Ottawa ankle rules x-ray recommendation
- if there is bony tenderness on palpation of the posterior edge or tip of either the lateral or medial malleolus
- if they have the inability to weight bear
Treatment for grade I and II ligament sprains
- first aid
- EPAs, joint mobilizations, soft tissue
- muscle strengthening, proprioceptive training, functional training
Treatment for grade III ligament sprains
- first aid
- surgery or protective bracing
- muscle strengthening, proprioceptive training, functional training
What is the main cause of tendon problems?
OVERLOAD
How can we rehab tendon injuries?
- progressive loading
Main term for tendon overuse injury
- tendinopathy
Pathology of tendinopathy
- Stress shielded tendons
- Normal or excessive load and individual factors leads to…
- Reactive tendinopathy
What happens if we keep excessively loading reactive tendinopathy?
- degenerative tendinopathy
What happens if we keep apply appropriate modified load to reactive tendinopathy?
- return to normal tendon
- if we apply optimized load there can be adaptation and strengthening to prevent further injury
Early vs late stage tendinopathy
- early stage likely to return to normal, late stage unlikely
What are the two diff interventions typically used to treat tendinopathy?
- interventions targeting pain/structure (drugs, modalities)
- interventions targeting poor function and load capacity
Which intervention is more likely to return a reactive tendon back to normal?
- interventions targeting rehabbing load capacity
How can we treat patients who present with a degenerative portion of their tendon and a normal portion that drifts in and out of a reactive state?
- treat the donut, not the hole
- interventions should target rehabbing load capacity in normal portion
What is something to consider with tendinopathy?
- some people present with poor function, pain and pathology at the same time or just a combination of a 2 or just 1
- not everyone with a a tendon that SHOULD be rehabbed has pain and so we dont want to not care about load capacity just bc they dont have pain
Clinical presentation of patients with tendinopathy
- pain after exercise or morning after
- can be pain free at rest and initially more painful with use
- can disappear after warming up for exercise
- can train through pain
- local tenderness or thickening
- swelling and crepitus maybe
Why is loading a tendon important for rehab?
- blood supply is stimulated by activities that cause tension to the tendon
