Wk 2 Masterclass + Prep Work Flashcards
What adjuncts should be avoided after initially injuring a lateral ankle sprain
Things that promote blood flow e.g hot showers, heat rub, excessive weight bearing
During the initial 24hrs of a lateral ankle sprain, what is the WB protocol
PWB with crutches
Less severe injuries braces and taping can be used
How soon should wobble board exercises be prescribed for lateral ankle sprains
First or second day if pain permits
What type of movement exercises are important for lateral ankle sprain
Eversion with ankle fully plantar flexed
PF, DF, Inv, Ev are also really important
What should happen if a pt complains of pain 3-6wk after lateral ankle sprain
Reassess for undiagnosed bone fracture, ligament, tendon or synovial dysfunction
Symptoms of ankle fracture
Clicking
Locking
Joint swelling
Inflammation of Sinus Tarsi
Generalised pain
Can athletes play through tendon pain?
No. Many athletes say they could play through ligament or bone pain but they can’t go play through tendon pain
What is the role of the mid tendon of the achilles
Energy storage
What type of load does the insertion of the achilles tendon take
Compressive load
What sort of exercise should be prescribed to achilles tendinopathy rehab
Eccentric exercise - loads the tendon to energy storage (ie ‘spring’), doesn’t load the muscle
Heavy Slow resistance - increases muscle strength, doesn’t adapt to energy storage
Should an achilles tendinopathy pt go through absolute rest
No. That’ll reduce the envelope of function and tendons love load
What is the progression of exercises for achilles tendinopathy
Isometrics (no compression)
Strengthen surrounding muscle (no compression)
Energy storage through using faster movements at the end of range ecc. loading (add compression)
Energy storage and release (ie plyometrics)
What is the weight bearing protocol for bone stress injuries
No need for prolonged NWB
Avoid NSAIDs to assist in pain free gait as they can mask symptoms of excessive loading
What adjunct therapy can be used for bone stress fractures?
Low intensity pulsed ultrasound (LIPUS)
How can bone stress injuries continue to maintain their CV fitness
low risk BSI can still participate in cycling, swimming, deep water running. Cycle with rigid sole shoes to reduce bending moments on a metatarsal BSI
What exercises should low risk tibial BSI perform early on
PF
When should low risk metatarsal BSI pt’s perform resisted PF exercises
After bone tenderness resolves due to large bending moments through the metatarsals
When should a progressive walk-run program be introduced in foot BSI injuries
After 5 consecutive pain free days while completing ADL
What demographic is more likely to experience foot BSI
Female adolescents with previous BSI are 6x more likely to get another BSI
Risk factors of foot BSI
Female: Prior BSI, low BMI, Age, past participation in dance or gymnastics
Male: Prior BSI, lack of playing ball sports.
Where does pain usually occur in achilles tendinopathy
Pt is able to specifically locate exactly where the pain is. In fractures the pain is very generalised
What are the 4 types of tendon in the tendon continuum
Normal tendon
Reactive tendinopathy
Tendon disrepair
Degenerative tendinopathy
Extrinsic risk factors of achilles tendinopathy
Training with muscle stiffness
Change in surface
Change in footwear
High loads when fatigued
Different drills
Increased frequency of training
Single high intensity session
Outcome measures of achilles tendinopathy
VISA-A
Numerical Pain Value
Functional Test (ie calf raise)
Manual muscle test
ROM
Pain with walking
What is the VISA-A used to measure
Achilles Tendinopathy severity
What is the minimal score change in a VISA-A for the intervention to have worked
12 points
is 100/100 on a VISA-A a score that represents lots of pain or no pain
No pain. Low score says that there’s lots of symptoms
How much pain should an achilles tendinopathy pt be able to tolerate
5/10. Anything more than that the pt should modify their activities
Tendinopathy Pt are often concerned that they’re going to rupture their achilles if they continue to exercise. Is this a real concern
They aren’t going to rupture it. Tendons love load. Educate pt about envelope of function and that exercise is needed to ensure that they don’t reduce their functional abillity
Is manual therapy important for achilles tendinopathy pt?
No. It’s a short term solution
What are the two types of achilles tendinopathy
Insertional achilles tendinopathy
Non-insertional achilles tendinopathy
What is the most common form of achilles tendinopathy
Non-insertional achilles tendinopathy
How to differentiate insertional and non-insertional achilles tendinopathy
Non insertional is less common, with pain at the insertion. Also has increased pain with DF ROM
How long can it take to recover from a lateral ankle sprain
2-36 weeks
Types of treatment for ankle lateral sprain
Education
Exercise therapy
Manual therapy
Taping
Bracing/orthotics
Electrophysical therapy
Cryotherapy/Heat therapy
Dry needling
What education should you provide to a pt with a lateral ankle sprain
Discuss prognosis and management plan
Risk of Chronic Ankle Instability. Advise to stay active, avoid immobilisation and introduce movement ASAP
Graded exposure to movement in ADLs
How is chronic ankle instability caused
Ankle sprain which hasn’t healed properly causing repeated ankle sprains
What is the difference in gait between normal pt and those with chronic ankle instability
Land more laterally
Centre of pressure is more lateral
Fully regressed ankle proprioception exercises
Tandem stance
Narrow DL stance
SL standing
RTP of ankle sprian
Simple injury - 3-4wk
Partial/torn rupture - 6-8wk
Post surgery - 12-16wk
