There is no doubt that the human body can be very resilient. Short of regenerating new limbs, our bodies are capable of recovering from large amounts of damage, including broken bones. With this in mind, many people are happy to let nature take it’s course following an injury, thinking that seeing a physiotherapist will only act to speed up already healing tissues.
The speed of recovery, however, is only one measure of healing and despite our body’s incredible capacity for repair, injury repair can be less than straightforward. Here are a few things about injury healing you may not have been aware of...
1. Scar Tissue is more likely to form without treatment.
Scar tissue can cause ongoing pain and stiffness in skin, muscles and ligaments. Physiotherapy can prevent excessive scarring from forming through advice regarding movement, massage and other hands-on treatment.
2. Your ability to sense the position of your body, known as proprioception, is often damaged after an injury and can be retrained.
Impaired proprioception is a major factor in re-injury. If you’ve ever heard someone say “my knee/ankle/shoulder still doesn’t feel 100%” then this could be why. The good news is that with a specific exercise program, proprioception can be improved and restored.
3. Once healing has finished, your body may not be exactly the same as before.
Following an injury, ligaments may be lax, joints may be stiffer and muscles are almost always weaker. While the pain may be gone, there might still be factors that need to be addressed to prevent more complicated issues in the future.
4. You may have picked up some bad habits while waiting for the injury to heal.
While in pain, we often change the way we do things, this can lead to the development of poor movement patterns and muscle imbalances. Even though the pain has gone, these new patterns can remain and create further problems down the road.
5. Injuries don’t always heal completely.
On occasion, injuries may not be able to heal completely on their own. The most serious example of this is a fracture that cannot heal if the bone is not kept still enough. Other factors that may prevent an injury from healing include poor circulation, diabetes, insufficient care of the injury and poor nutrition.
Your physiotherapist can assess your injury and develop a treatment plan that will both restore you to the best possible function and prevent further injuries.
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.
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.