Chronic ankle instability is an instability affecting the ankle joint and its surrounding structures. It usually develops after a severe ankle sprain. However some people are born with less stable ankles, who may be generally extra flexible throughout their entire bodies. Approximately 20% of ankle sprains lead to chronic ankle instability due to the resulting changes in ligament support, strength, postural control, muscle reaction time and sensation.
What are the symptoms?
As well as being more susceptible to ankle sprains, people with chronic ankle instability may notice they are extra cautious during high-intensity activities, if walking or running on uneven surfaces or when changing directions quickly. They may experience a sense of weakness or "giving way" when weight-bearing.
What are the causes?
The primary causes of this condition are ligament laxity, decreased muscle strength of the muscles surrounding the ankle and reduced proprioception.
Following an ankle sprain, ligaments can be stretched and slightly weaker. In more severe cases, they may have torn altogether, leaving the ankle structurally weaker. Without full rehabilitation, the surrounding muscles also become weaker, and studies have shown that balance and sensation of the ankle can also be reduced. This means that the ankle is more likely to be injured again, creating a vicious cycle leading to further instability.
How can physiotherapy help?
Physiotherapy treatment for chronic ankle instability focuses on improving strength, control and balance with a variety of techniques. This approach can significantly improve dynamic ankle stability and reduce the risk of future sprains. Physiotherapists can help patients to regain confidence and get back to their best performance.
In some cases, taping or bracing for support can be used. However this can lead to dependence and further loss of strength and control if used unnecessarily. In cases of extreme ligament laxity or if physiotherapy fails, surgery to repair the damaged ligaments is considered. This is usually combined with a full post-operative physiotherapy rehabilitation program for greatest success.
What is it?
Vertigo, the feeling that you are moving even though you aren’t, is an unpleasant yet common experience caused by a variety of conditions. It may surprise you to learn that in some cases your physiotherapist is able to treat vertigo.
The process of telling whether we are moving or not involves many parts of the nervous system, including the inner ear. The vestibulocochlear nerve sends information about head movement to the brain, where it is processed. However, certain conditions can disrupt this process, causing the brain to perceive movement when there is none. Physiotherapists may be able to help with a specific type of vertigo called Benign Paroxysmal Positional Vertigo (BPPV).
What are the symptoms?
BPPV, also known as positional vertigo, causes dizziness only when the head moves in certain positions or directions. People with BPPV often experience dizziness and nausea when rolling over in bed or looking upwards, as well as lightheadedness and disturbance of balance. While BPPV can occur for no obvious reason, it is often seen after a recent head trauma, respiratory infection, or aeroplane travel, as these conditions can disrupt the inner ear's normal function.
How does it happen?
The symptoms of BPPV can be explained by a disruption in the signal sent by the semi-circular canals of the inner ear to the brain. These canals are positioned in different directions and filled with fluid. As the head moves, the fluid in each canal moves differently, depending on the head's orientation. Receptors pick up this movement direction and speed, sending the message to the brain. However, sometimes small calcium crystals in the utricle, where the three semi-circular canals meet, can become dislodged and move into the semi-circular canals, disrupting the fluid and obscuring the messages to the brain.
What is the treatment?
If your doctor has diagnosed you with BPPV, they or your physiotherapist can show you a series of movements to help dislodge the calcium crystals and move them away from the semi-circular canal. You may also be asked to perform exercises to prevent the crystals from returning. Usually, only one or two treatments are needed for symptom resolution, although some cases may require more.
If you think you have vertigo, it is important to be assessed by a medical professional, as there are many conditions that can cause these symptoms and correct diagnosis is necessary before treatment. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your condition.
Maintaining balance is a complex process that your body does automatically. The body uses various systems to maintain balance, where if one system fails, the others can compensate to keep you stable. You may not notice a deterioration in your balance until you're in a challenging situation.
Our bodies have three systems that work together to keep us balanced: our vision, our inner ear, and our proprioception (our ability to sense the position and movement of our joints, muscles, and tendons). Our eyes provide visual information about the world around us, while the inner ear helps us maintain our balance by detecting changes in our head's position. Meanwhile, receptors in our joints, muscles, and tendons help us understand where our body is in space and how it is moving.
Poor balance can cause falls, broken bones, and serious injuries. The good news is that you can usually improve your balance with just a little practice. Here are a few quick tips you can try...
1. Maintain good posture.
Good posture helps align your body, which is important for balance. Stand up straight with your shoulders back and head up. Avoid slouching or leaning to one side as it can throw off your balance.
2. Practice standing on one leg.
Standing on one leg may seem easy, but it can be challenging if you're not used to it. Start near a wall or hold onto a sturdy surface for safety. Gradually try standing on one leg without support. This exercise improves proprioception, which is your body's ability to sense where it is in space.
3. Strengthen your core muscles.
Core muscles located in your abdomen, back, and hips help stabilize your body and keep you upright. Strengthening them through exercises like planks, side planks, and bridges can improve your balance.
4. Regularly challenge your balance.
Notice what the limits of your balance are and see if you can improve on this gradually every day. Setting small goals for yourself can result in large improvements in your balance over time.
Talk to your physiotherapist about creating a personalised program to improve your balance. Your physiotherapist is an expert who can evaluate which aspects of your balance need improvement and how to do it. They can assess which exercises are most appropriate for you, regardless of your fitness level or age.
Ankle sprains are extremely common, however this doesn’t make them easy to cope with when they happen to you. If you’ve ever spent two weeks hobbling around on crutches after a bad twist, you’ll understand just how painful and difficult they can be.
What are they?
An ankle sprain refers to an overstretch or tear to the ligaments of the ankle. Commonly, a person will roll their ankle inwards and tear the ligament on the outside. Occasionally, the ankle will twist outwards and the ligaments on the inside of the ankle are torn and even less commonly, the fibres of the ligament that hold the two bones of the lower leg together can tear (this is a "high ankle sprain"). A sprained ankle will usually be painful, swollen, bruised, difficult to walk on and in some cases unstable.
How does it happen?
Ankle sprains can occur from something as simple as putting weight onto your leg when you think your foot is flat even though it’s not. The most typical pattern is of a person jumping and landing on the outside of their foot or simply slipping and twisting their ankle. A sprained or twisted ankle is one of the most common injuries presented to hospital emergency departments around the world.
A medical or health professional should assess any ankle sprain. However, there are some guidelines to help decide if a sprained ankle needs an X-ray...
1. You are unable to put weight on the ankle immediately after the injury.
2. You are unable to take more than 4 steps immediately after the injury.
3. You have pain on the bony edges of the outer foot and ankle.
How long do sprains take to heal?
Depending on the severity of the tear, from one to six weeks. Your physiotherapist is able to help with recovery and ensure nothing slows down the healing process. Following any injury, joints may remain a little stiff and lose strength and control. Even though the injured tissues have healed, the ankle doesn’t move quite the way it used to. This means that your risk of twisting it again is higher than before the injury.
How can physiotherapy help?
Correct rehabilitation can help to speed up your recovery and prevent recurring injuries. As well as providing support to the unstable ankle, your physiotherapist will help you to strengthen any weak muscles and restore balance and control through exercise. They are also able to correct any abnormal movement of the joint following the injury.
If you've ever started a new hobby or activity and noticed your balance isn’t quite up to scratch, it can be quite a disturbing discovery. Balance is an important part of many activities and if it's not being challenged regularly, it's easy for it deteriorate without you noticing.
What is balance?
Keeping your balance refers to a state where your centre of gravity is maintained over your base of your support, preventing you from falling. Your body is always working hard to keep this equilibrium without you realising it. Balance is controlled by many systems that work together, including the visual, vestibular, proprioceptive and musculoskeletal systems.
What is proprioception?
Proprioception refers to the awareness of your body’s position in space. The central nervous system gains sensory input from the muscles, skin and tendons and interprets this information, creating a sense of where your body is positioned. This is how you know your foot is flat and ready to take your weight when you step, without needing to look at it. You may not have heard of proprioception before, but it is vital to keep you from falling and can be improved.
How can I test my balance?
Your physiotherapist is able to assess your balance more extensively, however here are a few quick tests you can do at home to see if your balance can be improved.
Stand with two feet together and close your eyes.
Try again, this time standing on one foot with your eyes open. Close your eyes only once you have found a steady posture with your eyes open.
To increase difficulty, stand on an uneven surface, like a pillow on the floor.
Aim to balance for at least 30 seconds in each of these postures. If you can't have a chat with your physiotherapist and see if your balance can be improved. They will also be able to offer you some practical tips on how to reduce falls and injuries.
Your physiotherapist has a wide variety of skills and can help you with so much more than just pain and injury. Here are a few reasons to visit your physiotherapist that can keep you healthy and pain-free, before injury strikes...
Stiffness and Inflexibility
Almost all of us have experienced pain and stiffness after a day of increased or unaccustomed exercise. This kind of stiffness usually wears off quickly and is referred to as DOMS (delayed onset muscles soreness). However, if you find yourself feeling stiff for more extended periods, or even most of the time – it might be time to see a physio. There are many different causes of stiffness and inflexibility. By far the most common is lack of movement. Our joints and muscles both lose flexibility if not moved through their range regularly. Muscle stiffness can feel like a tightness with a bouncy feeling of restriction, and joint stiffness can create a harder ‘blocked’ feeling when you try to move.
When it comes to stiffness that evolves from lack of movement, you may not even notice that you have lost range, as it can be easy to adapt your movements to compensate. Your physiotherapist can help you to identify where you have areas of inflexibility and help you to exercise, stretch and mobilise your joints to get them back to a healthy range. Disease processes such as osteoarthritis and rheumatoid arthritis can also cause prolonged stiffness, and your physiotherapist is well equipped to help you deal with these conditions.
Reduced Strength or Weakness
There are many possible reasons for weakness in the body, from generalised disuse, weakness in one muscle group following an injury, neurological weakness or structural weakness of joint following a ligament tear. Musculoskeletal deficiency of any kind can predispose you to future injuries and are difficult to resolve without targeted exercises. Your physio can determine the cause of your weakness and prescibe the best treatment to restore your strength.
Keeping your balance is a complicated process and your body works hard to make sure you stay on your feet. Humans have a small base of support for our height and we use all our senses together to determine which movements we should make to stay upright, including our visual, vestibular, muscular and sensory systems. As balance is essential for walking, if one system that supports our balance begins to weaken, the others will quickly compensate, so you may not notice that your balance has worsened until you fall or trip over unexpectedly.
As a general rule balance deteriorates as we get older, but this doesn't mean that falling should be an inevitable part of aging. Actively working to maintain or improve your balance can have a significant effect on your quality of life and confidence in getting around. Your physiotherapist is able to test all aspects of your balance and provide effective rehabilitation to help keep you on your feet.
Keeping active can be challenging. For many people, going out for a run or taking time to perform a full workout can be daunting, especially if this is not a part of their usual routine.
There are a few quick and easy ways to add some movement to your day, starting with something as simple as boiling the kettle. As the average kettle takes 2-3 minutes to boil, challenge yourself to see if you can complete these three exercises while waiting for your cup of tea or coffee. You can focus on one each day, or work through a different one each time.
1. Challenge your balance.
Standing on one leg is something many of us assume we can do, yet rarely take the time to check. This is an essential skill that can deteriorate without being noticed until everyday activities, such as getting dressed, are impacted. Being able to stand on one leg is important for putting on shoes, trousers and reduced balance can be a risk factor for falls.
Start by seeing if you can stand on one leg with your eyes open for the entire time the kettle is boiling. Test both legs, making sure you are close to a bench that you can use to support yourself. To increase the difficulty, try balancing with your eyes closed, then progress to balancing on your tiptoes. If you can balance on your tiptoes, with your eyes closed, then you can ask your physio for more suggestions.
2. Heel Raises
Start by keeping your knees slightly bent and lift both heels off the ground at the same time. You can begin with repetitions of 5, have a quick rest then repeat. Challenge yourself to increase the speed of your heel raises and see how many you can fit into your waiting time. As you bend your knees, aim to keep your knees over your second toe. If you feel this is a little too easy, you can progress to single-leg heel raises, which will also improve your balance!
You can start a daily competition with the people in your household to see who can complete the most repetitions in a set time period.
Squats are a great exercise to keep your large muscles working. You can start with 5 shallow squats, aiming to slowly increase your number and progressively squat to a lower position. As with heel raises, when you start to find squats to be less of a challenge, you can move to single-leg squats.
Don’t hesitate to ask one of our physios for tips on how else you can stay active at home or in the office.
Ankle sprains are one of the most common sporting injuries and most people have experienced one at least once in their lifetime. While they are common, this doesn’t lessen their negative impacts. Surprisingly, having poor balance might be increasing your risk of ankle sprains. Here we discuss a few facts about balance and what you can do to reduce your risk of ankle injuries
Why are ankles particularly vulnerable to injuries related to poor balance?
Our ankles have to support our entire body weight when standing on one foot. To provide us with agility as well as stability, our ankles have the ability to move from side to side as well as backwards and forwards. There is a complicated process constantly operating to keep your foot in the correct position while supporting all this weight, particularly with quick changes of direction, activities done on tiptoes, jumping and landing.
If the ankle rolls excessively inwards, the ligaments on the outside of the ankle can be damaged and torn. Balance is an important part of keeping the ankle in the correct alignment and not twisting too far to either side during challenging activities.
A study of high school basketball players by Timothy McGuine et al. in 2010 showed that students with poor balance were up to seven times more likely to sprain their ankle than students with good balance. Other studies have shown that balance training is an effective way of preventing falls in elderly populations.
Balance can vary from one leg to the other.
Most of us tend to favour one side of our body for all activities. This is more obvious in the upper body, with most of us identifying as either left or right handed. The same is also true for our lower body, with each of us favouring one leg over the other for balance activities. This can mean that one leg has better balance and strength than the other, leaving one leg more vulnerable to injury.
Reduced balance can mean your body has to work harder to perform activities, with muscles activating in a less coordinated way. Improving your balance can also improve your body’s efficiency of movement, which can, in turn, improve your overall performance without actually improving your muscle strength.
Balance can be trained rapidly.
Balance is one of the most overlooked dimensions of physical health however, the good news is that it can be improved relatively quickly. Do a quick check to see if you can stand on each leg for two minutes with your eyes closed. If this is difficult you might find that improving your balance is a great next step in your training program.
Your physiotherapist is able to identify any deficits in your balance is and is able to develop a training program for you to improve it. Come and see us for an appointment to see how we can help.