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It is estimated that 25,000 people sprain their ankle every day, and is therefore a very common injury treated with physiotherapy. Both athletes and non-athletes experience ankle sprains and it can occur when playing sports or simply when stepping off a curb or walking on an uneven surface. An ankle sprain typically occurs when the foot twists, rolls, or turns beyond its normal motion. Typically, the ankle "rolls" into excessive inversion (when the sole of the foot turns inward). Consequently, the ligaments of the lateral aspect of the ankle are overstretched and in severe cases can be torn because of this excessive motion. This mechanism of injury usually results in pain, swelling, and bruising, and you may even hear an audible "popping" sound. The amount of force and damage to the ligaments help to determine a grading system of severity. A mild sprain is considered to be a Grade I, a moderate sprain is a Grade II, and a severe sprain is a Grade III.

In a Grade I sprain, there is minimal tenderness and swelling of the ankle. The fibers of the ligament(s) have been overstretched and there may be some damage to the fibers of the ligament(s). The individual may weight bear on the affected ankle as tolerated. In a Grade II sprain, there is moderate tenderness and swelling, decreased range of motion and possible instability of the ankle joint. There is typically some tearing of the fibers of the ligament(s) and the ankle should be immobilized with tape or a splint/brace. In a Grade III sprain, significant swelling and tenderness are present, and the joint is unstable. There is complete tearing of the ligament(s). Grade III sprains require immobilization and/or possible surgery.

Ankle sprains may take up to 8 weeks to heal. If you are not able to walk normally without limping, you may require a cane or crutches. Your physiotherapist can instruct you on the proper use of either a cane or crutches and determine how long you should use them for. Immediately following the injury the "RICE" (rest, ice, compression, elevation) guidelines should be followed:

Rest - Try not to weight bear on your foot immediately following the injury. Use crutches or a cane.

Ice - Apply ice immediately following the injury. Ice helps to reduce swelling and inflammation that may occur following the sprain. Ice can be applied for 15-20 minutes several times per day. Ensure that you place a towel between the skin and the ice surface to prevent irritation of the skin.

Compression - The use of a tensor bandage or tape helps to limit swelling and provides immobilization in order to support the injured ankle joint.

Elevation - Lying flat on your back, use 4-5 pillows to prop your foot up above the level of your heart. Stay in this position for at least 45 minutes, several times per day to help reduce swelling.

There are many techniques your physiotherapist can apply to help your ankle return to normal functioning. These may include modalities such as ultrasound, laser, interferential current therapy, and ice. Range of motion and strengthening exercises, proprioceptive (spatial orientation/balance) training, manual therapy, and taping the ankle may also be performed. Please check with your physiotherapist to determine the appropriate treatment plan for your injury.

Plantar fasciitis is one of the most common causes of heel pain and pain on the sole of the foot. Fasciitis refers to inflammation of the fascia, which is a strong band of tissue that connects the heel to the toes. It is also responsible for supporting the arch of your foot. The plantar fascia absorbs the impact and stresses placed on the foot. When the fascia is over used or over stressed symptoms typically become first apparent at the heel area, where the plantar fascia attaches to the bone. The plantar fascia is put under strain when the toes are pulled into extension, which helps to push the foot off from the ground when walking. It can also be stressed when the arch of the foot collapses putting extra strain on the fascia.

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Risk Factors

Tight calf muscles that make it difficult to flex your foot may contribute to plantar fasciitis. In addition being over-weight can cause excess strain of the fascia. High impact activities such as running or starting a new activity can also contribute to the problem. Lastly, wearing non-supportive shoes that do not provide enough support to the foot may also be a contributing factor.

Symptoms

The most common symptoms of plantar fasciitis include: pain to the bottom of the foot near the heel, pain in the first few steps after getting out of bed in the morning or after long periods of rest, and increased pain after exercise.

Physiotherapy Treatment

Treatment of plantar fasciitis is aimed at reducing the inflammation and tension of the plantar fascia in order to restore strength and mobility. Some treatment options for inflammation include ice and pulsed ultrasound. Ice can be applied by freezing a plastic water bottle and rolling the bottle on the floor with the sole of the foot. In addition, your physiotherapist may tape the arch of the foot to help provide support for the foot. Wearing supportive foot wear, the use of orthotics, and reducing high impact activities may also be of benefit. Finally, exercises that help to strengthen the intrinsic muscles of the foot and stretching the calf muscles may also help to relieve symptoms of plantar fasciitis.

Please speak with your physiotherapist to determine the appropriate treatment plan for you.

Osteoarthritis (OA) is the most common type of arthritis of the knee. It can affect both middle aged and senior individuals. OA is defined as a slowly progressing degenerative disease that causes the cartilage of the knee to wear down over time. There are 3 compartments of the knee where OA can take place: Medial (inside) aspect of the knee, the Lateral (outside) aspect of the knee, or the Patellofemoral compartment (between the thigh bone and knee cap).

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Symptoms of Knee OA

Generally, symptoms arise over time and are not typically a sudden onset. Symptoms include stiffness of the knee especially in the morning or after long periods of sitting, pain that increases with activity and decreases with rest, swelling, a warm feeling surrounding the knee joint, decreased range of motion (mobility) and/or an audible creaking or grinding sound.

Diagnosis of Knee OA

Your doctor or physiotherapist will examine your knee for swelling and tenderness and your strength and range of motion will be assessed. X-rays order by your doctor can diagnosis OA by showing joint space narrowing and possible osteophyte formation. When the space between the femur (thigh bone) and the tibia (lower leg bone) decreases, the cartilage between the two bones begins to wear away. Osteophytes, which are tiny bone projections or bone spurs, are indicative of OA and can be very painful, limiting range of motion.

Conservative Treatment of Knee OA

Unfortunately, treatment can not reverse the onset of OA of the knee. However, the goal of treatment is to reduce pain and swelling and improve strength to ultimately increase function. Lifestyle modifications may be the first line of defence in the early onset of OA. For example, losing weight, and switching from high impact activities (running or jumping) to low impact activities (swimming, cycling) can help to alleviate pain. Exercise prescription by your doctor or physiotherapist can help target specific muscles that will help support the knee joint. Exercise is often effective in reducing pain and improving your function. Supportive devices such as the use of a cane or walker can also help reduce pain and discomfort. More specifically, the use of a supportive device can help stabilize your ability to walk without limping and can greatly reduce your risk of a fall. In addition, wearing a knee brace or sleeve may also add stability and compression to the knee joint. Please consult your doctor or physiotherapist prior to starting any of the above conservative treatments.

Surgical Treatment of Knee OA

If you suffer from severe OA and your symptoms continue to persist your doctor may consider referring you to an orthopedic surgeon for a consult. He or she will then be able to determine if a total or partial knee replacement may be of benefit to you. This type of surgery is elective and requires considerable rehabilitation post surgery.

Please check with your doctor or physiotherapist to determine which treatment options are best for you.

If you watched the Olympics last summer you may have noticed some very brightly coloured tape on the athletes. This tape is called Kinesio tape (KT) and is a therapeutic tape used to treat many types of injuries. This tape was originally developed by Chiropractor, Dr. Kenzo Kase, in the mid 1970's. He developed the tape with a texture and elasticity to mimic that of living human tissue. Kinesio tape gained popularity at the 2008 Olympic games, when it was donated to 58 countries for use on the athletes. Kinesio tape manufacturers claim that the tape supports injured muscles and joints and helps to reduce pain by lifting skin and allowing more blood flow.

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Properties of Kinesio tape:

The tape is made of an elastic polymer that is surrounded with cotton fabric. It is water resistant, and breathable. The elasticity of the tape lasts for up to 3 to 5 days and can get wet, unlike other types of sports tape. There is a "waveform" pattern on the sticky side of the tape so that it adheres well to the skin. Kinesio tape can be applied multiple times without leaving glue residue or causing skin irritation.

Specific Functions of Kinesio tape:

When Kinesio tape is applied over muscles and joints it helps to reduce pain and inflammation. Over used muscles benefit from relaxation and support the tissues on a 24 hour basis. Unlike other forms of athletic taping which enforces stability, kinesio tape allows for full range of motion of the joint. The tape also helps to reduce inflammation and swelling by lifting the skin, thereby promoting increased circulation and lymph flow.

Kinesio tape Techniques:

The tape is applied to an area when the muscles are in a stretched position. Typically the tape is applied from one end of the muscle to the other with varying degrees of stretch of the tape depending on the desired outcome. Practitioners are trained to tape an area in a specific direction and desired stretch for optimal results.

Kinesio tape Colours:

Kinesio tape comes in many different colours: red, blue, pink, black, and beige to name a few. There is no physical difference between any of the coloured tapes.

For Best Results....

Ensure that the skin is completely dry prior to application. In addition, skin should be free of oil, sweat, or lotion to ensure that it adheres. After the tape is positioned on the skin, the practitioner should rub the surface of the area, activating the heat-sensitive glue on the tape. Kinesio tape should be applied at least 1 to 2 hours prior to activity or showering to ensure it has adhered sufficiently.

Please see your physiotherapist to determine if Kinesio tape would be appropriate for your injury.