankle sleeve, applying ice to the region for 10 minutes 3-5 times a day, resting, and
elevating your foot while resting. This should help speed up healing and reduce your ankle pain over the
first few days. In fact if you do this, you are likely to not only get better faster but also need less
physiotherapy sessions!

What can my physio do?
The good news is that most ankle sprains are not serious, however, they do require rehabilitation. Your
physiotherapist will guide your ankle rehab. Exercises and therapy will focus on restoring full normal
range of motion to your ankle, ankle strengthening and balance training.
A guided rehabilitation program, prescribed to you by your chartered physiotherapist, will enable you to
return to your chosen activities and greatly reduce your risk of recurrence.


Ankle Sprain

Ankle Fractures

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.


Wrist fractures


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.

Research-Based Useful Consumer Resources

Neck Pain

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



Neck Pain

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.



Picture Conor McCabe Photography.

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.


Patellar Tendonitis and Tendinopathy (Jumper’s Knee)


The Patellar tendon joins the lower end of the knee cap to the top of the shin bone. Acute inflammation of this tendon is known as patellar tendonitis. If this is managed appropriately, symptoms should improve within 6 weeks. Assessment by a chartered physiotherapist to address the reason for the acute inflammation e.g. muscle imbalance, biomechanical problem, training error etc is advisable so that the injury does not become more chronic (lasting more than 6 weeks). When pain below the knee cap persists beyond 6 weeks, one possible cause is patellar tendinopathy. Tendinopathy (or tendonosis) means that inflammation in the tendon is no longer present but the tendon shows signs of microscopic degeneration. Many factors can contribute to patellar tendinopathy e.g. overuse, strength imbalance between various muscles, postural mal-alignment of the lower limb, biomechanical foot type, reduced ankle movement and lack of muscle strength or flexibility. At Iona Physiotherapy, we will first take a detailed history e.g. how long the pain has been present, your training regime etc before undertaking a comprehensive biomechanical and physical assessment with regard to the above possible causes. Treatment will include addressing any of the factors that are causing excessive load on the tendon and a progressive strengthening programme. There is a specific type of exercise that has been shown in research to rehabilitate tendinopathy (reversing degenerative changes) and help you return to your sport/activity, which is known as eccentric training


Sportsman’s Groin

hip and groin

Groin pain can become chronic (lasting for more than 3 months or recurrently presenting) for some athletes. A small percentage of this will have a hernia that may require surgical repair (Gilmore’s Groin) but the majority have a collection of non-structural groin problems that will respond to comprehensive rehabilitation.

Bone, ligamentous, tendinous or muscular pain can all occur individually or collectively. The common factor at play is ‘abnormal tension’ on the groin. This may be due to over-training, poor flexibility, poor core control or poor gluteal muscle control.

At IONA Physiotherapy, a detailed assessment of your training regime and physical factors will be undertaken. Sometimes, diagnostic imaging (MRI) may be required to assist in treatment decisions, but in the majority of cases, surgical referral is not considered until conservative management has failed to resolve your symptoms.

Rehabilitation will follow (link to groin strain) and temporary ‘relative’ rest may be necessary to get the symptoms under control and allow progressive rehab.

‘Relative’ rest simply means looking at all training / sporting activities and reducing the most provocative elements to get you down to the point where no symptoms are produced during activity. Total rest does not work – you may not feel pain while you rest, but often the symptoms re-appear more severely when you recommence your sport.


Groin Strain

hip and groin

Certain sports carry with them a risk of acute groin injury/ groin strain. Sports such as GAA, soccer and rugby that involve running, kicking and fast change in direction, carry an increased risk of groin injury compared to repetitive sports like swimming or cycling.
The most common muscle involved is the Adductor Longus and if this is strained, sudden pain will be felt on the inside thigh up to the groin. Often these injuries are very straightforward to diagnose and treat. A thorough history taking and physical exam can usually identify the injured structure.

Treatment will involve advice to rest, ice, compression and protection (taping or brace) to treat the initial pain and swelling and importantly, prevent any further injury from occurring. Strapping can be very effective in the first few days for pain relief. Manual therapy and exercise will follow. Exercise focused towards stretching long-term muscle tightness in the area and strengthening primarily gluteal and core muscles and later, adductor muscles.

Manual therapy (massage) will be used if indicated by the presence of increased adductor muscle tone in the early days or shortened scar tissue a number of weeks later. The key theme of your rehab for a groin strain will be building the blocks towards a safe return to your sport and preventing a similar injury occurring in the future.


Hip Osteoarthritis

hip and groin

Osteoarthritis (OA) commonly affects the hip joint. Pain and stiffness are the most common symptoms, although a ‘creaking’ sound (crepitus) can be heard later on for some people. Pain can be felt in the groin, the thigh or buttock.
Occasionally, hip joint OA may even present exclusively with pain in the knee and not the hip! As OA involves degeneration of the joint cartilage, pain is primarily provoked by loading the joint, for example, bearing weight during running or walking.

Stiffness tends to be worst in the morning time or after a prolonged period sitting e.g. at a desk job or after a long car journey.

OA is a condition that needs to be managed and conservative treatment is enough for many people to help them do so. The focus of treatment is on optimising your quality of life and conserving the joint for as long as possible. Conservative (non-surgical) treatment includes the following:

  • Exercise – research supports exercise as the most important element of treatment. Exercise prescription will be bespoke, depending on your physical assessment but the most common elements for people with hip OA include mobility exercises (stretches or Yoga) and strengthening exercises for anti-gravity muscles that protect the joint (gluteal and core muscles).
  • Analysing your current lifestyle and suggesting modifications that lead to less load on the joint. Examples include changing sporting activity from long-distance running to swimming or, in the case of a less active individual for whom walking has become painful, introducing a walking stick to reduce pain and foster a better walking pattern.
  • Manual Therapy – may be useful to assist with pain relief or improving mobility. It is possible to regain some mobility, particularly in the early stages of OA.
  • Medication – pharmacological management can improve quality of life for people with hip OA and should be discussed, in detail, with your GP.

After a trial of conservative treatment, if your hip OA symptoms are not responsive, it may become appropriate to discuss the timing of referral to an orthopaedic surgeon, for consideration of hip surgery.