Ankle Injuries

 

An ankle sprain is a very common injury that can happen to athletes, non-athletes, children and adults.  A sprain refers to a stretching or tearing of a ligament.  Ligaments are tough bands of fibrous tissue that connect one bone to another, and help stabilize joints, preventing excessive movement. 

Most ankle sprains can be managed conservatively.

Initial conservative management of ankle sprains should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation).

The P.R.I.C.E. principle helps decrease pain and swelling and can be used during the rehabilitative process as needed.

Additional treatment options include:

• Electrotherapy
• Ultrasound
• Laser therapy
• Taping
• Bracing
• Soft tissue techniques
• Manual mobilization

Rehabilitative strategies should also include:

• Exercises that incorporate active range of motion
• Stretching and strengthening for the ankle joint and lower extremity
• Proprioceptive/balance training to minimize the risk of ankle instability and re-injury.

An untreated ankle sprain may lead to chronic ankle instability.  This may also result in secondary foot, knee, hip, and back problems because of subtle changes in movement patterns. 

If you are having difficulty with ankle pain, our qualified health professionals can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.

Contact us:

519-662-4441

www.nhwc.ca

 

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Ice Therapy For Muscle And Joint Injuries

By Dr. John A. Papa, DC, FCCPOR(C)

Ice therapy is an effective self-care treatment strategy for muscle and joint injuries.  It is commonly used for acute injuries (within the first 72 hours), but can also be very helpful in managing flare-ups of chronic problems, and as a preventative measure following activities or exercise.

Ice therapy reduces the amount of swelling and inflammation at the injury site and also acts as an anesthetic to provide pain relief.  Icing as soon as possible after an injury will help with speeding up recovery time, and minimize the chances of secondary problems such as muscle spasm and joint irritation.

Below are some helpful  tips that should be followed when using ice therapy:

·       Crushed ice and ice cubes are ideal sources of ice because they easily mold around an injury site and can stay cold for long periods of time.  Commercial ice/gel packs and frozen vegetable bags are good secondary choices when crushed ice or cubes are not available.

·   Use compression when applying ice to an injury site.  Compression is most easily achieved with an elastic tensor bandage to add support and slow swelling.  The principles of elevating and resting the injured site should also be followed during initial injury management.

·       Ideal ice application time is 10 to 20 minutes.  There should also be a period of 10 to 20 minutes or more where there is no ice application before icing is done again so that skin temperature can return to normal.  This cycle can be repeated as often as necessary within the first 24 to 72 hours after injury or activity.

Below are some precautions that should be followed with ice therapy:

·       Ice should never be applied directly over the skin for a prolonged period of time as this can damage skin tissue.  A wet towel can safely be used as a barrier between the ice and skin and acts as an excellent conductor of cold.

·       Ice should never be applied on blisters, open cuts or sores.

·         Ice should not be applied before exercise or activity as this impairs your body’s ability to detect proper joint and muscle function, making one more susceptible to further injury.

·        Ice therapy should not exceed the treatment time recommended as prolonged exposure can reverse the positive effects of ice and can lead to possible frostbite.

·    Special care must be taken when icing the elbow, wrist, knee, or foot as superficial nerves in these areas can become irritated or damaged with prolonged icing.

·     People hypersensitive or allergic to cold and those who have a circulation problem should avoid ice.

If you have a muscle and joint injury that is not resolving, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.  From all of us at the New Hamburg Wellness Centre, have a safe and enjoyable summer!

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Muscle And Joint Injury First Aid

By Dr. John A. Papa, DC, FCCPOR(C)

Physical injury to your muscles and joints can occur with workplace, household, sporting, and recreational activities.  This can cause pain, stiffness, and swelling in a joint or muscle, leading to injuries known as sprains, strains, and contusions.  Initial conservative management and first aid of such injuries should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation) outlined below.

PROTECTION:  Immobilize the injured area to protect from further injury.  This can be accomplished with the use of an elastic wrap, brace, splint or sling.  Walking aids such as crutches or a cane can be useful to help you get around.

REST:  To ensure proper healing, rest the injured area and avoid activities that cause pain.  Do not restrict all activities completely.  Other regions of your body can still be used.  This will help prevent physical de-conditioning.  An attempt should be made to return to regular or modified activities as soon as possible provided it does not put you at risk for further injury.

ICE:  Ice cubes, frozen vegetable bags, or commercial ice/gel packs are examples of cold sources that can be molded or applied to an injury site immediately.  Icing will help to reduce pain, swelling, and inflammation in the injured tissues.  Ice application should not exceed 10 to 20 minutes at a time.  Allow for skin temperature to return to normal before ice is reapplied.  This cycle can be repeated as often as necessary within the first 24 to 72 hours.  Ice should never be applied directly over the skin for a prolonged period of time as this can damage the skin.  A wet towel can safely be used as a barrier between the ice and skin and acts as an excellent conductor of cold.  Do not apply ice to blisters, open cuts, or sores.  Individuals hypersensitive to cold and those who have circulation problems should avoid ice.

COMPRESSION:  Compress the injured area with an elastic tensor bandage.  This will help decrease swelling.  Do not wrap the bandage too tightly as to cut off circulation.  You should not feel an increase in pain with compression.

ELEVATION:  Elevate the injured area (whenever possible) above the level of the heart, especially at night.  Gravity helps reduce swelling by draining excess fluid.

You should seek immediate medical care under the following circumstances:  a popping sound heard during the injury accompanied by a feeling of joint instability or inability to weight bear; obvious evidence or suspicion of a broken bone, fracture or joint dislocation; or injuries at risk for infection.

By using the P.R.I.C.E. principle after an injury, you can significantly reduce swelling, tissue damage, inflammation, muscle spasms, pain, and recovery time.  In the event that you suffer from ongoing muscle and joint pain following an injury, you should contact a licensed health professional who can diagnose your condition and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Defining Common Muscle And Joint Injuries

By Dr. John A. Papa, DC, FCCPOR(C)

Physical injury to your muscles and joints can occur with workplace, household, sporting, and recreational activities.  Common mechanisms of injury include slip and fall or collision-impact type accidents, overstretching a body part, twisting awkwardly, or performing repetitive movements.  This can cause pain, stiffness, and swelling in a joint and/or muscle, leading to injuries such as sprains, strains, and contusions.

A sprain refers to a stretching or tearing of a ligament.  Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  One or more ligaments can be injured at the same time.  Common locations for sprains are the ankle, wrist, and knee joints.

A strain refers to a stretching or tearing of a muscle or tendon.  Muscles are responsible for producing force and causing motion, whereas tendons are the tough fibrous extensions of muscle that attach to bone.  A strain injury can occur when the muscle-tendon complex suddenly or powerfully contracts, or when it is overstretched.  This is called an acute strain.  Overuse of certain muscles over time can lead to a chronic repetitive strain.  Strains are commonly referred to as “pulled muscles” or "tendinitis".  The shoulders, forearms, low back, and leg regions are common locations for strains to occur.

Contusions are commonly called “bruises”, and occur when small blood vessels in the skin, muscles, or bones are subjected to trauma. 

Sprain, strain, and contusion injuries can exist on their own or in combination with each other.  Initial conservative management and first aid of these injuries should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation).  This can significantly reduce swelling, tissue damage, inflammation, muscle spasms, pain, and recovery time.  With a mild injury you should experience progressive improvement within 2 to 3 days.  You should gradually begin using the injured area after this time.  Mild injuries usually heal completely without any residual consequence in 1 to 4 weeks. Moderate injuries usually require 4 to 12 weeks to heal and may require basic rehabilitative treatment and exercises.  Severe injuries will take longer to heal.  Healing times may also vary depending on a persons age, physical condition and general health.

You should seek immediate medical care under the following circumstances:  a popping sound heard during the injury accompanied by a feeling of joint instability or inability to weight bear; obvious evidence or suspicion of a broken bone, fracture or joint dislocation; or injuries at risk for infection.  For less serious injuries that do not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of muscle and joint pain.  They can determine the cause of your pain and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance. For more information on managing muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Plantar Fasciitis: A Common Source Of Heel Pain

By Dr. John A. Papa, DC, FCCPOR(C)

Plantar fasciitis is caused by injury to the plantar fascia, which is the tendon-like soft-tissue along the bottom of the foot that connects your heel bone to your toes.  This condition is a common source of heel pain that can be quite disabling.

Plantar fasciitis usually develops gradually, but it can also come on suddenly.  Sharp, knife-like pain on the inside-bottom part of the heel is often characteristic.  Pain and discomfort can also extend into the arch of the foot.  Heel pain tends to be worse with the first few walking steps in the morning, and after extended periods of sitting or inactivity.  If plantar fasciitis becomes severe or chronic, heel and/or arch pain will be present with all weight-bearing activities, and may result in secondary areas of discomfort in the foot, knee, hip or back due to compensatory movements.

Under normal circumstances, your plantar fascia acts like a shock-absorbing rubber band, supporting the arch of your foot.  Excessive tension and repetitive stretching can create small tears in this soft-tissue fascia, causing it to become irritated or inflamed.  This may occur with activities that require running, jumping or prolonged walking and standing.  Improper footwear can make the plantar fascia more susceptible to stretch and strain during these activities.

Faulty foot mechanics may also contribute to the development of plantar fasciitis.  Individuals with flat feet or those who excessively pronate (role feet inward) will experience added strain on their plantar fascia.  Old lower extremity injuries such as ankle sprains and fractures can increase susceptibility due to altered lower limb movements.  Being overweight is also a risk factor.  Carrying extra pounds can break down the protective fatty tissue under the heel bone, causing heel pain and putting additional mechanical load on the plantar fascia.

Self-care strategies for reducing the pain of plantar fasciitis include: ice application; rolling a tennis ball or soup can from your heel and along the arch of your foot; and gentle stretching of the achilles tendon, calf muscles, and plantar fascia.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.

Plantar fasciitis that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic or laser modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  A custom made orthotic may also be helpful by minimizing pronation, cushioning the heel, and supporting the arch.

It is important to establish an accurate diagnosis of plantar fasciitis.   Other causes of heel pain may include stress fractures, heel fat pad syndrome, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Rehabilitation Of Ankle Sprains

By Dr. John A. Papa, DC, FCCPOR(C)

An ankle sprain is a very common injury that can happen to athletes, non-athletes, children and adults.  A sprain refers to a stretching or tearing of a ligament.  Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  One or more ligaments can be injured at the same time.  Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position.  This may occur while participating in sports and recreational activities, wearing inappropriate shoes, or running, walking or stepping on uneven surfaces.

Inversion ankle sprains constitute 90% of all ankle sprains.  This type of injury occurs when the foot is forced inward (inversion) and produces most of the pain on the outer side of the ankle.  Eversion ankle sprains are less common and occur when the foot is forced outward (eversion), causing the most pain on the inner side of the ankle.  A high ankle sprain is a unique and separate injury in which the ligaments around and above the ankle joint are injured.  This is known as a syndesmotic sprain.

Pain and swelling are the most common symptoms of an ankle sprain.  There may be bruising over the area of injury which may spread down into the foot towards the toes several days following the injury.  Individuals may also experience difficulty walking or weight bearing on their injured ankle.  Most ankle sprains can be managed conservatively.  However, obvious evidence or suspicion of a broken bone, fracture or joint dislocation necessitates the need for emergency medical care.

Initial conservative management of ankle sprains should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation).  The P.R.I.C.E. principle helps decrease pain and swelling and can be used during the rehabilitative process as needed.  Additional treatment options include electrotherapy, ultrasound, laser therapy, taping, bracing, soft tissue techniques, and manual mobilization to assist in returning to full functioning.  Rehabilitative strategies should also include exercises that incorporate active range of motion, stretching and strengthening for the ankle joint and lower extremity, along with proprioceptive/balance training to minimize the risk of ankle instability and re-injury.

Assuming that proper rehabilitative strategies are employed, successful recovery from an ankle sprain injury will depend upon the severity of ligament damage.  Mild injuries usually heal completely without any residual consequence in 1 to 4 weeks.  Moderate injuries usually require 4 to 12 weeks to heal.  Severe injuries will take longer to heal.  In some circumstances, surgery may be required for severe ankle sprains.

An untreated ankle sprain may lead to chronic ankle instability.  This may also result in secondary foot, knee, hip, and back problems because of subtle changes in movement patterns.  If you are having difficulty with ankle pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Defining Common Muscle And Joint Injuries

By Dr. John A. Papa, DC, FCCPOR(C)

 

Physical injury to your muscles and joints can occur with workplace, household, sporting, and recreational activities.  Common mechanisms of injury include slip and fall or collision-impact type accidents, overstretching a body part, twisting awkwardly, or performing repetitive movements.  This can cause pain, stiffness, and swelling in a joint and/or muscle, leading to injuries such as sprains, strains, and contusions.

 

A sprain refers to a stretching or tearing of a ligament.  Ligaments are tough bands of fibrous tissue that connect one bone to another.  They help stabilize joints, preventing excessive movement.  One or more ligaments can be injured at the same time.  Common locations for sprains are the ankle, wrist, and knee joints.

A strain refers to a stretching or tearing of a muscle or tendon.  Muscles are responsible for producing force and causing motion, whereas tendons are the tough fibrous extensions of muscle that attach to bone.  A strain injury can occur when the muscle-tendon complex suddenly or powerfully contracts, or when it is overstretched.  This is called an acute strain.  Overuse of certain muscles over time can lead to a chronic repetitive strain.  Strains are commonly referred to as “pulled muscles” or "tendinitis".  The shoulders, forearms, low back, and leg regions are common locations for strains to occur.

Contusions are commonly called “bruises”, and occur when small blood vessels in the skin, muscles, or bones are subjected to trauma. 

Sprain, strain, and contusion injuries can exist on their own or in combination with each other.  Initial conservative management and first aid of these injuries should follow the P.R.I.C.E. principle (Protection, Rest, Ice, Compression, Elevation).  This can significantly reduce swelling, tissue damage, inflammation, muscle spasms, pain, and recovery time.  With a mild injury you should experience progressive improvement within 2 to 3 days.  You should gradually begin using the injured area after this time.  Mild injuries usually heal completely without any residual consequence in 1 to 4 weeks. Moderate injuries usually require 4 to 12 weeks to heal and may require basic rehabilitative treatment and exercises.  Severe injuries will take longer to heal.  Healing times may also vary depending on a persons age, physical condition and general health.

You should seek immediate medical care under the following circumstances:  a popping sound heard during the injury accompanied by a feeling of joint instability or inability to weight bear; obvious evidence or suspicion of a broken bone, fracture or joint dislocation; or injuries at risk for infection.  For less serious injuries that do not subside, you should contact a licensed health professional who deals in the diagnosis and treatment of muscle and joint pain.  They can determine the cause of your pain and prescribe appropriate therapy, exercises, and rehabilitation strategies specifically for your circumstance. For more information on managing muscle and joint injuries, visit www.nhwc.ca.

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Ice Therapy For Muscle And Joint Injuries

By Dr. John A. Papa, DC, FCCPOR(C)
 

Ice therapy is an effective self-care treatment strategy for muscle and joint injuries.  It is commonly  used for acute injuries (within the first 72 hours), but can also be very helpful in managing flare-ups of chronic problems, and as a preventative measure following activities or exercise.

 

Ice therapy reduces the amount of swelling and inflammation at the injury site and also acts as an anesthetic to provide pain relief.  Icing as soon as possible after an injury will help with speeding up recovery time, and minimize the chances of secondary problems such as muscle spasm and joint irritation.

 

Below are some helpful  tips that should be followed when using ice therapy:

 

·        Crushed ice and ice cubes are ideal sources of ice because they easily mold around an injury site and can stay cold for long periods of time.  Commercial ice/gel packs and frozen vegetable bags are good secondary choices when crushed ice or cubes are not available.

·        Use compression when applying ice to an injury site.  Compression is most easily achieved with an elastic tensor bandage to add support and slow swelling.  The principles of elevating and resting the injured site should also be followed during initial injury management.

·        Ideal ice application time is 10 to 20 minutes.  There should also be a period of 10 to 20 minutes or more where there is no ice application before icing is done again so that skin temperature can return to normal.  This cycle can be repeated as often as necessary within the first 24 to 72 hours after injury or activity.

 

Below are some precautions that should be followed with ice therapy:

 

·        Ice should never be applied directly over the skin for a prolonged period of time as this can damage skin tissue.  A wet towel can safely be used as a barrier between the ice and skin and acts as an excellent conductor of cold.

·        Ice should never be applied on blisters, open cuts or sores.

·        Ice should not be applied before exercise or activity as this impairs your body’s ability to detect proper joint and muscle function, making one more susceptible to further injury.

·        Ice therapy should not exceed the treatment time recommended as prolonged exposure can reverse the positive effects of ice and can lead to possible frostbite.

·        Special care must be taken when icing the elbow, wrist, knee, or foot as superficial nerves in these areas can become irritated or damaged with prolonged icing.

·        People hypersensitive or allergic to cold and those who have a circulation problem should avoid ice.

 

If you have a muscle and joint injury that is not resolving, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.  From all of us at the New Hamburg Wellness Centre, have a safe and enjoyable summer!

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.

Heel Fat Pad Syndrome

By Dr. John A. Papa, DC, FCCPOR(C)
 

Heel Fat Pad Syndrome (HFPS) refers to damage or disruption of the fatty pad that sits under our heel bone (calcaneous).  This structure is approximately one inch thick and is made up of fatty tissue enclosed by ligamentous chambers.  The purpose of this structure is to absorb shock and cushion the heel bone.  If the fat pad is displaced or thins, then its ability to protect the heel bone from impact is decreased, which can result in heel pain.

 

HFPS is commonly misdiagnosed as plantar fasciitis.  Plantar fasciitis symptoms tend to be located towards the inner front portion of the heel and can extend into the arch of the foot, whereas symptoms of HFPS are characteristically located in the centre of the heel and described as a deep, dull ache that feels like a bruise.  Other symptoms characteristic of HFPS include central heel pain that is aggravated by prolonged periods of standing and barefoot walking on hard surfaces.  It is also possible to have both plantar fasciitis and HFPS present at the same time.

 

There are several factors that can contribute to the development of HFPS.  Trauma to the heel from high impact sports or a forceful blow to the heel from a fall can cause injury to the fat pad.  Repetitious chronic overload from activities such as running, jumping or prolonged walking and standing can also cause injury which can be exacerbated by the use of improper footwear.  It is known that the fatty heel pad breaks down as we get older which can make an individual susceptible to this condition.  Carrying extra pounds can also break down the protective fatty tissue under the heel bone.

 

Self-care strategies for reducing the pain of HFPS include: relative rest from any painful activities; ice application; and gentle stretching of the achilles tendon, and calf muscles.  Gel or “donut pads” placed under the affected heel(s) in shoes may also provide relief.  Long-term strategies may include activity modification and weight loss where applicable.

 

HFPS that does not respond to self-care strategies may require professional treatment.  This can include electrotherapeutic modalities to assist in healing, manual and soft tissue therapy to supporting structures, therapeutic taping of the heel, and specific rehabilitative  exercises for the muscles and joints of the lower leg and foot.  Supporting the foot with proper footwear and correcting faulty foot mechanics can decrease excessive strain on the fat pad.  A custom made orthotic with a deep heel cup design to cradle and cushion the fat pad may also be helpful for decreasing symptoms.

 

It is important to establish an accurate diagnosis of HFPS.  Other causes of heel pain may include stress fractures, achilles tendonitis/bursitis, arthritis, gout, or nerve irritation.  If you are having difficulty with heel pain, a qualified health professional can determine the cause of your pain and prescribe appropriate therapy and rehabilitation strategies specifically for your circumstance.  For more information, visit www.nhwc.ca.

 

This article is a basic summary for educational purposes only.  It is not intended, and should not be considered, as a replacement for consultation, diagnosis or treatment by a duly licensed health practitioner.