Tag Archives: physical therapy

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Ankle Sprains

How many times have you sprained your ankle? Chances are if you’ve sprained it once, you may experience recurrent sprains as well. Inversion ankle sprains, commonly referred to as “rolling your ankle” are common among active people. In the United States, approximately 23,000 individuals sprain their ankle every day, with female athletes being the most susceptible to experience this injury.1

Often, these sprains go untreated which can lead to reinjury and functional deficits down the road. One result of untreated ankle sprains is chronic ankle instability which may lead to osteoarthritis of the ankle.3 When an injury like this occurs, it is especially important to ensure a fracture hasn’t occurred. Some indicators that you may have broken a bone include, inability to walk or put weight on your lower extremity and pain/tenderness at any of the bones in the ankle and/or foot. An x-ray is necessary if you suspect a fracture.

What many people don’t know is that physical therapy is an effective solution for ankle sprains and chronic ankle instability.3 One common thought is that crutches may be necessary for an ankle sprain, however current research has found that in most cases progressive weight bearing with external support (brace, wrap, etc.) is actually more effective and aids with healing during the acute phase.3  Another important factor in ankle sprain rehabilitation is strength and balance training. Physical therapy programs incorporating manual therapy, strength, range of motion and balance training have shown effectiveness at reducing pain, disability and reinjury.3 Below we have included two general exercises we commonly use with patients recovering from ankle sprains. (Please note these are just general recommendations and for individualized treatment it is best to see a PT.)

The first is balancing on one leg… simple enough right?

This can eventually be progressed to uneven surfaces such as foam pads, BOSU ball, etc. According to research, individuals 18-40 should be able to do this for approximately 40 seconds with their eyes open and ~10 seconds with eyes closed. Those who are 40-60 years old should aim for ~36 seconds with eyes open and ~6 seconds eyes closed. Individuals >60 should aim for ~25 seconds with eyes open and ~5 seconds with eyes closed.1

The second exercise is a stretch to improve ankle range of motion – specifically dorsiflexion. Limitations with this range of motion are important to address in order to avoid reinjury.3  Keeping the knee facing forward, bend and straighten your knee keeping your heel on the ground. This is recommended to be performed 30 times in an on/off manner for 3 sets.3

Please let us know if you have any questions about these exercises or ankle injuries you may be experiencing!

References:

  1. Whitman J.M. et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. 2009; 39(3): 188 – 200
  2. Martin RL, McPoil TG. Reliability of ankle goniometric measurements: a literature review. J Am Podiatr Med Assoc. 2005;95(6):564-572.
  3. American Physical Therapy Association, Orthopedic Section. Current concepts of orthopedics. 2006. La Crosse, WI.
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Patellofemoral Pain Syndrome – What Is It & How To Prevent It!

Pain in the front of the knee (anterior knee pain) aka Patellofemoral Pain Sydndrome (PFPS) is one of the most common diagnoses among active individuals. This type of knee pain may be experienced during squatting, going up/down the stairs, sitting for long periods of time as well as repetitive activities such as running and jumping. This diagnosis can be confusing because not all individuals with anterior knee pain possess the same underlying cause or contributing factors.  There are criteria that put individuals at increased risk of PFPS which include female gender, tight quads, hyper/hypomobile (moves too much or not enough) patella, and decreased quad strength and/or neuromuscular control.1 Addressing known impairments such as weakness and tightness is key to treating and preventing PFPS.

Research has shown the following common impairments contributing to PFPS:1

  • hip abductor weakness,
  • quad weakness,
  • patellar hypomobility,
  • patella hypermobility,
  • pronated foot posture (decreased arch height)
  • lower extremity muscle tightness

These impairments can contribute to malalignment of the patella which means it will not sit and move in where it is supposed to. Below is a picture of the patella and surrounding musculature as well as a picture demonstrating how hip drop due to weak hip abductors, excessive pronation at the foot may cause dysfunction at the knee. 1

The good news is exercise can help address a lot of these contributing impairments! Here are a couple exercises that may help you prevent patellofemoral pain… If experiencing knee pain currently, contact us today and let us know if you have any questions about these exercises! (Please note these are just general exercise recommendations and to get an individualized plan it is best to see a PT)

  1. Clamshells – these are great for hip abductor strength, particularly glut med which helps prevent hip drop during walking & running.

2. Quad stretch – increase flexibility of the quads can help decrease compressive pain at the patella; it is important to tighten your abs while performing this to avoid excessive arching in the low back

3. Side plank with hip abduction – this is a bit more advanced of an exercise in that it requires core stability as well; it’s important to now lift the leg too high otherwise you will be utilizing other muscles and not the target muscle (glut med)

References:

  1. American Physical Therapy Association, Orthopedic Section. Current concepts of orthopedics. 2006. La Crosse, WI.
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Is Your Tibialis Posterior Causing Heel Pain?

Heel pain is one of the most common complaints we hear about in the clinic. Whether it is a runner, gymnast or someone who’s always on their feet, heel pain is notorious for interfering with every day activities that once seemed simple. More often than, not people self-diagnose or determine after googling that they have plantar fasciitis. While plantar fascia irritation is definitely a possibility, there are a ton of other structures in the foot that can mimic plantar fascia pain. One of those is the posterior tibialis muscle & tendon. Check out the picture below to get an idea of where this muscle is located…1

The posterior tibialis is a dynamic stabilizer of the arch and has many attachments at the foot which make it susceptible to irritation. The actions of this muscle are to plantarflex (point your toes down) and invert (turn your foot in) your ankle & foot. A dysfunction of this tendon can lead to a collapse of the arch which research has found to be linked to knee dysfunction as well as running injuries.2

Last week, University of St. Augustine DPT students invited a few Orthopedic Manual Fellowship trained PTs to present various manual therapy and exercise techniques and Steve was one of them. Check out his original posterior tibialis exercise that targets both concentric and eccentric strength throughout the full range of motion. Note that before doing this exercise it is best to address foot/ankle mobility & muscle length deficits as these are required for optimal muscle function & strengthening.3

If you are interested in learning more about running related injuries or refining your running mechanics, contact us today at info@vighettipt.com. Be sure to let us know if you try this exercise out!

 

References:

  1. Kendall, F. P., McCreary, E. K., Provance, P. G., Crosby, R. W., Andrews, P. J., & Krause, C. (1993).Muscles, testing and function: With Posture and pain.
  2. Hughes C. The foot and ankle: physical therapy patient management using current evidence. Current Concepts of Orthopaedic Physical Therapy. LaCrosse, Wis: Orthopaedic Section, APTA, 2011. Print.
  3. Patla, C, Chaconas E, et al. Cuboid manipulation and exercise in the management of posterior tibialis tendinopathy: a case report. Int J Sports Phys Ther, 2015; 10(3):363-370
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Foam Rolling 101

It seems like every gym & athlete owns a foam roller…. Even the target dollar section sells foam rollers! But what does foam rolling really do and will it really improve your flexibility and decrease soreness after a workout?

Recent research has shown that foam rolling can be helpful in multiple ways if performed appropriately.

Benefits include:1

  • Reduced pain associated with delayed onset muscle soreness (DOMS)
  • Acutely increases range of motion when performed for a longer duration of time (30-60 seconds)
  • Reduces muscle tender spots
  • Improves neuromuscular efficiency after foam rolling which can improve athletic performance
  • Foam rolling after static stretching seems to improve flexibility to a greater degree than stretching alone

To summarize, recent evidence seems to point to the idea that longer durations of foam rolling (30-60 seconds, 2-3x per muscle group) performed after static stretching (2 sets of 30 seconds per day per muscle group) performed 5-6 days a week may be the best way to improve flexibility.2 Let us know if you try this out!

 

References:

  1. Behm, D. ECSS 2017
  2. Thomas et al 2018