Is this what physiotherapists are meant to do?
Hi,
About 6 weeks ago I got injured playing basketball. Here is my diagnosis:
There was evidence of severe soft tissue oedema overlying the ankle joint.
There was a complete full thickness tear of the anterior talofibular ligament.
This was accompanied by a joint effusion.
There was also evidence of tibialis posterior, peroneus longus and peroneus
brevis tenosynovitis.
I've been seeing a physiotherapist for about a week, and it's my first time ever seeing a physio, so i'm not sure whether he's doing the right thing or not. He's pressing on my ligaments and pushing down on my left ankle to the point where it is excruciatingly painful, and i can barely walk. I'm then told to do calf raises and then on the exercise bikes. After my session today, I got told to start jogging 10-20 minutes a day. I'm not sure whether its the right thing to do, my ligaments haven't healed up completely, and I'm still feeling uncomfortable walking with an ankle brace. Is this standard protocol or am i being a bit paranoid?
Re: Is this what physiotherapists are meant to do?
Hi there,
Is your physio pressing on ligaments or on your tendons? Which part of your ankle is he pressing on? I would say as a general rule that Physio should not be excruciatingly painful. Your physio may be doing deep tissue work on the injured muscles (tibialis posterior, peroneus longus and bevis) which can be quite painful, however this should be done at your level of comfort. It definitely shouldn't be making you worse, which you seem to be indicating by saying that you are finding it difficult to walk now. There is not much evidence anyway for the use of massage in tenosynovitis conditions- it is more appropriate to try specific type of exercises (concentric and eccentric), and to use other methods to control the irritation of the tendon (which may include ultrasound, taping for support, orthotics, ice).
Also, you need to be able to walk 100% painfree before you consider jogging. Jogging can be quite stressful on the foot and ankle and shouldn't be progressed to until you are comfortable with walking (which will be based on you as an individual more so than expected/protocol timeframes).
At six weeks, ligament will show good healing- except in your case there is a full thickness tear- meaning the ATFL won't be able to repair/ grow back. However you can still recover well from this provided you have good balance and muscle control around the ankle. I think that it is the tenosynovitis of the other muscles which would be the cause of pain at present- this can be a relatively slow condition to resolve, depending on the severity, a few months may be required to get good control of this aspect.
Quote:
Originally Posted by
rabc20
Hi,
About 6 weeks ago I got injured playing basketball. Here is my diagnosis:
There was evidence of severe soft tissue oedema overlying the ankle joint.
There was a complete full thickness tear of the anterior talofibular ligament.
This was accompanied by a joint effusion.
There was also evidence of tibialis posterior, peroneus longus and peroneus
brevis tenosynovitis.
I've been seeing a physiotherapist for about a week, and it's my first time ever seeing a physio, so i'm not sure whether he's doing the right thing or not. He's pressing on my ligaments and pushing down on my left ankle to the point where it is excruciatingly painful, and i can barely walk. I'm then told to do calf raises and then on the exercise bikes. After my session today, I got told to start jogging 10-20 minutes a day. I'm not sure whether its the right thing to do, my ligaments haven't healed up completely, and I'm still feeling uncomfortable walking with an ankle brace. Is this standard protocol or am i being a bit paranoid?
Re: Is this what physiotherapists are meant to do?
Quote:
Originally Posted by
bikelet
Hi there,
Is your physio pressing on ligaments or on your tendons? Which part of your ankle is he pressing on? I would say as a general rule that Physio should not be excruciatingly painful. Your physio may be doing deep tissue work on the injured muscles (tibialis posterior, peroneus longus and bevis) which can be quite painful, however this should be done at your level of comfort. It definitely shouldn't be making you worse, which you seem to be indicating by saying that you are finding it difficult to walk now. There is not much evidence anyway for the use of massage in tenosynovitis conditions- it is more appropriate to try specific type of exercises (concentric and eccentric), and to use other methods to control the irritation of the tendon (which may include ultrasound, taping for support, orthotics, ice).
Also, you need to be able to walk 100% painfree before you consider jogging. Jogging can be quite stressful on the foot and ankle and shouldn't be progressed to until you are comfortable with walking (which will be based on you as an individual more so than expected/protocol timeframes).
At six weeks, ligament will show good healing- except in your case there is a full thickness tear- meaning the ATFL won't be able to repair/ grow back. However you can still recover well from this provided you have good balance and muscle control around the ankle. I think that it is the tenosynovitis of the other muscles which would be the cause of pain at present- this can be a relatively slow condition to resolve, depending on the severity, a few months may be required to get good control of this aspect.
HI! I totally agree. The adage is RICE (rest, ice, control, & elevation) ...followed by exercise as tolerated & ALWAYS warm up & cool down, esp w/an injury that is now "guarding" I am constantly preaching to my patients to listen to their bodies!...there is a distinct difference between "tight" & "sore" The goal is to increase the flexibility, not cause more 'guarding behavior" then work on the strength. I totally agree w/the modalities & support & progressing from arom as tolerated, of course icing down when done. I like the bike for muscle warm-up, supported & w/o resistance initially, but again, as tolerated & ice down when done (notice all of the mention of ice?) I totally agree that jogging & jumping types of activities mean you're just about healed due to the body weight's resistance being compounded by the force involved in the movement....Resistance/strength progress much better when it doesn't hurt to do it. Even babies "must learn to walk before (they) can run" as the old proverb states. There definitely should be more 2-way communication in treatment....I would hope that you are communicating the degree & circumstances of the pain to the therapist, as each patient is different & that should impact the treatment. Increased pain is frequently caused by muscle fatigue & continually overtired muscles can't recoup to heal...that's why you use the ankle support & cane, when the muscles need rest, & weaning from them when the activity doesn't hurt.
