Ankle Sprains: How Physical Therapy Can Help!

by Kristin Keafer DeRousse, PT, DPT
Hampton PT Helps with Ankle Sprains
Ankle sprains are one of the most common musculoskeletal injuries. Often times this injury is brushed aside as “I just rolled my ankle and it’s sore” and unfortunately goes untreated. How many people do you know that have “rolled” or sprained their ankle? How many people do you know that have done this over and over again?

Research demonstrates that 25% of lateral ankle sprains results in time lost, potentially 1 week off from school or work. Very often those who sustain a lateral ankle sprain experience residual symptoms, leading to longer term chronic ankle instability. Essentially you are at high risk of rolling your ankle again in the future if it goes untreated. This has shown to significantly alter an individual’s health causing a less active lifestyle in addition to accelerating the arthritic process.4 With the high percentage up to 75% of initial lateral ankle sprains leading to repetitive sprains and chronic symptoms, it is imperative to treat and rehabilitate the FIRST occurrence of these injuries.(3)

What does it actually mean to sprain your ankle?
A sprain is an overstretching or tearing of ligaments. Ligaments are connective tissue that attaches bone to bone to support a joint. There are 3 types of ankle sprains. The most common ankle sprain is called an inversion or lateral ankle sprain.(2)
ankle-injuries-hpt
Inversion (lateral) sprain
Your foot rolls inward which can stretch or tear the ligaments on the outside of the ankle

Eversion (medial) sprain
Your foot rolls outward which can stretch or tear the ligaments on the inside of the ankle

High (syndesmotic) sprain
This is caused by a rotational stress with the foot moving outwards which stretches the ligament above the ankle between the tibia and fibula bones

When should you seek help?
Screening is the first step. Seeking the help of a medical professional as soon as possible to evaluate the need for treatment is very important. This will accelerate the healing process and reduce the risk for recurrent injury in the future. With all of our physical therapists holding a doctorate degree, we are able to directly assess the musculoskeletal injury and determine a need for treatment or referral out to a medical doctor if X-rays are indicated.

What are the signs that you may need treatment?
Difficulty bearing weight on that foot, limping, swelling, difficulty performing daily functional activities such as walking, climbing stairs, and managing uneven ground.

What to expect for treatment?
A full evaluation of your injury will determine a need for referral to a medical doctor or orthopedic specialist. Otherwise many times an ankle sprain can be treated with physical therapy alone.
The first step of treatment is focused on reducing swelling (RICE: Rest, Ice, Compression, Elevation), improving walking mechanics, and possible immobilization. The more you limp on an injured joint the longer the healing process will take. Typically there is a need for hands on treatment by the physical therapist to improve the mobility of your ankle joint, to loosen up tight muscles around the joint, and help reduce the pain.

The next steps of treatment will focus on improving flexibility and strength of your entire leg. Each individual will be assessed for their own impairments and which muscle groups need to be addressed with specific stretching and strengthening exercises. Typically this involves stretching the calf and strengthening the stabilizing muscles on the medial and lateral sides of the joint.
balance-hpt
The last steps of treatment focuses on primarily balance training. This is where we are working on improving your proprioception to increase the stability of the joint and prevent re injury in the future. Proprioception is the ability to sense the orientation of your body in your environment. There is a constant feedback loop in her nervous system where the sensory nerve endings in your joint and muscle send a signal to your brain. Joint position and how much stretch or strain is on your muscle is interpreted by your brain and your body will adjust for this subconsciously. For instance, if you are walking on a sidewalk and turn to walk on grass, your body knows how to adjust for this without your vision because of proprioception. However, with an injury to the joint and muscles of your ankle after a sprain, proprioception is impaired and the risk of rolling your ankle again increases up to 75% secondary to a problem with this feedback loop.3 This is probably the most important long term treatment to prevent re injury in the future.

So what have you learned?
Next time don’t wait to have your injury screened. Deficits in range of motion, strength, and proprioception sustained with an ankle sprain are all factors that can lead to long term chronic ankle instability.5 Physical therapy can help to normalize all of these factors, so why not seek out treatment. Let’s help to get you back on your feet faster and prevent problems with ankle instability in the future!
Visit either of our Hampton Physical Therapy locations in both Hampton, NH and Seabrook, NH for an assessment of an old or new injury.

  1. References
  2. (1) Al-Mohrej O,  Al-Kenani N Chronic ankle instability: Current perspectives. Avicenna J Med. 2016 Oct-Dec; 6(4): 103–108. doi:  10.4103/2231-0770.191446
  3. (2) Doherty CDelahunt ECaulfield BHertel JRyan JBleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40. doi: 10.1007/s40279-013-0102-5.
  4. (3) Hubbard T, Wikstrom E. Open Access J Sports Med. Ankle sprain: pathophysiology, predisposing factors, and management strategies. 2010; 1: 115–122. Published online 2010 Jul 16.
  5. (4) Shweta Shah, MHA, Abbey C. Thomas, PhD, ATC, Joshua M. Noone, PhD, Christopher M. Blanchette, PhD, MBA,  and Erik A. Wikstrom, PhD, ATC, FACSM. Incidence and Cost of Ankle Sprains in United States Emergency Departments. Sports Health. 2016 Nov; 8(6): 547–552.  doi:  10.1177/1941738116659639.
  6. (5) Thompson CSchabrun SRomero RBialocerkowski AMarshall P. Factors contributing to chronic ankle instability: a protocol for a systematic review of systematic reviews. Syst Rev. 2016 Jun 7;5:94. doi: 10.1186/s13643-016-0275-8.
  7. (6) Verhagen RAde Keizer Gvan Dijk CN. Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg. 1995;114(2):92-6.

Sciatica Pain – Causes and Remedies

sciatica pain - hampton ptby Katherine Younes, PT, DPT- Hampton Physical Therapy – Hampton, NH Clinic

Do you have a nagging pain that radiates down the back of your leg? These are the symptoms that everyone refers to as “sciatica”. Did you know that these symptoms can be a pain pattern referral coming from your lumbar spine? This is a condition referred to as lumbar radiculopathy.

  • There are several factors that can cause referred pain into one leg:3
      • Herniated/Bulging disc
        • irritates/pinches nerve root at the lumbar spine

      • Degenerative Disc Disease
        • natural process that occurs with aging that causes a decrease in disc height which can irritate/pinch nerve root at the lumbar spine

      • Spinal Stenosis
        • narrowing of spinal canal compresses/irritates nerves of lumbar spine

      • Piriformis Syndrome
        • tightness of the piriformis can result in pinching/irritation of the sciatic nerve as the nerve is located right under the piriformis muscle

        • these symptoms can replicate lumbar radiculopathy symptoms

    sciatica-painSymptoms You May Feel:

    • -Pain is typically located in 1 leg

      • -Pain will radiate down the back of the hip/buttock and into the leg, can go as far down as the lower leg and foot

      • -Pain will worsen with sitting or standing

      • -Pain described as sharp, shooting

      • -May or may not experience numbness/tingling

    How can physical therapy help?

    Research has supported the use of physical therapy and application of the traditional lumbar stabilization exercises with mobilization techniques for the sciatic nerve to improve the function and health of patients.1 “Both hamstring stretching and nerve mobilization can be usefully applied for the therapy of patients with lower back pain and sciatica related symptoms.”2

    At Hampton Physical Therapy, we have several treatment options to address your symptoms, such as neuromobilization techniques, soft tissue massage, dry needling, lumbar traction and exercise. Also, in conjunction with previously mentioned treatments, we also provide spinal manipulation to the appropriate candidate. If your symptoms do not radiate below your knee, you are a candidate for spinal manipulation. We can provide education about position modifications for your desk, car and furniture at home, as well as proper transitional mobility techniques and lifting techniques to reduce symptom exacerbation and risk of further injury.

    Here are a couple exercises you can try to address your symptoms.

    but-lift-sciatica-hamptonptBridges: While lying on your back, both knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as high as you can comfortably, however do not go high enough to create arch in your low back. Hold and then lower yourself and repeat.4

    piriformis-stretch---hamptonptPiriformis Stretch: While lying on your back and leg crossed on top of your opposite knee, hold your knee with your opposite hand and bring your knee up and over across your midline towards your opposite shoulder for a stretch felt in the buttock. Hold for 10 seconds, repeat 10 times.4

    If you have any questions regarding this condition feel free to call or stop by one of our two Hampton Physical Therapy locations in either Hampton or Seabrook, NH to speak to one of our physical therapists.

  • Citations:
    1. (1)Jeong U-C, Kim C-Y, Park Y-H, Hwang-Bo G, Nam C-W. The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. Journal of Physical Therapy Science. 2016;28(1):46-50. doi:10.1589/jpts.28.46.
    2. (2)Lee J, Kim T. The treatment effect of hamstring stretching and nerve mobilization for patients with radicular lower back pain. Journal of Physical Therapy Science. 2017;29(9):1578-1582. doi:10.1589/jpts.29.1578.
    3. (3)Sciatica Symptoms – Spine-Health. https://www.spine-health.com/conditions/sciatica/sciatica-symptoms
    4. (4)HEP2go – Build a HEP Home Exercise Program For Free, https://www.hep2go.com/exercises.php

Do You Have Noisy Joints?

hpt-snapping-jointsby Michael Lambert, DPT –  Hampton Clinic

Have you ever heard a pop or a crack in your knee when trying to get down on the floor? Or maybe you heard some noise in your elbow one morning when you picked up your coffee cup or even a little click in your shoulder when you reached over to your alarm clock? The sounds you are hearing are called “crepitus”.

What is crepitus?
Crepitus is the pop, crack, or click sound that you hear from your joints with movement. Crepitus is commonly caused by air making its way into soft tissues that surround your joints. When you move your joints and use the soft tissues, the air pockets can “pop” causing an audible sound (1). Crepitus can start following an injury such as fall, after an increase in activity level, or from repetitive use. These sounds can be considered normal, and if you do not have any pain they can be considered harmless!

Can crepitus be painful?
Crepitus can be painful in some instances. Below are a few common instances where crepitus can be painful.

popping-shoulder2Labral Involvement:
Both your hip and shoulder are considered ball-and-socket joints, and are structured to allow movement in multiple directions. The “socket” portion over these joints is lined with cartilage to deepen the socket and allow for more joint congruency. This cartilage is called your labrum. Dysfunction or damage to either labrum can cause painful crepitus that would feel “deep” in the joint (2).

Osteoarthritis:
According to the Arthritis Foundation, osteoarthritis is the most common chronic condition that affects the joints, and although osteoarthritis can occur at any age, it is more common in people over the age of 65. In healthy joints, the ends of each bone are covered with cartilage, which allows for smooth, pain-free movement. With osteoarthritis, the cartilage is broken down, which can cause painful, noisy movement.

Myth Buster! It was previously believed that purposely cracking the knuckles in your hands and fingers could lead to osteoarthritis. Recent research suggests that there is no relationship between regular knuckle cracking and osteoarthritis (4).

Patellofemoral Pain Syndrome (Also Known As “Runner’s Knee”):
As previously mentioned, sometimes air can make its way into the soft tissues around the kneecap (1). When this happens, when you bend your knee to sit down, squat to pick something up off the floor, or climb up some stairs, the air pockets can pop, causing an audible sound. If you have pain with these activities or pain with the popping sound, it may be caused by muscle imbalances or by tight or irritated structures around the knee.

What should I do if I have painful crepitus?
If you have painful crepitus, the first step is identifying the cause of the crepitus. You may have tight muscles that need to be stretched, weak muscles that need to be strengthened, or a neuromuscular system that needs to be revamped (balance training, specific muscle recruitment, etc.). Or maybe you just may learn new techniques for activities that cause pain, such as lifting something off of the floor.

What If I do not know where to start?
Come to physical therapy! New Hampshire is a direct access state. This means that many patients can come to physical therapy without a physician referral for problems related to the musculoskeletal system! If you have crepitus associated with pain or feel that you are limited with your everyday activities, let us help! We can help uncover the route of your crepitus, and establish a plan to get you feeling better! Along with education for the best stretches, strengthening, neuromuscular exercises, and activity modifications for you, we are skilled in multiple manual intervention techniques (soft tissue mobilization, mobilizations/manipulations, dry needling, etc) that may provide relief and speed up your recovery! Call Hampton Physical Therapy and schedule an assessment at either our Hampton or Seabrook location!

References

  1. Crepitus (Joint Popping).” Aurora Health Care, www.aurorahealthcare.org/services/orthopedics/conditions/crepitus. Accessed 12/02/2017.
  2. Labrum” MedicineNet.com, www.medicinenet.com/script/main/art.asp?articlekey=18656. Accessed 12/02/2017.
  3. Arthritis.” Aurora Health Care, www.aurorahealthcare.org/services/orthopedics/conditions/arthritis. Accessed 12/02/2017.
  4. Deweber, K., Olszewski, M., & Ortolano, R. (2011). Knuckle Cracking and Hand Osteoarthritis. The Journal of the American Board of Family Medicine, 24(2), 169-174. doi:10.3122/jabfm.2011.02.100156
  5. What is Arthritis?” Arthritis Foundation, www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php. Accessed 12/02/2017.