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:
There are 3 grades to a sprain:
Phase 1 - Acute management of ankle sprain (within 24-72 hours of injury):
Phase 2 - Post-acute phase management (Recovery time will vary depending on severity):
Phase 3 – Return to play when all of the above is achieve:
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).
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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
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
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 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. 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:
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:
Acute management of ankle sprain (within 24-72 hours of injury):
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:
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. Training is an integral part of any athletes daily routine. It allows the body to cope with the demands of the sport and helps gradually build strength, endurance and improve skill levels. Training helps to gain motivation, ambition and confidence as well as learning about the importance of having a healthy mind and body. Many people believe that to be successful you need to spend hours on hours playing that sport. While part of this is true, time must be devoted to learning the finer principles of movement to excel at the chosen sport. This must be specific to the athlete and their sport and include a range of training types including aerobic exercise, strength training and functional training. This will help to improve endurance, power, speed, co-ordination, flexibility, agility, balance, muscle recovery and decrease the risk of injury. Now how does this relate to young athletes looking to improve in their sport and gain an extra edge over opponents?
As mentioned, strength training is just one component of training and not the most important factor but can be very useful for young athletes. Firstly, there is a negative stigma around young athletes and strength training and how it may affect the athletes growth and health. This is because most people immediately think of a young athlete throwing around heavy weights, but this is not the case. Heavy bodybuilding exercises serve little to no purpose for athletes in general. They have little neural requirements and do not improve movements or skill in fact they’ll most likely make the athlete slower and inefficient. Instead it should be focussed on specific movements to activate certain muscles. Strength is a component of what the body requires to perform athletic actions against resistance. Current research highlights that resistance training can be safe, effective and worthwhile for young athletes. This must be under the supervision of a qualified professional with age-appropriate exercises and proper lifting techniques. For best results the athlete should focus on their weaknesses which will show up in a series of tests and skill assessments, it will also help monitor progress. Working on weaknesses will continually challenge the athlete’s ability in those movements and skills. The importance of strength training for young athletes and how to be safe and effective. Strength training has been shown to improve performance which can give an extra edge over opponents. Young athletes may not have the strength, endurance or stability to properly perform the techniques within the sport as their bodies are still developing. Strength training will guide the young athlete for optimal mobility, co-ordination, strength, stability, and movement efficiency. The training should begin with simple light exercises, even body weight and then progress slowly once technique is perfected. This should be done under guidance of a strength coach/professional. If the strength training is completed properly not only will the athlete build strength but also knowledge and understanding of muscle mechanics, body position and proper technique. This will reduce the risk of injury during training and sport. The weight will never injure someone if done properly and safely, improper technique (even with light weight) can lead to injury during the exercise or in the future. Strength training can also help the athlete to create a platform to build on as they go into adulthood with the development and growth of those motor skills and muscle mechanics. Research suggests it can also have a positive effect on self-esteem and self-confidence. A training program allows the athlete to gain focus, attention and dedication. Although, need to take into consideration that young athletes are still kids and must design the program to be fun and enjoyable and also need to avoid burning out or pushing them too hard. So, I know what you’re thinking, is it safe for my child to “lift weights?” or what is the “best age to start?” or “when is it safe?” or “It will stunt my child’s growth?”. Age-specific strength training can begin as early as 8 years old, but most recommendations are during pre-adolescent phase when the athlete has developed some health and skill related fitness. Strength training if done properly it will not stunt growth of the athlete and in fact promote health and growth. Further research on strength training: A research conducted in AFL showed there was a decrease in the amount of hamstring injuries after adding a training program including anaerobic interval training, stretching and sport specific training drills. This also highlights that balance is important not to just focus on strength, but the training program should encompass endurance, power, speed, co-ordination, flexibility, agility, balance and muscle recovery. Sprinting for example research has shown that plyometric training, including unilateral exercises and horizontal movement of the whole body elicits significant increases in sprint acceleration performance. Research has also shown that there is a large amount of force travelling through the spine during a golf swing, in fact eight times their body weight. With such force through the spine it is important that the golfer has a training program that improves strength and stability of the core and spine whilst maintain range of motion. https://www-sciencedirect-com.simsrad.net.ocs.mq.edu.au/science/article/pii/S1440244012000357 https://journals-humankinetics-com.simsrad.net.ocs.mq.edu.au/doi/abs/10.1123/ijspp.1.2.74 https://bjsm-bmj-com.simsrad.net.ocs.mq.edu.au/content/39/6/363.abstract https://www.noregretspt.com.au/index.php/resources/blog/43-2014/213-6-must-haves-before-embarking-on-strength-training-for-sports https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827762/ https://bjsm-bmj-com.simsrad.net.ocs.mq.edu.au/content/44/1/56.short https://www-ncbi-nlm-nih-gov.simsrad.net.ocs.mq.edu.au/pmc/articles/PMC3105332/ https://www-ncbi-nlm-nih-gov.simsrad.net.ocs.mq.edu.au/pmc/articles/PMC3105332/ https://www-tandfonline-com.simsrad.net.ocs.mq.edu.au/doi/pdf/10.1080/07303084.2001.10605847 Warming up before exercise is vital, it serves two purposes, to enhance performance and prevent injury. A warmup is a period of time devoted prior to doing physical exercise and usually consists of light cardiovascular exercises combined with stretches. Most recommendations for the length of a warm up is between 10-20 minutes. The idea is to prepare the body physically and mentally for the main activity. Keep the warm up mostly at a low intensity at the beginning and then gradually increase as you progress through the warm-up period. Keeping the muscles warm prior to activity has not only shown to decrease the chances of acute injuries such as muscle strains and overuse injuries but it will also decrease muscle soreness post exercise. There is also a mental component to warming up as mentioned, which is very important. It allows the mind to be prepared for the activity. There is evidence suggesting that mentally preparing/visualising for the activity or event can improve technique, skill and co-ordination. It also prepares the athlete for possible discomfort experienced during activity. If the mind is not ready or not focussed, then physical performance may be limited and could increase the risk of injury. What happens to the body during a warm up?
Tips
https://link-springer-com.simsrad.net.ocs.mq.edu.au/article/10.2165/00007256-198908040-00004 https://link-springer-com.simsrad.net.ocs.mq.edu.au/article/10.2165/00007256-200737120-00006 https://www-sciencedirect-com.simsrad.net.ocs.mq.edu.au/science/article/pii/S0004951407700417 https://www-sciencedirect-com.simsrad.net.ocs.mq.edu.au/science/article/pii/S144024400600051X https://www-tandfonline-com.simsrad.net.ocs.mq.edu.au/doi/abs/10.1080/15438620802310784 https://www-degruyter-com.simsrad.net.ocs.mq.edu.au/downloadpdf/j/hukin.2012.35.issue-1/v10078-012-0079-4/v10078-012-0079-4.pdf https://www.active.com/triathlon/articles/the-real-reason-you-should-warm-up-4682 https://www.verywellfit.com/how-to-warm-up-before-exercise-3119266 Cool it down with Ice or turn up the heat?
One of the most common approaches for clinicians and the public alike, to find pain relief for lower back pain, is to apply heat or cold therapeutics. These take the form of heat packs, hot water bottles, wheat bags as well as ice packs, ice gel packs etc. It’s one of those topics that everyone has an opinion on what works for them (and what will work for you). But what does the research have to say on this topic? Unfortunately there is no high quality research on this subject. There is moderate level evidence to support the use of heat packs for short term symptom relief, and only low levels of evidence that shows minimal benefit from cold therapies for the treatment of lower back pain in acute (< 6 weeks ) and sub-acute patients. There appears to be a benefit of adding exercise to this approach which has ever increasing levels of support in the research. So what can we take away here? Both heat and cold therapies are commonly used low risk interventions for lower back pain. Heat has moderate evidence demonstrating some benefit in pain reduction and this enhanced with adding exercises. French, S. D., et al. (2006). "Superficial heat or cold for low back pain." Cochrane Database of Systematic Reviews(1). Concussion is a disturbance to normal brain function, rather than a structural injury to the brain. A mild/subtle concussion is when the person is seeing stars and a more obvious one will show function deficits. Biomechanical forces of concussion can be linear or rotational. A concussion can occur due to impact to another player, the playing surface or playing equipment (e.g. ball or goal posts). According to data in the US there is reports of 1.6-3.8 million sports related concussions and unreported rates are 6-10 times more than this figure. Rugby league + union show a prevalence of 3.9 rates per 1,000 player hours (horse racing has the most, between 17-95 rates per 1,000 player hours). NRL in the past 4-5 years in elite competitions reports that between 5-7 concussions will be seen per team per season. Signs and Symptoms that a concussion has occurred Obvious signs may include:
Indications during play:
Management of acute concussion:
Return to play:
Each stage should be a minimum of 24 hours duration, this means that a period of 7-8 days as minimum time for return to contact sport and this period is twice as long for young athletes (18 years and younger). If there is a return of symptoms at any stage, then the athlete should move back to the stage where they were not experiencing symptoms. http://sma.org.au/resources-advice/concussion/ https://playnrl.com/trainer/concussion/ Josh Hallinan - Chiropractor
Tue & Thur 8am - 6pm With pre-season preparation coming to an end and footy season about to start the excitement and anticipations are high. Some simple advice and preparation can enhance your participation in sport regardless of age.
To get off to a flying start here are some helpful tips:
Each season make sure all your protective equipment is in good working order:
In our practice we unfortunately help people when accidents happen. Fortunately for many this is not often or too serious. It is different for children and adults. We commonly attend to lower limb concerns (knee, ankle, thigh, calf). A common ankle sprain, a sore foot or calf strain. These are very common and in most situations not serious. Quick care can get you back to full steam in no time. Things that we often see in practice that lead to these occurrences include:
A good example is a sprained ankle. Imagine the ligaments in your ankle are like an elastic band. If you stretch it too much it will lose its elasticity and not work as well. This is a good way to think about the ligaments in an ankle. Sometimes when they have been hurt, they might not do their job as well and you could continue to roll to the side. The good news is, is that there are some simple and effective exercises that can help and improve stability so that the pesky ankle sprain doesn't occur again. Well, at least not too often. At Health Associates we are here to help you 'do the things you love.' If you have any questions please contact us and our friendly team members can help you. Sources https://sma.org.au/resources-advice/rugby-league/ https://physioworks.com.au/Injuries-Conditions/Activities/rugby-league-injuries https://www.ncbi.nlm.nih.gov/pubmed/7886357 Headaches in short is a continuous pain around the head, face or neck, they can occur in any part of the head, on both sides of the head or in just one location. They are one of the most common medical complaints and can have a disabling effect on a day to day basis like quality of sleep, mood and overall function of the body. Headaches are broadly categorised as either primary or secondary. A primary headache is when the headaches are not caused by another condition or disease. The two most common primary headaches are migraines and tension type headaches. A secondary headache is caused by problems elsewhere in the head or neck, or by a condition. The two most common secondary headaches are cervicogenic and medication overuse headaches. One major contributing factor to both primary and secondary headaches can be upper back tension and poor posture due to the increase time using technology and more demand for people to work longer hours. A poor posture results in certain muscles tightening up or shortening while others lengthen and become weak. It can present with shoulders being rounded and elevated with the head in a forward position. This position is not ideal and leads to an increase in stress on the spine. It also has an effect on the shoulder blades as stability is decreased altering the movement pattern of the upper extremities. It’s not just the upper body that is affected by poor posture, the hips tilt forward increasing the curve in the lower back. This position also affects multiple muscles and places increase stress on both hip joints and lower back which can also have an input into the cause of headaches. There is significant dissatisfaction with headache drug outcomes and the side effects that come with taking these drugs. Headaches are third most common reason for why people seek help from chiropractors. So how does chiropractic care actually help with headaches? Assessment of normal posture, muscle tone, functional movement patterns and how the spine and extremities are moving while taking into account work, hobbies and other daily activities is vital for pin pointing the possible cause of the headache. After this, appropriate treatment, lifestyle changes and patient education is needed. Treatment includes spinal manipulative therapy on areas of the spine that may be stiff or causing pain and soft tissue therapy on muscles that are overactive. Lifestyle changes may be needed such as improved posture at work or during particular activities and implementation of exercises and stretches. Patient education explaining possible variables contributing to the headaches and ways to manage them. There are multiple contributing factors to the cause, pain intensity and frequency of headaches but if a factor such as postural related stress is decreased or removed this can have a positive outcome and possibly stop the headaches altogether. Simple management plans that you can implement straight away include:
Joshua is a very focused, dedicated and committed practitioner. He graduated from his Masters of Chiropractic in 2018. During his studies he worked as a chiropractic assistant and gained invaluable knowledge and experience. Joshua is committed to health and has achieved significant personal success in sport and through adopting a healthy lifestyle. Appointments available: Tuesday & Thursdays 8am to 6pm (alternate times by appointment) Saturday - By Appointment Health Associates are enthusiastic to grow our practice to match the evolving needs of our community.
In 2018 we conducted a customer satisfaction survey. With over 100 replies your feedback was positive, supportive and encouraging. Our results exceeded industry averages and ranked us as an outstanding health practice in terms of customer satisfaction. With that in mind there are many opportunities for growth and improvement that were expressed by our patients. We intend to action the feedback to improve your patient experience and outcomes. Health Associates has set an intention as an organisation for 2019. At the heart and soul of who we are it is to be of service. To use our knowledge, skills and attributes to serve in meaningful and impactful ways. So it goes without saying that our intent for 2019 is service. So what does the 2019 year of service look like? Cultural Service - To the best of our ability we will honour and serve the traditional custodians of the land we inhabit, preserve their memory, emancipate their identity and respect their customs. We value the wonderful diversity of this country and the indigenous roots on which it is founded. As conscious influencers we choose to bring our proud indigenous connections within the realm of our responsibility. Professional Service - To the best of our ability we will continue to strive to produce outstanding service offerings within our scope of practice. Our practitioners will commit to professional development, staff training and enhanced customer service to provide an outstanding clinical experience. The leadership team will strive to create an environment that supports its practitioners and will be progressive in expanding our service offerings to enhance the health of our community. Educational Service - To the best of our ability we will generously share our knowledge to educate, inform and inspire to improve the health and wellbeing of our community. We will do this by providing educational content in a variety of formats - online, email and paper to meet the diverse needs of our patients. Relational Service - To the best of our ability we will foster positive, supportive and healthy relationships with our patients, team members and community. We believe healthy relationships are vital to a healthy life and we acknowledge the important role we play in developing healthy relationships and will continue to develop ourselves to be able to do this effectively. Community Service - To the best of our ability we will serve our community. We will do this by engaging with clubs, charities and community organisations. We will offer our time through volunteering and will support fundraising initiatives through service donations and sponsorship where possible. Environmental Service - To the best of our ability we will take responsibility for the environmental impact our organisation makes. We will consider how our decisions impact our environmental footprint and practise in a way that supports our environment rather than diminish it. Economic Service - To the best of our ability we will positively impact the economic health of our community. We will do this by providing employment, competitively priced services and offerings to support all social sectors so that economic status does not discriminate people from accessing our health services. From all of us here at Health Associates we extend our warmth and gratitude. We look forward to serving you in 2019. Yours in Health, Chris and Alana Bowles |
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