Sprain & Strain Rehabilitation & Sports Injury Treatment in Toronto

Sprains usually involve joints and the ligaments surrounding them. Strains involve muscles and connective tissues. They are often confused because both are considered soft tissues of the musculoskeletal system and both present themselves with similar symptoms. Common conditions and injuries that we treat include:

• Tennis/golfer’s elbow
• Ankle sprains
• Plantar fasciitis
• Knee meniscus injuries
• Iliotibial band friction syndrome

Ligaments are like strong cloth or leather, tough but when pulled to their limit they can tear. Muscle fibres are pliable like elastics. They are resilient but, when overexerted or overstretched, can tear. Depending on the severity of the tear, a sprain or strain can be mild, medium or severe, often referred to as level 1, 2 or 3. The accumulation of fluids after an injury gives rise to the characteristic symptoms of pain, swelling and bruising and makes it difficult to differentiate one from the other. Physiotherapists specialize in their differentiation during the initial assessment. If the injury resulted from trauma while playing sports, the physiotherapist may find evidence of both types of soft tissue injury and therapy may overlap considerably. Acute injury treatment follows the RICE formula: Rest, Ice, Compress, Elevate. The goal of treatment for all soft tissue injuries is to restore function as soon as possible. By seeking prompt diagnosis and treatment, including physiotherapy, you can be back to your usual activities in the shortest time possible.

If you have a sprain or strain revolving around a sports-related incident, contact us today to schedule an appointment and begin your individualized treatment plan.

Tennis / Golfer’s Elbow

You’ve most likely heard of both of these conditions, but may be a little confused about which you may be suffering from. Both conditions are similar in nature, but are caused by different wrist and elbow activities. Basically, if you have pain on the top (outside) of your elbow, it’s tennis elbow; if it is on the underside (near the “funny bone”), it’s golfer’s elbow.

Tennis elbow is caused by stress and eventual microscopic tearing and inflammation of muscle and tendon where your wrist extensors, the muscles which bend your wrist back, attach to the outside of your elbow. Activities which can aggravate this condition include a weak tennis backhand, prolonged hammering, working at a computer keyboard, activities involving holding the wrist back and using the fingers to grip to perform small movements like spraying a hairspray bottle or lifting a carton of milk.

Golfer’s elbow involves the same microscopic trauma, but involves the muscles which flex, or bend your wrist toward your forearm. Activities which aggravate this condition can include striking the ball during your golf swing (the elbow of the dominant, shooting side will feel the stress), and activities which involve gripping with the fingers or gripping and turning the wrist, like using a wrench or carrying groceries. 

What Can You Do to Heal or Prevent These Injuries?

• When performing repetitive activities such as typing, hammering and carrying, make sure your wrist is well supported in a neutral position (the midway point between flexion and extension). This can be accomplished by consciously maintaining this position, or with the help of various external supports or splints.
• If you do a job or like to play a sport which might make you prone to developing either of these conditions, be sure to keep the muscles of your forearm strong, particularly your wrist extensor muscles. You can do wrist curls and wrist extension exercises with small weights at the gym, at work on your break or at home.
• Make sure your tennis racquet, golf clubs and tools have proper grip or handle sizes.

If you do end up having symptoms of either of these conditions, be sure to modify the aggravating activity immediately. Also, seek the advice of a physiotherapist, who will help you identify the cause, help to reduce the inflammation and show you stretching and strengthening exercises that will prevent the condition from becoming chronic. Furthermore, a physiotherapist will advise you if bracing is necessary, and if so, the type of brace that would be available these days. But it is important to have the brace type and size suit you and your condition for most effective relief of symptoms.

Ankle Sprains

An ankle sprain is the most common athletic injury and involves stretching and possible tearing of ligaments around the ankle. Nearly 85% of ankle sprains occur laterally, or on the outside of the ankle joint, when you “roll” your ankle. 

Sprains of the inside ligaments are less common, but can happen.

Many sprains occur when participating in sports, or by twisting the ankle when walking on an uneven surface. Some individuals, due to their bone structure or foot type, are more prone to ankle sprains.

With good management by a physiotherapist, you can return to full activities, including high level sports, safely and quickly after an ankle sprain. 

Symptoms vary, depending on the severity of the sprain. Often, the ankle is tender, swollen and discoloured. The ankle can be quite painful to touch. Initially walking is usually painful, and the degree of the pain usually depends on the severity of the sprain. A feeling of instability may occur, especially in severe ankle sprains when ligaments are torn.

Ankle sprains can be divided into several classifications:

• Type I ankle sprains are the least severe and occur when ligament fibres have been stretched or slightly torn
• Type II sprains occur when some of the fibres of the injured ligaments are completely torn
• Type III sprains are the most severe and occurs when the entire ligament is torn and there is significant instability of the ankle joint

You should see a physiotherapist as soon as possible after injury. In more severe cases, it may be better not to walk on the ankle, so crutches may be recommended.

If you have an ankle sprain, the first thing you should do is “RICE,” which helps to decrease swelling and pain and kick-starts the healing process.

• Rest: try to keep off the injured ankle in the first few days, and only do gentle range of motion exercises, like ankle circles.
• Ice: wrap the injured ankle in a cold pack or ice pack. Never put cold plastic directly on your skin; cover the pack with a moist towel. Never leave ice on for more than 15 minutes at a time, and make sure you have good sensation in the area, so you don’t freeze your skin by accident!
• Compression: you can gently wrap the ankle with an elastic “tensor” type bandage, making the bandage tighter at your toes and looser as you go up to your foot and lower leg. A tape job applied by your physiotherapist can also make your ankle feel supported, decrease swelling and make walking more comfortable in the early stages.
• Elevation: when you’re not up and around, elevate your injured ankle on a foot stool or chair. This will decrease swelling, as it stops the fluid from pooling around your injured ankle.

As your initial symptoms decrease, your physiotherapist will increase your activity level slowly. You will start to do more range of motion and weight bearing exercise, including balance or “proprioception” exercises. It is essential that you rehabilitate your sense of proprioception in order to decrease the chance of having another sprain.

Most ankle sprains heal in three to eight weeks. In more severe cases, ligaments may require more healing time to promote ankle stability. Repeated ankle sprains may cause chronic instability, interfering with walking or sports activities. In extreme cases, surgical stabilization may be required, but in general, a good brace, which can be recommended to you by your physiotherapist, can decrease the chance of re-injury.

Plantar Fasciitis

Plantar fasciitis is a condition which involves pain in the heel. It occurs when the plantar fascia, a thin layer of tough tissue supporting the arch of the foot, becomes sore where it attaches to the heel. Under certain conditions, the plantar fascia can undergo excessive strain, which causes the heel to hurt, feel hot or sometimes even swell.

Typically, with plantar fasciitis, the pain is worse when first getting up after sitting for a while. Usually, after walking for a few steps, the pain will ease. In some people, the pain gets worse with prolonged standing or walking.

There are a number of possible causes of plantar fasciitis, and they are often working in combination. Walking for prolonged periods of time in shoes that don’t give good support and/or don’t fit well (especially if they are too small), tightness of the foot and calf, improper athletic training and anything that causes excessive stress on the arch are potential causes. People with low arches, flat feet or high arches are at increased risk of developing plantar fasciitis.

In some cases, excessive strain on the plantar fascia over a long period of time can cause extra bone growth at the heel, which is known as a “heel spur.” Heel spurs may be present with plantar fasciitis, but not always. Likewise, the plantar fascia can be very sore, even though there are no heel spurs present. No treatment can make the bony growth of heel spurs go away, but the inflammation that causes the pain can be very effectively treated, and the symptoms will stop.

Treatment

The general rule with plantar fasciitis is the sooner you seek treatment, the sooner you will be better. Without treatment, symptoms can sometimes go on for 6 to 18 months or more.

Your physiotherapist will start you on an excellent treatment program, which may include:

• Stretching exercises, especially for the calf
• Strengthening exercises for your foot muscles and legs
• Treatment on the painful heel, including deep tissue massage, and possibly using machines, such as ultrasound
• Taping of the arch may be used to give support
• Advice on proper sizing and shoes made for your particular foot type. For instance if you have flatter arches, a shoe with very good arch support may be recommended
• Advice on altering athletic training and/or general activities as necessary

You may be advised to purchase orthotics, which are custom-made inserts to your shoes that support your arch

Knee Meniscus Injuries

The menisci are structures that fill the space between the femur (the large bone of the upper thigh) and the tibia (the shin bone). They are made of a tissue called cartilage. There is a lateral meniscus on the outside of the knee and a medial meniscus on the inside of the knee, and they are both attached to the tibia.

Menisci act as shock absorbers in the knee joint. Specific movements or positions of the knee will stress either the lateral or the medial meniscus. If these movements are taken to the extreme of the range with force, the meniscus can be torn or irritated.

How It Happens

Meniscal injuries can happen in a variety of ways. However, the position of injury is usually a forceful twisting inward while the knee is flexed and the foot is planted. These injuries are common amongst the athletic population, especially if the athlete is involved in a contact sport such as wrestling or football, or sports which involve a lot of running on a field, such as soccer or ultimate frisbee.

The damage can be caused by less forceful twisting movements in older people. As we age, the flexibility of the meniscus decreases. Also, most people have done a lot of activity over the years, and possibly have had previous injuries, especially people who were involved in rougher sports when they were younger. These factors can add up to cause a meniscus injury during an otherwise normal movement.

Symptoms

• Sudden onset of pain, which is often associated with “giving way” in the joint
• The knee joint will often lock when the leg is almost straight, and often the patient will try to wiggle the leg back and forth to unlock the knee
• Intermittent buckling and clicking of the knee for no apparent reason
• Chronic or intermittent swelling
• Walking with a bent knee because it is painful to straighten

If there is bruising and swelling with severe generalized pain within minutes of the injury, this often indicates there is also a tear of a ligament within the knee joint.

What You Should Do

Following a meniscal injury, it is important to try and control the swelling. An ice pack applied to the knee for 10 to 15 minutes will help to decrease the inflammation, and as a result, the pain and swelling will also decrease. It is also important to avoid the activities that aggravate or caused the injury. Try not to twist the knee or forcefully extend it.

How Physiotherapy Can Help

Meniscal injuries may or may not require surgical repair. In either case, consult a physiotherapist immediately. He or she will start by working to reduce the swelling, inflammation and pain in the knee. Once the inflammation in the knee has started to improve, the physiotherapist will give you exercises to increase the range of motion, strength and balance, or proprioception in your knee. It is important to go through full rehabilitation with a physiotherapist to return your knee to its pre-injury level of function.

Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome is a condition which causes pain on the outside of the knee during vigorous walking, hiking or running. The pain worsens as you continue to exercise and eases with rest. The pain can be sharp and stabbing or dull and aching.

The iliotibial band is a very thick tough band of tissue that starts at the outside of your hip, travels down the outside of the thigh, across the outside edge of the knee and attaches to the outside of the shin bone just below your knee. It also has some fibres, which attach to the outside of your kneecap. When the knee bends (flexion) and straightens (extension), the iliotibial band slides over the bony parts of the outside of the knee. In normal conditions, this sliding is smooth and painless.

If the iliotibial band becomes tight for some reason, a friction syndrome can develop. This means that the band no longer slides smoothly over the bony parts of the outside of the knee, but rubs and causes irritation, inflammation and pain. It is a well-recognized cause of knee pain in runners, so it is commonly called “runner’s knee,” although not only runners get it. The tightening can be caused by overtraining activities such as running, stair climbing, cycling or weight lifting involving deep knee bends.

If iliotibial band friction syndrome is allowed to go unchecked for a long time, the kneecap can become involved. This means that the fibres of the iliotibial band that attach to the knee cap tighten and actually start to pull the knee cap to the outside. This causes friction and pain under the knee cap because it no longer tracks smoothly in the groove of the thigh bone.

Some of the things that make it more likely you might experience iliotibial band friction syndrome are:

• Bowed legs
• Walking with turned in toes (“pigeon toed”)
• Inadequate stretching program
• Tight heel cords
• Heel and foot pronation (“fallen arches”)

If you think you are experiencing the pain of iliotibial band friction syndrome, you should consult a physiotherapist immediately. Your physiotherapist will advise you on a number of points, including:

• STOP training immediately, or alter training to include only exercises that do not cause pain
• If the symptoms were a result of running, you will be advised to avoid hills, shorten your stride and run on alternating sides of road
• Ice the sore area for 15 minutes at a time, up to 3 times per day. Do not put plastic directly on the skin, but wrap the ice pack in a moist towel to prevent frost bite
• Stretches to lengthen the iliotibial band and loosen the knee cap
• Treatment to decrease inflammation and promote healing of the sore area
• Your physiotherapist may use taping techniques to inhibit the strength of the iliotibial band
• Exercises to improve muscle strength, joint alignment and balance (proprioception) in the hip, knee and ankle
• As you improve, your physiotherapist will advise you on a slow, pain free return to your full activities

If it is appropriate, you may be advised to purchase orthotics, which are custom-made inserts for your shoes to help correct problems with your feet