Health Associates
  • Meet the team
    • Chiropractors >
      • Chris Bowles
      • Joshua Hallinan
    • Podiatrists >
      • Anel Kapur
    • Massage Therapists >
      • Carlie Isemonger
      • Anna Teasel
    • Administration Team >
      • Gillian Mara
  • Services
    • Chiropractic >
      • What is Chiropractic
      • Common Conditions Treated >
        • Spinal Stenosis
        • Scoliosis - Childhood
      • F.A.Q
    • Podiatry >
      • Podiatry Services >
        • Ingrown Toenails >
          • Feet >
            • Toe Nails
            • Flat Feet
        • Custom Orthotics
        • Diabetic Foot Care
    • Remedial Massage >
      • About Remedial Massage
  • Blog
  • Bulk Billing
  • Covid Safe
  • Book Online
  • Contact us

Ankle Sprain and Rehabilitation

5/27/2019

0 Comments

 
Picture
An ankle sprain occurs when the ligaments of the ankle are undergone a force that stretches them beyond their capabilities and tear. Ligaments of the ankle are tough bands of tissue that provide support to hold the ankle bones together and prevent excessive movement. The lateral (outer) part of the ankle is made up of three ligaments the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). The deltoid ligament supports the entire medial (inner) aspect of the ankle. There is an interosseous ligament, which is tissues that runs between the entire length of the tibia and fibula. Most ankle sprains occur on the lateral aspect of the ankle, affecting the ATFL ligament. Anyone can experience an ankle sprain at any age.
 
There are three different types of ankle sprains:


  1. Inversion ankle sprain
    - Usually involves inversion + plantar flexion + rotation
    - Damages the lateral ligaments of the ankle
    - Peroneal muscle and tendon strains (lateral muscles of the leg)
    - Peroneal nerve injury may also occur in serious cases
  2. Eversion ankle sprain
    - Rare
    - Most events are severe
    - Damages medial ligaments of the ankle
  3. Diastasis/syndesmosis
    - Damage to the distal talofibular ligaments
    - There can be ankle instability
    - Often associated with a fracture
 
There are 3 grades to a sprain:


  1. Grade one
    - No bruising, mild swelling and tenderness
    - Mild to no limp, can raise up on toes
    - No joint laxity, pain at end range of motion
    - 1-2 weeks recovery
  2. Grade 2
    - Bruising on one side of foot, more extensive swelling
    - Less localised tenderness, i.e. both sides of ankle
    - Visible limp and unable to raise up on toes
    - Slight laxity and pain with most movements
    - 4-8 weeks recovery
  3. Grade 3
    - Bruising and swelling both sides of foot.
    - Tenderness on both sides
    - Unable to weight bear
    - Large amount of laxity
    - 2-6-month recovery
Picture
Phase 1 - Acute management of ankle sprain (within 24-72 hours of injury):

  • RICE protocol – rest, ice (20 min on, 1 hour off), compression, elevation
  • Move ankle through pain free active range of motion as soon as possible
  • Watch for significant swelling or changes to ankle which means major damage has occurred
  • Weight bear when tolerable, use crutches if it is too painful to load the ankle
 
Phase 2 - Post-acute phase management (Recovery time will vary depending on severity):


  • Provide support around the ankle when needed.
  • Continue to move the ankle through pain free range of motion
  • Strengthen muscles that invert (turn foot inwards) and everters (turn the foot outwards), this depends on the type of sprain. This can be achieved with a resistance band.
  • Single leg stance with eye close to improve proprioception (perception/awareness of the position and movement of the body). This can be made more difficult with an unstable surface such as a foam matt or folded pillow.
  • Ankle manipulations (done by an allied health practitioner) to promote movement and healing within the joint of the ankle.
  • Use massage ball to release tight muscles that have compensated because of the injury.
  • Increase weight bearing; use pain and swelling as a to guide the intensity
  • Heel/calf raises to increase strength and stability of the ankle
  
Phase 3 – Return to play when all of the above is achieve:


  • Begin running with focus on agility and side stepping.
  • Jump rope/hopping with increase the intensity of bearing weight onto the ankle.
  • Return to sports specific drills.
  • Return to play if there is no discomfort during the sports specific training.
​
Josh Hallinan
Chiropractor
Available for Appointment Tuesday & Thursday at Health Associates


Vuurberg G, Hoorntje A, Wink LM, et al Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline British Journal of Sports Medicine 2018;52:956.
 
Kerkhoffs GM, van den Bekerom M, Elders LAM, et al Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline British Journal of Sports Medicine 2012;46:854-860.
 
Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8
 
Wolfe, Michael W. "Management of ankle sprains." American family physician 63.1 (2001).

 
Picture
Book Online
0 Comments

Get the latest research on football shoes!

5/16/2019

3 Comments

 
Picture
 A great study titled "Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football" has recently been released discussing what type of football (soccer) shoes are best for reducing the risk of lower limb injuries such as the commonly experienced ACL damage.

Football involves a high amount of acceleration, deceleration and changing direction. Both require an adequate amount of traction between shoes and surface in order for the movement to be executed quickly, safely and effectively.

Previous studies have shown that compared to other team sports football requires the greatest amount of cutting movements. A player can perform up to 800 cuts per game! 

A players ability to accelerate, decelerate and change direction is influenced majorly by the tractional properties of boots and playing surface.

The components of traction studied in this paper were translational and rotational. Translational relating to the player moving in a straight or side to side pattern.

Previous studies have proven that increased translational movement is linked to improved performance whereas increase rotational movements are associated with an increased risk of lower limb injuries such as ACL damage. 

The study looked at the relationship between:-
Shoe outsole purpose
  • Artificial grass
  • Firm ground
  • Soft ground
  • ​Stud cleat configuration
With 
  • Playing surface
​
This study was completed to shed some more light on which external factors are contributing to lower limb injury in football players. The external factor here being footwear and the way they interact with the playing surface.

The study was done in Doha, Qatar at the Qatar national team outdoor training pitch. The study was carried out over a single season on the one natural grass football pitch.

6 Nike Shoes were included:-
Artificial grass
  • Tiempo (AG)
Firm ground
  • Hypervenom
  • Tiempo
  • Magista
  • Mercurial
Soft ground
  • Tiempo (SG)
​
​
All 6 shoes, one at a time, were attached to a portable traction testing device which is designed to mimic foot movements employed by football players.

This allowed the researchers to pool data about all 6 shoes and their translational and rotational traction qualities.

What were the results?!
Soft ground outsoles showed to have the highest translational traction, however they also showed to have had the highest rotational traction!

Shoe outsoles designed for artificial grass, so the Nike Tiempo (AG) had the lowest rotational traction and came out on top.

So what does all this mean?
Decreased rotational traction in a shoe is proven to decrease lower limb injuries WITHOUT causing any detriment to player performance. 

So YOU want increased translational traction, helping the player move forward and side to side more effectively and safely, and decreased rotational traction, meaning they can rotate and pivot without that increased chance of hurting themselves!

This doesn't mean that if you put the Nike Tiempo on that you're invincible and you'll never hurt yourself. Many things come in to play when aiming to reduce the risk of injury. Adequately strengthening and stretching the correct muscle groups, building the appropriate skills and recruiting safe and effective movement patterns and strategies all compound together to make you a stronger, better player that will be able to stay in the game for longer.

Moving forward towards purchasing footwear, artificial grass shoe outsoles are small round moulded studs vs the screw in metal studs used with soft ground outsole shoes. Also, making sure the fit of the shoe is correct is just as important as getting the appropriate outsole. Having a shoe that is wide enough, deep enough and long enough is crucial!

Moving forward in the world of research they forecast studies looking further into the relationship between shoes and several different playing surfaces, soil types, and grass species to get a more complete understanding of shoe-surface traction.

Stay tuned players!

Access the whole research paper here, hot off the press!
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216364

References
Taylor JB, Wright AA, Dischiavi SL, Townsend MA, Marmon AR. Activity demands during multi-directional team sports: a systematic review. Sports Medicine. 2017 Dec 1;47(12):2533–51. pmid:28801751

Picture
Anneliese Ball
Podiatrist
Anneliese joins Health Associates as a podiatrist working Monday and Saturdays.
She holds both a Bachelor of psychology and podiatry and has dedicated herself to studying full time for 7 years.
As a podiatrist she combines her proficient knowledge of human mechanics and ability to connect and engage with her patients to deliver outstanding clinical outcomes and an exceptional customer experience.
Anneliese loves health and fitness and enjoys encouraging her patients to maximise their health.

Book Online
3 Comments

Tips and tricks - Ankle sprains and what to do about them.

5/9/2019

0 Comments

 
Picture
Soccer is the most popular sport on the globe with over 270 million participants and it’s easy to see why. It is fast, dynamic, exciting and crazy, almost every emotion within 90 mins can be experienced. The performance of a soccer player is made up of many different variables such as tactile, mental, technical and physiological. During a game, elite level players run about 10km at an average intensity close to the anaerobic threshold (80-90% of maximal heart rate). Within this time there are a number of explosive movements including jumping, kicking, tackling, sprinting, turning and deceleration. Strength and power are equally as important as endurance in soccer. Now with this large number people playing and the high demands of the game there will be injuries. Let’s analyse to trends of injuries in soccer and how they can be managed and prevented, paying close attention to ankle sprains
Most soccer injuries occur to the lower extremity at approximately 87% and the common injury types include strain, sprain and contusion. The UEFA injury study showed thigh strains makes up 17%, hamstring 12% and ankle sprain 7%. The incidence is higher during the game at 57% making injuries quite high during training at 43%. 16% accounted for more than 28 days away from training and game. 12% with season ending injuries. Another study among amateur soccer players in Spain showed there was an average of 0.11 injuries per player per year. A large number of injuries led to 1 competitive match being missed (87%). Midfielders had the highest injury rate at 34.3%. The knee and ankle making up 42.3% making them the most common injury location. Ligament sprains accounted for 32.1%.
Risk factors:

  • Previous injury
  • Age (older players tend have a greater number of injuries)
  • Play intensity
  • Poor rehabilitation to injured area
  • Lack of strength and stability
  • Increased risk towards end of the game – fatigue
  • Inadequate preseason preparation (see more overuse injuries)
 A change in score also has a strong correlation with an increase in injury incidence, this is because it changes:
  • Team strategy
  • Player precautions
  • Players attitudes
  • Intensity of the match
  • Competitiveness


As mentioned, ligament sprains are common within especially in the ankle. 80-90% of ankle injuries are on the outer aspect of the ankle (lateral) with 69% being on the dominant leg. Most of the time the sprains are uncomplicated, however, 60% suffer from a repeated sprain after the initial event. 63.3% occurs with player contact and most occur to defenders. The mechanism of injuring is due to landing, twisting, turning or running which leads to rolling the ankle.
 How to recognise an ankle sprain:
  • Pain or discomfort around ankle post rolling it
  • Swelling
  • Discoloration
  • Limited ROM
  • Non-load bearing pain
  • Instability
  • Weakness
  •  
There are 3 grades to a sprain:
  1. Grade one;
    - No bruising, mild swelling and tenderness
    - Mild to no limp, can raise up on toes
    - No joint laxity, pain at end range of motion
    - 1-2 weeks recovery
  2. Grade 2;
    - Bruising on one side of foot, more extensive swelling
    - Less localised tenderness, i.e. both sides of ankle
    - Visible limp and unable to raise up on toes
    - Slight laxity and pain with most movements
    - 4-8 weeks recovery
  3. Grade 3;
    - Bruising and swelling both sides of foot.
    - Tenderness on both sides
    - Unable to weight bear
    - Large amount of laxity
    - 2-6 month recovery
Picture
Acute management of ankle sprain (within 24-72 hours of injury):
  • RICE protocol – rest, ice (20 min on, 1 hour off), compression, elevation
  • Move ankle through pain free active range of motion as soon as possible
  • Watch for significant swelling or changes to ankle which means major damage has occurred
  • Weight bear when tolerable, use crutches if it is too painful to load the ankle

Once swelling and pain have decreased begin a rehabilitation program to be able to return to play and decrease the risk of re-occurrence.
Prevention strategies for ankle sprains:
  • Bracing
  • Tape
  • Strength, flexibility and balance training
  • Good warm ups
  • Hydration
  • Conditioning
  • Good pre-season preparation


References:Lehnhart RA, Lehnhart HR, Young R, et al. Monitoring injuries on a college soccer team: the effect of strength training. J Strength Cond Res 1996; 10 (2): 115–9
Stølen, T., Chamari, K., Castagna, C. et al. Sports Med (2005) 35: 501. https://doi-org.simsrad.net.ocs.mq.edu.au/10.2165/00007256-200535060-00004

Am J Sports Med. 2014 Jan;42(1):78-85. doi: 10.1177/0363546513507767. Epub 2013 Oct 17. Injuries among Spanish male amateur soccer players: a retrospective population study.
Ryynänen J, Dvorak J, Peterson L, et al Increased risk of injury following red and yellow cards, injuries and goals in FIFA World Cups Br J Sports Med 2013;47:970-973.
Walls RJ, Ross KA, Fraser EJ, et al. Football injuries of the ankle: A review of injury mechanisms, diagnosis and management. World J Orthop. 2016;7(1):8–19. Published 2016 Jan 18. doi:10.5312/wjo.v7.i1.8
Med Sci Sports Exerc. 1999 Jul;31(7 Suppl):S470-86. Foot and ankle problems in the young athlete.
Kofotolis, N. D., Kellis, E., & Vlachopoulos, S. P. (2007). Ankle Sprain Injuries and Risk Factors in Amateur Soccer Players during a 2-Year Period. The American Journal of Sports Medicine, 35(3), 458–466. https://doi.org/10.1177/0363546506294857
Safran MR , Benedetti RS , Bartolozzi AR 3rd , Mandelbaum BR  Medicine and Science in Sports and Exercise [01 Jul 1999, 31(7 Suppl):S429-37] Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis. 
Picture



Book Online
0 Comments

    RSS Feed

    Archives

    July 2020
    February 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    July 2018
    February 2018
    November 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    December 2016
    November 2016
    October 2016
    September 2016
    May 2016
    April 2016
    March 2016

Contact Details
Call 9542 3330
99A Loftus Ave, Loftus NSW 2232

Hours
Mon & Wednesday 9am - 6pm 
Saturday: 8am - 12pm
Early morning or later evening available by appointment
​
Our reception is available for walk-ins on Monday, Wednesday & Saturday. Or by telephone 7 days.
Book Online
  • Meet the team
    • Chiropractors >
      • Chris Bowles
      • Joshua Hallinan
    • Podiatrists >
      • Anel Kapur
    • Massage Therapists >
      • Carlie Isemonger
      • Anna Teasel
    • Administration Team >
      • Gillian Mara
  • Services
    • Chiropractic >
      • What is Chiropractic
      • Common Conditions Treated >
        • Spinal Stenosis
        • Scoliosis - Childhood
      • F.A.Q
    • Podiatry >
      • Podiatry Services >
        • Ingrown Toenails >
          • Feet >
            • Toe Nails
            • Flat Feet
        • Custom Orthotics
        • Diabetic Foot Care
    • Remedial Massage >
      • About Remedial Massage
  • Blog
  • Bulk Billing
  • Covid Safe
  • Book Online
  • Contact us