Sprains & Strains

Chronic Ankle Instability

Chronic ankle sprain and instability treatment

Chronic ankle sprain and instability treatment

What Causes Chronic Ankle Instability?

People who have a sprained their ankle may develop chronic (long-lasting) ankle instability. It is considered to be chronic if the ankle joint still gives way too easily six months after the first sprain, or if the ankle is sprained again within six months of the first sprain. One quarter of all sporting injuries are ankle related, and 85% of the time these are lateral ligament complex problems.

This kind of instability can develop if the ankle ligaments are overstretched or torn, and heal too loosely (mechanical instability). The interactions between the bones in the ankle and the surrounding ligaments and muscles may be disrupted too. The body has an unconscious awareness of movement and spatial orientation within the body, known as proprioception. This helps to coordinate the movements of the joints by using unconscious reflexes to stabilize them and keep the body balanced. So if an ankle feels permanently unstable, this might not only be caused by overstretched ligaments, but also by a problem with proprioception or resulting problems with muscle coordination.

Chronic Ankle Instability Treatment Options

There are a few different treatment options for chronic ankle instability. At first “functional treatment” is tried, involving physiotherapy to strengthen the joint, and possibly wearing an ankle brace or rigid tape to stabilize it.

One common approach is called neuromuscular training. The aim is to improve the stability, strength and coordination of the ankle. Studies show that neuromuscular training can speed up the healing process of ankle stability and mobility in the first few weeks. But there is not enough research to be able to say what effects this treatment has in the long term.

If the joint remains unstable despite training because the ligaments are too loose, surgery may be considered. One option is to shorten and tighten the ankle ligaments. This is not a very common approach and is usually utilized when all other avenues have been exhausted.

Chronic Ankle Instability Rehab

Chronic Ankle Instability Rehab

Chronic Ankle Instability Surgery Recovery & Rehab

Getting back to sport after surgery

Ankle instability often leads to problems with muscle coordination. For this reason, ankle exercises are a very important part of rehabilitation after surgery. Wearing an ankle brace during this time may also help. Braces not only support the joint from the outside – the pressure will also help you develop a good sense of muscle coordination again.

People probably benefit from starting movement, strength and coordination exercises two to three weeks after surgery at the latest. Studies suggest that people who do this become active again sooner than those who wear an ankle brace for six weeks and do not do any exercises during that time. In the studies, the participants who started doing exercises and strength training earlier were able to go back to work about one to two weeks sooner. They were also able to do sports again about three weeks earlier. But after about two years no advantages could be seen anymore: the stability and mobility of the affected ankle were the same in both groups.

Physiotherapy Vs surgery?

There were no studies comparing surgery directly with physiotherapy or other treatments. For this reason, it is not possible to say who might benefit most from surgery or how effective it is compared with non-surgical (conservative) treatment.

It is also not clear how the different surgical procedures compare with one another. There are only few small trials on this, and they do not provide reliable results. More research is needed to be able to answer this question.

Overall, it is currently not clear whether surgery leads to a faster recovery than strength and coordination training does. But if the ankle remains unstable because of loose ligaments, surgery might be an option. Whichever treatment you go for: with a little patience, sprained ankles usually become stable again.

If you are suffering from an ankle injury and are looking for a Sydney CBD physio contact the team at Sydney Physio Solutions who can help you get back on your feet again.

Recurrent Hamstring Strains

HamstringRecurrence of a hamstring strain is incredibly frustrating, not only for the injured person, but also to see as a physiotherapist!  A hamstring strain may reoccur if a person suffers a worsening of their original strain, or otherwise another area of muscle along the muscle/group becomes injured. Commonly this occurs when the person is just getting back into training or attempting to return to their previous sport. It is disappointing to see as a physiotherapist, since often re-injury is preventable with good management. Different outcomes will depend on factors such as the degree of the initial injury, its location (i.e. muscle versus tendon) as well as personal and external variables, however general guidance can be provided for optimal rehabilitation.

Best tips for best rehabilitation and avoiding re-injury:

  1. Progress your hamstring through a series of exercises aiming to achieve full concentric/eccentric strength, dynamic muscle length, power and plyometric ability (strength with speed), and endurance, before considering returning to sport and sport specific drills. See Dynamic Stretches
  2. Ensure your hamstring has been rehabilitated through sport-specific tasks, when it is appropriate to do so. Exercises need to consider the location of the injury in the hamstring, stage of injury, and the multiple functions of the hamstring muscle. Your hamstrings will work hard when you are speeding up and slowing down from a run, stopping quickly, kicking a ball, bending forward from the hips (e.g. picking something up), and control twists and turns of the leg when you are moving at quick speeds. As such – the muscle group needs to be trained well to be able to cope with these activities for a successful return to sport. Even if your main sport is running, your hamstring should still be progressed to be able to tackle less frequent tasks with confidence for best function.
  3. Perform a graded, specific running programme which is best advised by a suitable physiotherapist. This should incorporate graduated progressions of running distance for endurance, sprint exercises, forwards/backwards/sideways and cutting movements, and stop-start work. Hamstring strains most commonly occur during quick acceleration or deceleration – and therefore this needs to be trained back for the tissue to be able to cope with this, under high repetition/load.
  4. Return to sport gradually! Make sure you progress back carefully towards a previous level of activity/intensity. The tests we can do for a hamstring in a physiotherapy clinic and even outdoors assessment are only one level of assessment. Fatigue has big implications for muscle. Only when you can manage full training sessions at 100% intensity over the week, then consider playing or running at a competition level. And even then, only playing only part of the first game back rather than the full game is best, since you will likely be working a lot harder in this situation! De-conditioning occurs from not playing sport in a while, and this may be when you are more prone to injury.
  5. Listen to the muscle. The helpful thing about a hamstring strain is that it often gives you big clues as to how it is going, and when it might be about to restrain! If the muscle or group feels tired, or like it is “tightening”, or “about to go”, then stop! It is at a high risk of reinjury at this point. “Pushing it” has a high chance for reinjuring the torn tissue or injuring healthy hamstring tissue from overload.
  6. Address any contributing factors. Common culprits which contribute to hamstring strains include biomechanics and imbalances about the spine, pelvis, hips and legs. For example, players of kicking sports may have imbalances from constant rotational forces in one direction, influencing pelvic/hip stability. Optimising core stability and glute/hip timing/power and balance with specific exercises is important to prevent overwork through hamstrings. Neural tension through the injured tissue or from tight associated hip/back structures can also increase likelihood of restrain and there are treatments/exercises available to help this. Read more
  7. Maintain good hydration and nutrition throughout your rehabilitation, and  use good recovery practices, for optimal muscle tissue healing and recovery.

If recurrent hamstring strains are a problem for you, seek advice from a good physiotherapist to help answer any questions and assess for any contributing reasons that may be leading to re-injury, as above.


Muscle Strains and Tears

• Acute strains occur from undue pressure or overstretching of a muscle which results in a tear and damage to the muscle fibres and/or its attaching tendons

• Damage can occur to a small area causing a partial tear to the muscle fibres, or a large portion of the muscle causing a complete rupture of the muscle belly. They are graded accordingly from 1 to 3
• Muscle strains can occur in all muscles of the body during normal activities of daily life, work tasks etc, but most commonly present as a sporting injury
• Typical symptoms are pain, swelling, weakness and bruising or discolouration around the site of injury
• Chronic muscle strains can occur as small tears which happen over time with a continuously overloaded muscle
• The grading of acute muscle strains can determine the prognosis of the injury and helps to plan for return to sport
• A bad grade 2 tear may take 2-3 months to completely heal
• Depending on how many fibres are affected, grade 3 tears may require surgery

What you can expect/look out for
• Expect to see swelling and bruising/discolouration, this may continue to worsen in the days following the injury
• Pain, swelling and bruising usually subsides gradually over 1-3 weeks and the torn muscle begins to heal through scar tissue
• In most cases, with proper treatment most people completely recover from a muscle strain


Muscle Tears – More information

• If surrounding muscles and/or joints are not working properly, one particular muscle may be being overloaded, leading to that muscle being injured with a smaller force.

Hints for self-management
• Initial management is as for most soft-tissue injuries
• Rest, may involve immobilising the area, a sling for the arm or crutches for the leg
• Ice the area with an ice-pack or ice-blocks wrapped in a tea-towel, for 20 minutes, every 2-3 hours over the next 72 hours
• Compress the area with a bandage
• Elevate the area above the heart i.e. a lower limb injury should be rested lying down with the foot up on a small stool/pillows

Management options
• After a period of relative rest it is necessary to exercise the injured and surrounding muscles to regain full function
• Exercises to stretch, strengthen and correct muscle imbalances are necessary
• Deep tissue massage may be appropriate after an initial period of rest to release the thickened scar tissue

Corked Thigh

Corked Thigh – Ouch!

A ‘corked thigh’ in the medical world is referred to as a quadriceps contusion. This occurs when a direct force (usually a knee) makes contact with someones thigh. As a result of the direct blow, localized bleeding occurs intermuscular (between muscles) or intramuscular (confined to one muscle). Significant bruising, swelling and restriction of range of motion is commonly evident.


In some cases, the bleeding and resultant hematoma can calcify and cause a painful condition called ‘myositis ossificans’. In this instance, the body mistakenly lays down osteoblasts (bone cells) into the thigh! Ouch! Luckily, the bone stops growing after a few weeks and the body reabsorbs the bone.

Physiotherapy is very useful in speeding up the recovery process. Early mobilisation through massage, stretching and exercise is vital to ensure a quick and safe return to play.

Sprained Ankles

Sprained Ankles

Sprained ankles are common in tennis players and are usually caused by a sudden sideways or twisting movement, particularly if the surface is slippery or the player is fatigued. This will cause damage to ligaments and other soft tissues around the ankle.

How can you prevent an ankle sprain?

Below is a series of useful preventative exercises designed to build the strength of the tendons that support your ankle and improve your ankle stability.

A final option is to tape your ankle before you play (please see my ankle taping video for instructions on how to tape). This will give you more support when you’re returning to tennis after ankle sprain, or if you suffer from repeated ankle sprains.

If you’ve experienced an acute ankle sprain or have ongoing ankle problems, then why not book in a physiotherapy assessment at either our Chatswood physiotherapy clinic or one of our CBD Physio clinics. We also stock a range of supports currently used by grand slam winners!

Hamstring strains – When can I play?

Assessment during motion by monitoring data from sensors fixed to the body

These sensors are fixed to your body and transmit data to be analysed

As the soccer/football season ramps up locally, those of you with an old, recurrent or new hamstring injury will be asking………When am I safe  to play?

You no longer need to be unsure.

The latest technology which objectively measures when you are ready to resume full training and take the field again, as used by Manchester United, is dorsa Vi.

Sydney Physiotherapy Solutions is proud to have this cutting edge technology to assist you with your recent or recurrent hamstring injury. We use it to direct rehab and return you to any running sport without any guess work.