Injury & Recovery

Note: if you are not used to regular exercise, before beginning any new workout routine, it is important to CONSULT WITH A DOCTOR OR HEALTHCARE PROFESSIONAL.

Moving is the best thing you can do for your mind, body and soul.  It provides a level of healing, sustenance and wellness that few things can compete with.  We encourage our patients to move not just as a path to recovery but to employ it as a sustainable way for developing/maintaining strength and for general mental wellness.  This is not new information for our readers, but the general practice by most does not include integrating movement into our lives daily in a meaningful way.  We know moving is good for us, so why do so many of us neglect to move?

We Take Movement for Granted

We miss it most when it’s gone.  We tend to only remember that movement is a privilege when we get injured.  We are reminded of the luxury of being able to walk when we sprain an ankle, injure a knee or pull a hamstring.  Or how important fingers are, only after we sprain one of them.  Or how dependent we are on our back when strain or exertion from the day before makes it hard to sit up to get out of bed.  There are countless instances where we are reminded of how important our bodies are not just to compete in sport but for everyday living.

What’s at Stake?

One thing is certain, the less we move now, over time than can translate into a decrease in our ability to move comfortably for everyday living.  Everyday things like getting up from a chair, bending to pick up a box, putting on your socks, walking up steps, going down onto the floor.  Whether you decide to move more or move less the effects will compound over time.  Just like compounding interest, a little can grow into a lot.  Investing in daily movement now will compound over time into building strength, heart health, improved mental wellness, lowering stress, minimizing joint pain, weight management, improved sleep, better balance and more brainpower.  The reverse also holds, less movement will create the reverse effects with the same benefits just shared.  And the effects can sneak up on you unexpectedly – coughing too hard throws out your back, you pull a hamstring running to catch a bus, etc.

So How Can We Move More?

If you’re interested in adding more movement into your day, be deliberate and create a plan.  Start with figuring out what your goal is:

• Strengthening and muscle building
• Weight-loss
• Mental Wellness
• Improved Health
• Recovering from injury
• Improving or sustaining general health

Once you’ve identified your goal(s), it’s time to design a plan.  Planning includes what type of activity you are going to do when you are going to do it, and whether you need some support (a friend or a trainer).  The type of activity you decided on should be in alignment with your goal.  For example, if you’re interested in sustaining your fitness level, 30 mins of daily activity can do the trick.  But, if you are interested in strengthening or losing weight, you’ll need a larger time commitment (approx. 60 – 90 mins), at least 3 times a week.

To Build a Habit of Movement…Start Simple

If incorporating more movement/activity into your day, is a new thing for you start with simple steps.  For example, don’t set a goal of running in a marathon in 3 months and schedule 30-minute runs 5 days a week.  Instead, begin with basic movement like a 25-minute brisk walk every other day and build from there.  If you prefer to walk inside you can check out Walk at Home by Leslie Sansone on Youtube.  If building strength is the goal, it won’t be safe to start with 60-minute workouts lifting heavy weights.  Begin with a 10 to 15-minute workout relying solely on body-weight – you can YouTube “HIIT workout”, “Calisthenics”, or “Full body workout, no equipment” for ideas and motivation (there are many videos to chose from).

Tips to Help You Succeed

1. Each day that you complete your activity, note it on your calendar.  You’ll be able to turn to it for motivation once you start to see the checkmarks adding up.
2. Dress for success.  The right attire can make you feel good and encourage you to stay active.
3. Be comfortable with uncomfortable.  As you transition into new activity and challenge your body, it may not always be enjoyable – no problem, understand that’s normal and embrace a bit of discomfort. (Note: if you feel pain, stop the movement and consult a healthcare provider).
4. Schedule your activity.  Give yourself a specific time of day that you plan to move and commit to it.
5. Remember the why.  Write down your goal and the reasons why so that you can refer to your notes from time to time for added motivation and encouragement.

Good Luck as You Work to Move More

Remember movement is good medicine.  So, use it so you don’t lose it.

Disclaimer: Understand that when performing any exercise or exercise program, there is the possibility of physical injury. If you engage in any activity or exercise that’s referenced on the yorkrehab.com website, you agree that you do so at your own risk, are voluntarily participating in any such activity, assume all risk of injury to yourself, and agree to release and discharge York Rehab from any and all claims or causes of action, known or unknown, arising out of any content provided or referred to.  The information provided on yorkrehab.com is not intended to be a substitute for medical guidance, diagnosis or treatment.  You should not delay pursuing medical advice because of something you have read on this website.  York Rehab (yorkrehab.com) is not responsible or liable for any advice, course of treatment, diagnosis or any other information, that appears throughout yorkrehab.com.  If questions arise from any content that appears or is referred to on yorkrehab.com you are encouraged to consult a medical professional such as your doctor.

The article below was conceived and written entirely by a past patient of York Rehab. We did not solicit the article nor has the patient received any compensation or special privilege for the submission of this piece. His motivation to write this article was because his treatment outcome has been life-changing and he wants to share his story so that others suffering a similar fate are aware of the possibilities for healing. We are immensely grateful for this individual’s thoughtfulness and his time spent to produce this article, especially without the need for recognition or reward.

I’ve wanted to share my experience for a while but had not discovered an outlet until now – thank you York Rehab for allowing me a platform! Here goes: A friend (and soccer teammate) of mine recently turned the corner on a year of suffering from an injury. Feeling unqualified to share my opinion while I observed his situation, I bit my tongue only gently offering suggestions on what he might consider re-evaluating with his treatment approach. My advice was usually politely dismissed, and understandably so given my untrained perspective was different from his surgeon’s. When his lack of recovery reached a point where he was getting ready to give up playing soccer (a game he loves so much), he was then willing to listen and try anything. I won’t provide any specifics of his injury and experience, that’s his story to share. But I told him about McKenzie Therapy, which he had never heard of (as is the case with most people). The short story was that after a year of debilitating pain, one visit to a trained McKenzie physiotherapist reduced his pain by almost 70%, allowed him to return to play within a week and restored hope that recovery was possible. Helping my friend led me to want to help others by sharing my own story. Although not related to McKenzie Therapy (a treatment approach I’ve significantly benefited from many times), it’s another type of treatment that changed my life in an unimaginable way. I want my story out there to let people know about the possibilities of healing from long-term and chronic ailments.

Now my story. I’ll start with some background information. First off, I should quantify my reference to “soccer career”. I’m not a professional, I don’t make a living playing soccer, I play the game for its pure enjoyment (for over 4 decades). It has been and will continue to be an important part of my life until my very end. Let me add that although I may watch the occasional game on TV, my interest and love for the sport lies in my ability to get on a field and play. If I never see another professional league game for the rest of my life, no sweat…if something happens that prevents me from playing soccer, my life would feel like it’s over. And that’s the direction things were heading about 4 years ago, leading up to my visit to Glenn Woodland (a chiropodist at York Rehab).

My problems started about 2 years prior to my first meeting with Glenn (Chiropodist at York Rehab). I had been really struggling with recovery after my weekly soccer game. The typical minor muscle and joint pain from my once-a-week calling on underused body parts like knees, ankles, and quads had been manageable in the past, but a new problem was surfacing…Achilles pain and it was escalating. Initially, I assumed the cause was from the ankle braces that I had been wearing for the past 15 years to protect me from chronically rolling my ankle during play. A result of loose ligaments from repeatedly spraining my ankles when I was younger. I figured the brace was the culprit because it was rubbing on my Achilles in the area the pain was originating. I began to become more concerned when the pain began to limit my ability to play and the post-game recovery process which consisted of 2 days of waddling around like a penguin to minimize the pain coming from my throbbing Achilles. My self-imposed number of days between games which I set to 3 days to allow for the usual recovery was becoming insufficient.

As my pain continued, my thinking changed from the ankle bracing being the culprit. Maybe the progressing pain and discomfort was something that simply came with age. The pain was starting to become more intense and drag on for days and the thought of taking some time away from the game started to surface. That became a very depressing thought! My wife sensing my panic with the thought of having to stop playing the game I love suggested I go see a chiropodist. Maybe orthotics could help she said. I then remembered a teammate of mine from 15 years ago had Achilles issues, got orthotics and his problems went away. I knew of orthotics but always figured it was for someone who had inherently bad foot design issues. I always considered myself more of an athlete (all in my head) with a perfectly aligned body and would never need to rely on devices like orthotics to correct my movement.

So, my wife’s suggestion brought me to Glenn’s clinic for an appointment. His assessment began with observation and minor contact of the affected area…he noticed how swollen my Achilles was, how sensitive they were to mild contact (as they had been for 15 plus years), and how bumpy (scaring) they felt below the skin from the recurring trauma due to the demands of playing soccer. He then started to focus intensely on the design and movement of my legs and feet and measuring parts of them with instruments I’d never seen before. He took stock of:

• How I stood up still.
• How I walked on the treadmill.
• How my feet moved as I tiptoed.
• He looked at the soles of my shoes.
• And finally, he moved my feet and toes a few different ways

This data gathering process led him to a few conclusions all of which he shared with me in detail to ensure I understood his reasoning.

• First, he noted that I have a slight bow to my legs, i.e. when I stand up straight with my feet together, my knees don’t touch – this by itself wasn’t news to me I’d always known this but never thought anything of it. He explained that the bow was likely causing me to wear the soles of my shoes on the outside edge – something I’d also observed all my life but never knew why it happened – I was now really listening. Glenn suggested that shoe inserts (Orthotics) would help – they’d correct how my feet make contact with the ground.
• Because of my slight bow, my feet hit the ground on the outside edge which is part of the reason why I would roll my ankle so easily when playing soccer. According to Glenn orthotics would help to correct my chronic ankle rolling too. I was hopeful but skeptical, after all, I’d needed ankle supports for the last 15 years of playing soccer. And I didn’t wear them for a game, without fail – I would roll my ankle. I was super dependent on them.
• Lastly, because I was so dependent on ankle supports, my ankles were very weak and unstable – which was partly leading to more strain on my Achilles. Orthotics would help to reduce the strain on my Achilles which would reduce the inflammation.

Although Glenn felt that orthotics would help, he wanted to test how I would respond to some adjustments to my current footwear. So, he hand-crafted some temporary inserts on the spot for me to use in my shoes for the next two weeks (he had me bring in the 2 pairs of shoes that I’d wear the most during that time: running and soccer). I left Glenn’s Chiropody clinic with my inserts, slightly hopeful of pain relief but still full of skepticism that a solution to my pain and injury rested in a couple small pieces of cork (the material the inserts were made of). What happened over the next several days was pretty miraculous.

• I played my first soccer game two days later with the inserts and without my ankle supports. I started the game very timidly because I anticipated I’d roll an ankle (or two). Halfway through the game, I was going full tilt and had forgotten I didn’t have on my ankle supports…I finished the game without any ankle injury (I was amazed but thought it must be luck) and minimal Achilles pain.
• I had another soccer game 3 days later and again I played without ankle braces but this time with less in trepidation and more intensity…and again no injury. I didn’t even notice my Achilles weren’t hurting. It’s strange how quickly you forget you had pain once the healing process begins. It wasn’t until the next morning when I instinctively stepped down from my bed slowly anticipating pain…but there was none…that’s right, none!

Fast forward to 3 months later and regularly using my actual pair of orthotics. I was able to jog and play soccer twice a week with no issue and no pain whatsoever. Playing without my ankle supports has allowed me to play like I’m 15 years younger – my mobility, agility and speed have both improved immensely. And no longer does it take me 15 minutes to suit up to play – lacing up my ankle braces was always a hassle. I’m ready for play in 2 minutes…it’s a new lease on life. And the Achilles pain is gone…so is the swelling and tenderness. I haven’t been able to touch my Achilles for decades because they were so tender.

It’s been two years and my ankle and Achilles situation has permanently changed for the better. After a lifetime of wearing out my soles on the outside edge (since I was a kid!) it no longer happens! I thought I’d be playing soccer with ankle braces for the rest of my life, but I don’t need them anymore. I don’t even carry any in my gear bag just in case. Ankle exercises and the mere fact that I’m not restricting my ankle’s mobility has allowed my ankles to strengthen nicely. There are other small changes that are actually big things to me. Like the fact that I can put up my legs on a table or ottoman and cross them so that my Achilles rests on the front part of my ankle without me wincing in pain. I’m also playing soccer as I did 20 years ago because my ankles are no longer restricted, the mobility and agility that I once knew are back – things I thought were lost as I age. I also wake up the next morning after a game and can simply walk (no more wobbling to avoid pain). I never imagined that a small shoe device could do so much for me – they have made the inconceivable possible. By sharing my little story, I hope others who are suffering from chronic pain take a small step forward and visit a chiropodist (or physiotherapist if the pain is elsewhere). I must include “physiotherapist” because I’ve had a couple of life-changing recovery experiences with one as well. I am motivated to share my story because like many people I assumed your body slows down and falls apart with age – but I’ve learned that it’s the other way around. Your body falls apart because you slow down as you age – simply put, don’t slow down. Walk, run, and play forever because if you stop using it you will lose it.

Thank you, Glenn!

Course: September 8-9, 2018

A World of Hurt: Peripheral Neurogenic Pain Neural Entrapment to Neural Dysfunction Exercise Prescriptions

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COURSE DESCRIPTION
This two-day course focuses information critical to the assessment and treatment of patients dominated by Nociceptive Pain Mechanisms involving the peripheral nerve. The Peripheral Neurogenic Pain Mechanism (PNPM) requires specific neurodynamic mechanical exercise prescriptions as well as pain science education about peripheral nerves and the pain alarm system. Outlining Chapter Five and Six of “A World of Hurt: A Guide to Classifying Pain,” pain clinicians will learn how to assess and classify neurogenic nociceptive pain mechanisms as either “trapped,” “tight,” or “sensitive” utilizing neurodynamic evaluation testing and clinical reasoning. This course assists identifying neural entrapments, dysfunctions and/or the beginning signs of central sensitivity in both the upper, lower body and spine. This pain science course provides interventions in patient education for neurogenic conditions and specific prescriptive neurodynamic exercises for each neurogenic mechanical problem. This course includes an active manual therapy workshop for common upper and lower body neural entrapment sites and local tissue treatments. The workshop is dedicated to both active neurodynamic exercise progression and passive neurodynamic testing, in addition to manual therapy. Video, paper cases and live patient demonstrations (when available) will aid application to each clinician’s practice by understanding the importance of the specific “words” and “moves” necessary to reverse neurogenic mechanical nociceptive pain mechanisms.

WHO SHOULD ATTEND
Physical and Occupational Therapists, Chiropractors, Osteopaths, Physical Therapist Assistants, Occupational Therapy Assistants, Medical Doctors, Psychologists, Athletic Trainers, Massage Therapists, Personal Trainers, and any other practitioners who are involved in treating musculoskeletal pain and prescribing exercise.

COURSE OBJECTIVES
At the conclusion of this course, participants should be able to:

1. Differentiate subjective and objective clinical characteristics in peripheral neurogenic and central sensitivity pain mechanisms.
2. Differentiate subjective and objective clinical characteristics for mechanical syndromes of the nervous system including neural entrapments, neural dysfunction and central sensitivity.
3. Prescribe patient education and exercise interventions for mechanical syndromes related to neural entrapments, neural dysfunction in spine, upper and lower extremities.
4. Perform passive repeated movement neurodynamic evaluation and treatment for common upper and lower extremity peripheral nerves.
5. Classify the dominant pain mechanism and prescribe patient education and active care intervention to paper, video and live patient demonstrations.
6. Demonstrate common manual therapy techniques for upper and lower extremity entrapment sites.

Course Fee: (Canadian dollars)
$550.00 (early registration received on/before July 31, 2018)
$600.00 (registration received on/before August 23, 2018)

FACULTY (Course Instructors)
Annie O’Connor, PT, OCS, Cert. MDT, is Corporate Director of the Musculoskeletal Practice and Clinical Manager of the River Forest Outpatient Center at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. Annie has co-authored 2018, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach, Liebenson C (3 ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection. She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice.” Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings. She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS), and McKenzie Institute. She serves on the 10X25 tactile coalition task force to reduce spine related disability by 10% in year 2025 sponsored by the Spine Foundation a national group of the NASS. She continues to treat orthopedic, neurological patients, and canines with musculoskeletal pain to achieve the best life possible.

Melissa Watson, MSPT, Cert. MDT, received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Willowbrook Outpatient Center with 16 years of clinical experience in neurological rehabilitation. Melissa has been helping to lead RIC’s Clinical Ladder Program for over 7 years where she mentors other clinicians on their professional and clinical development. She is a certified clinical instructor and consistently mentors students in clinical practice. She is practicing clinically in the Day Rehabilitation setting with an interest in musculoskeletal pain and applying both MDT and pain classification principles within the neurological population for pain and spasticity. She is currently leading a Day Rehab Pain Group Committee where she is mentoring other Day Rehab clinicians on running pain groups that are focusing on pain education and active care treatment for patients with centrally dominated pain throughout 6 sites of care and facilitating a standard for education through Inpatient clinicians. She is certified in Mechanical Diagnosis and Treatment – McKenzie Method. She has been training the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” for last 3 years and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.

Disclosures
Financial: The presenters will receive an honorarium and expenses for teaching this course.

Nonfinancial: The presenters have no relevant financial relationships to disclose.

Course Book: “A World of Hurt: A Guide to Classifying Pain”

References:

• Kolski M, O’Connor A. World of Hurt: A Guide to Classifying Pain, Chapters 1-8. Thomasland Publishers Inc, 2015
• Kolski M, OConnor A, VanDerlaan K, Jungwha A, Koslowski A, Deutch A. (2016) Validation of a pain mechanism classification system (PMCS) in physical therapy practice. Journal of Manual and Manipulative Therapy; 08 September, 1-8.
• Smart KM, Curley A, Blake C, Staines A, Doody C. (2010) The reliability of clinical judgments and criteria associated with mechanisms-based classifications of pain in patients with low back pain disorders: a preliminary reliability study. Journal of Manual and Manipulative Therapy, Volume 18, No. 2: 102-110.
• Smart KM, Blake C, Staines A, Doody C. (2010) Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Manual Therapy; 15:80-87.
• Smart, K., Blake, C., Staines, A., & Doody, C. (2011) The Discriminative validity of “nociceptive”, “peripheral neuropathic”, and “central sensitization” as mechanisms-based classifications of musculoskeletal pain. Clin J Pain; 27(8), 655-663.
• Donelson R, Long A, Spratt K, Fung T. Influence of directional preference on two clinical dichotomies: acute versus chronic pain and axial low back pain versus sciatica. Physical Medicine & Rehabilitation. 2012;In press.
• Doth AH, Hansson PT, Jensen MP, Taylor RS (2010). The burden of neuropathic pain: a systematic review and meta-analysis of health utilities. Pain, 149:338-344.
• Kleinman, N; Patel, A; Benson, C; Macario, A; Kim, M; Biondi, D (2014). “Economic Burden of Back and Neck Pain: Effect of a Neuropathic Compnent.” Population Health Management Volume 0, Number 0, DOI: 10.1089/pop.2013.0071
• Schmid AB, Nee RJ, Coppetiers MW. (2013) Reappraising Entrapment Neuropathies- Mechanisms, diagnosis and management. Manual Therapy (18), 459-457.
• Nee, R. J., C. H. Yang, et al. (2010). “Impact of order of movement on nerve strain and longitudinal excursion. A biomechanical study with implications for neurodynamic testing.” Manual Therapy (on-line).
• Saban B, Deutscher D, Tomer Z. (2013) Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heal pain: A pilot randomized clinical trial . Manual Therapy (on-line).
• Thomes EJ, et al. (2013) The effectiveness of conservative treatment of patients with cervical radiculopathy. A Systemic Review. Clin J Pain, Volume 29, Number 12, 1073-1087.
• Moriarty O, et al. (2011) The Effect of Pain on Cognitive Function: A review of clinical and pre-clinical research. Progress in Neurobiology 93, 385-404.

Download registration form and payment instructions.

Groin injuries are a common injury amongst active people, as well as those unlucky enough to strain the area by falling, tripping, or getting their leg caught on something. It is usually characterized by pain along the inner thigh where the muscles are thought to have been over-stretched. It also has a reputation for being a “difficult” injury to recover from, although this reputation is somewhat undeserved. Sometimes the nature of the injury is incorrectly assumed from the beginning, which can lead to ineffective treatments and prolonged pain. Groin pain following a strain can result from several different injury mechanisms, each of which requires a different management approach.

Groin or inner thigh pain can be a manifestation of a hip joint problem. The hip is a ball and socket joint that is lined with cartilage and surrounded by other supportive soft tissue for protection. Sometimes when the groin is “strained”, the soft tissue can become pinched and cause pain. The resulting pain comes from compression of this tissue by normal hip movements. Usually, though, the hip can be “unlocked” by moving it in the proper direction, which can be found under the supervision of a well-trained physiotherapist, and relief of pain will quickly follow.

Another possibility is that the ligaments and tendons of the groin take the majority of the force rather than the muscles themselves. These tissues have notoriously poor blood supplies and so don’t receive the nutrients and support needed for good quality healing. Therefore, they can remain painful for weeks or even months if the proper intervention is not undertaken. However, they are quite responsive to tension or resistive forces, and with a specific exercise program, they can be remodeled slowly to decrease the pain and regain the strength. This does require discipline, as the changes will occur slowly over a number of weeks, but should ultimately result in recovery.

When a groin strain primarily affects the muscular tissues, which is what most people assume groin injuries to be, healing will usually proceed over a number of weeks, because of the aforementioned good blood supply. As long as the muscles are not over-stressed during this healing period, and movement and strength are gradually regained as the symptoms allow, the recovery will proceed uneventfully.

For all the different injury mechanisms listed above, once full movement and strength of the area have been attained, treatment will focus on recovering a level of function required by the person’s work or athletic activities. For example, a physiotherapist can guide a tennis player to safely progress and return to running, cutting, lateral movements, and lunging, all of which are necessary components of the sport.

In summary, the crux of the matter with groin injuries is to determine what kind of problem it is. To say you have a “groin injury” on its own does not say enough for a healthcare professional to be able to treat it effectively; they have to be able to understand it on a deeper level to direct the appropriate treatment. The physiotherapists at York Rehab possess the assessment skills necessary to diagnose such injuries and help you to recover as efficiently and effectively as possible.

A common injury for people involved in sports such as soccer, tennis, squash, or running is an ankle sprain. Many athletes and weekend warriors alike have experienced this injury, often multiple times, and may rely on using a brace for support to prevent re-injury or be forced to cut back on their participation due to recurring injury. It is possible to minimize the recurrence rate of this injury by seeing a qualified physiotherapist who can assess for and address the following limitations that are common in people with repetitive ankle injuries.

Some people who have had a long history of ankle injury have range of motion limitations. What can happen is the ankle swells following the sprain, and it gradually recovers, but the scar tissue that forms to rebuild the injured tissue does not get adequately stretched. This is how a stiff ankle can develop, and playing sports with this movement loss can lead to another injury quickly. A physiotherapist can identify these limitations and prescribe the proper stretches to recover as much mobility as possible.

Secondly, following the recovery from an acute (within 6 weeks of injury) ankle sprain there might not be any residual pain, but often there is a lingering weakness. Because the ankle feels free of pain the athlete is compelled to return to their sport, neglecting the strength deficits that are present. Depending on the sport, this might manifest as decreased endurance, overall strength, or explosive power such as in jumping sports. This can be remedied by regularly performing the appropriate exercises specific to your sport, exercises which can be determined by a physiotherapist.

A hidden impairment that an athlete may not notice after an ankle injury is decreased proprioception. This refers to the “position sense” of your joints and ligaments, similar in a way to other senses such as vision and smell. There are sensors embedded in these tissues that give the body feedback about where it is in physical space, and we rely on this sense to maintain good balance and stability during weight-bearing activity. After an ankle sprain, we often lose some of this sense, but it can be readily retrained much like muscle strength can. Specific balance exercises can be done to regain this sense, with progressions to sport-specific activity.

Building on that last point, before returning to your activity is considered, an athlete should be able to perform the necessary tasks involved in the activity. For example, a soccer player should be able to sprint, change directions quickly, kick, and dribble a ball. Often the speed at which these activities can be done following an ankle injury is much less than in normal conditions. Agility exercises and plyometrics, which are a type of exercise involving explosive movements such as jumps and sprints, are essential here. Regaining these skills is crucial to minimize the risk of long-term ankle injury recurrences.

To summarize, if you have had trouble with repetitive ankle injuries, you should consider seeing a physiotherapist who will assess to see if any impairments discussed above are present and design the optimal program for you to address them. Frequently the solution to the problem is relatively simple; it just takes some diligence to stick with the program to see results. Instead of worrying about your ankle every time you return to activity, wouldn’t it be nice to pivot, jump, sprint or whatever you do with confidence? You can make that a reality following an individualized physiotherapy regimen to help with your recovery, so you can get you back in the game as quickly and safely as possible.