Injuries & Treatments

The ankle joint is a complex hinge joint joining the foot to the lower limb. It plays a key role in walking, running and jumping, and without a stable and pain-free ankle, these activities will be impaired. As the ankle is a weight-bearing structure, an injury to the joint or surrounding muscles and tendons will often cause an altered gait (walking) pattern. Even if this altered pattern is only for a short time, this will have an impact on the other muscles in the lower limb, often causing weakness and muscle imbalance which needs to be corrected.

Assessment

A physiotherapist will assess the ankle to establish whether there is a problem with the joint or the muscles. It is important to assess walking pattern, balance, as well as muscles in the calf, thigh and around the pelvis which act to stabilise and control the lower limbs as we walk

Treatment

• Correction of foot position if required
• Ultrasound to reduce swelling and enhance the healing process of ligaments and muscles
• Taping of the joint to stabilise and reduce pain
• A specific strengthening and stretching exercise programme to improve lower limb strength, range of movement and proprioception

Common types of injuries

• Achilles tendonitis – inflammation of the tendon at the back of the heel and lower leg, normally worse immediately on standing, and can be worse with walking, running etc.
• Instability – weakness of the muscles and ligaments around the ankle joint making it less stable and more susceptible to injury if not treated.
• Ligament sprain – damage to the ligamentous tissue that surrounds the joint which maintains stability.
• Fracture – fracture of the bones around the lower leg at the ankle.

At some point throughout our life, most of us will experience back pain, which can be as a result of poor posture, muscle imbalance, injury or simply degeneration from inactivity or as we age. Most people with back pain describe an ache across the lower back which can radiate into the buttocks or legs. It often causes pain on bending forwards or backwards and can lead to stiffness of movement. In some cases, you may experience pins and needles or numbness in the lower limbs.

Assessment

An assessment of the back will include observing the range of movement in the spine, testing muscles around the back and pelvis to check for weakness or tightness, and if appropriate, assessing the nerves of the lower limbs.

Treatment

• Electrotherapy to treat deep tissues, reduce muscle spasm and promote healing
• Soft tissue massage or trigger point release to relieve tension in the back muscles
• Joint mobilisations to improve the range of movement and reduce stiffness
• Muscle stretching and strengthening
• Specialised Pilates exercise programme to improve core strength, posture, muscle strength and reduce muscular tightness, to prevent further episodes of back pain

Common types of injuries

• Muscle strain – a simple strain or pull on a muscle can cause a mild ache or pain in the affected area.
• Prolapsed or herniated disc  – a portion of the intravertebral disc protrudes on adjacent nerve roots often causing pain and/or tingling or numbness in the leg.
• Spondylosis  – degenerative osteoarthritis (wear and tear) of the joints between the centre of the spinal vertebrae.
• Spondylolisthesis – a condition in which a bone (vertebra) in the lower part of the spine slips out of the proper position onto the bone below it.
• Stenosis – a common condition that occurs when the small spinal canal that contains the nerve roots and spinal cord becomes restricted.
• Sciatica – a condition where the sciatic nerve is impinged commonly due to a disc bulge or inflammation. Altered sensations for example pins and needles and numbness can be felt in the buttocks and lower legs.
• Facet joint problems – pain originating from the facet joint on either side of the vertebra. Stiffness or locking of these joints can cause significant pain in the back.
• Sacroiliac joint dysfunction – the SI joints are a pair of inherently stable joints found in the pelvis, which can be a source of pain when dysfunction occurs.
• Coccydynia – pain in the tailbone, which can result after a fall or trauma.

The elbow, although not noticeable in terms of function at first glance, is a very important part as it is the link between the shoulder and the hand. In fact its close link to the shoulder can actually be the cause of some injuries if the shoulder is not functioning well.

Assessment

It is important to assess the range of movement in all directions, as a stiff elbow will mean the hand cannot function optimally to do most tasks. Strength is also very important. Elbow pain or injury can also be due to deficits in the shoulder or hand so a physiotherapist will also assess this.

If pain is caused by tennis or golfers elbow, it could be due to poor equipment, technique or repetitive stresses, therefore it is important to address these factors during assessment.

Treatment

• Soft tissue therapy to loosen any tight structures
• Mobilisations to regain the joint range of movement
• Electrotherapy to reduce stiffness, ease pain and improve the elasticity of any tight structures
• Programme for stretches and strengthening in the upper limb
• Pilates can help to improve elbow function and enhance whole body stability.

Common types of injuries

• Tennis elbow – pain experienced on the outer aspect of the elbow after repetitive movements of extending the arm.
• Golfer’s elbow – pain experienced on the inner aspect of the elbow after repetitive movements of extending the arm.
• Osteoarthritis of the elbow – pain and swelling associated with loss of range of movement at the elbow joint.
• Elbow fracture – a break in one of the bones forming the elbow joint.

Although small in size, the wrist and hand have amazing dexterity and allow us to perform most of the tasks we take for granted daily. Injuries such as repetitive strain injury and carpal tunnel syndrome can cause considerable amounts of pain and discomfort to the area.

Assessment

It is important to have the injury assessed by a trained physiotherapist, as what starts off as a slight pain in the wrist can lead to a severe case of Repetitive Strain Injury (RSI) which can effectively debilitate you for an extended period of time where even the easiest of task will seem too painful to perform.

A physiotherapist will assess muscle length and strength in forearm and hand and identify areas of weakness. Ergonomic factors are also very important to stop the aggravating/causative factors.

Treatment

• Soft tissue therapy to loosen tight structures.
• Strengthening exercises for weaker muscle groups.
• Electrotherapy to help with stiffness, pain and improve healing of ligaments, muscles and tendons.
• Specialised home exercised programme and ergonomics advice.
• A specialised Pilates exercise programme to help with posture and body alignment, which will help all RSI injuries.

Common types of injuries

• Fracture – a small break in any bone in the hand or wrist, often caused by falling onto an outstretched hand.
• Repetitive Strain Injuries (RSI) – pain in wrist and hand, usually accompanied by pain in shoulder and elbow caused by performing repetitive tasks in an inefficient or less than optimum manner.
• Carpal Tunnel syndrome – pain and tingling in the wrist and hand, commonly experienced during pregnancy and frequently with office workers and people with repetitive jobs.
• Sprains and dislocations – usually from trauma such as falls or direct blow.

The hip joint connects the femur (long thigh bone) with the pelvis. It is a stable joint with many muscles and ligaments crossing and surrounding the joint. Due to numerous structures around the hip joint, hip pain often requires more involved assessment to accurately discern the source of pain.

Assessment

Differential diagnosis will be performed to find out the exact source of pain so as to come up with the most appropriate and efficient treatment plan. Range of motion will also be assessed.

Treatment

• Modalities such as ultrasound are used to decrease inflammation in the joint or to warm up stiff and tightened tendons.
• Manual therapy techniques such as soft tissue and mobilisation, traction, Proprioceptive Neuromuscular Facilitation (PNF) are helpful in regaining full pain free range of motion and muscle facilitation around the joint.
• Therapeutic exercises, like Pilates, can help to stretch tight muscles/joints, and strengthen weak muscles. Exercises are also used to correct positional faults or improper loading of the hip joint during movement.

Common types of injuries

• Trochanteric bursitis – inflammation of the bursa (fat pad) that lies over the hipbone.
• Labral tear – a small tear in the lining of the hip joint caused by aging or a traumatic injury.
• Osteoarthritis – wear and tear of the joint, normally related to aging causing pain and loss of movement in the joint.
• Tendonitis – inflammation of the tendon as it joins onto the bone.

Knee injuries are becoming increasingly common amongst active people especially when you participate in winter activities. Accidents cannot be avoided but the majority of injuries occur due to weakness and poor preparation for an event or sport.

Assessment

Assessment is very important as biomechanics and muscle imbalance play an important role in injury management and preventing injuries.

Treatment

• Ultrasound and/or other electrotherapy modalities to reduce inflammation, swelling and pain. Some modalities can also be used to stimulate muscle contraction in severe cases.
• Soft tissue therapy to assist with ligament healing and restructuring/remodelling of sprained/torn fibres.
• Specialised home exercise programme to stretch tight structures and strengthen weak ones.
• Pilates is very beneficial for knees as it helps with alignment, posture and correction of biomechanical issues and prevention of further injuries.
• Pilates can slow down the deterioration process with OA knees.
• Pilates can be useful for many specific sports such as running, skiing, golf and tennis.

Common types of injuries

• Ligaments sprains and tears – anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament.
• Meniscus injuries – injuries of two small cushions within the knee joint (could be tear or contusion).
• Osgood Schlatter’s disease – a painful swelling of the bump on the upper part of the shinbone, just below the knee. It occurs during adolescants as the patellar tendon is overused before bone growth has peaked.
• Osteoarthritis (OA) – wear and tear in the knee joint, which causes inflammation and pain.
• Patella-femoral (anterior knee) pain syndrome – mechanical pain that is not caused by any significant damage to the structures in the knee such as the ligaments, tendons and bone.
• Patella fracture – fracture of the kneecap, normally after a fall or direct blow to the patella.
• Patella tendonitis – inflammation or degeneration of the tendon at the base of the knee cap leading to pain and discomfort in the area.
• Ilio-tibial band friction syndrome – lliotibial band syndrome (ITBS) is the result of inflammation and irritation of the iliotibial tendon as it rubs against the bone at the outer part of the hip or knee. It commonly causes knee pain in long distance runners.

The neck is one of the most important parts of the body as it is the top part of our spine supports our head and brain. It is also one of our more neglected body parts of our body. We all stretch our limbs but almost always never stretch our necks which can lead to increased tension and tightness in the muscles.

Assessment

Assessment is an integral part, as a physiotherapist needs to look at posture and muscular imbalances to determine if these factors are causing the pain. They also need to feel for cervical vertebrae alignment, movement and stiffness. Neck problems can produce referred pain into the arm(s) so assessment of any neurological impairment is necessary.

Treatment

• Posture re-training and education.
• Soft tissue therapy to loosen tight muscles and fascia.
• Mobilisations to help stiff vertebrae return to their normal state of movement.
• Electrotherapy to relax muscle spasm, reduce stiffness and relieve pain.
• Traction to ease the pressure on trapped discs.
• Specialised home exercise programme to maintain and improve range of movement or strength and prevent reoccurrence of symptoms.
• Pilates training to improve posture, body alignment and core control to prevent further injury.

Common types of injuries

• Headache – pain into the neck or head often due to poor posture and alignment.
• Whiplash – restricted and painful movements and the neck can feel unstable and weak. This usually happens after car accidents or high impact sports such as rugby, water skiing or skiing.
• Slipped disc – neck pain, which is usually associated with altered sensation into arm(s) and hand(s).
• Wry neck – stiff and painful neck, usually from falling asleep with the neck in a compromised position.
• Fracture – A break in one or more of the bones in the neck.

The shoulder joint provides mobility to allow us to carry out everyday tasks such as reaching our arms out, placing our hand behind our head or back, and playing sports. It is designed to be highly mobile and relies heavily on correct muscle strength and balance for optimum functioning. Often shoulder pain starts gradually and is usually caused as a result of repetitive poor movement at the joint causing inflammation. When the shoulder joint becomes painful to move, it inevitably becomes stiff and function is impaired.

Assessment

A physiotherapist can examine the shoulder joint and surrounding structures to establish the nature and cause of the pain. From this assessment the physiotherapist can address any underlying issues such as postural issues and muscle imbalance, which if left untreated can lead to reoccurrence of pain.

Treatment

• Ultrasound to reduce inflammation.
• Soft tissue massage to break down adhesions and release tension in surrounding muscles.
• Joint mobilisations to regain or improve range of movement.
• Taping of the shoulder or shoulder girdle to retrain postural and stabilising muscles.
• A specialised exercise programme including stretching and strengthening of the stabilising muscles around the shoulder joint and shoulder girdle.
• Pilates provides excellent benefits to the body in terms of building core control and stabilising the body as a whole. This enables the shoulder and upper limb to move in an optimum position on a stable torso, avoiding new or further injury.

Common types of injuries

• Shoulder impingement syndrome – pain caused by inflammation of the muscles or bursa as they pass through the sub-acromial space at the shoulder join.
• Rotator cuff sprain/tear – a tear of the small stabilising muscles around the shoulder, which leads to pain and loss of range of movement and strength.
• Shoulder bursitis – inflammation of the protective fat pad (bursa) within the shoulder joint, this can have a sudden onset and cause severe pain.
• Shoulder instability/dislocation – weakness of the rotator cuff muscles surrounding the joint, which can lead to increased risk of shoulder dislocation.