Dr. Annabel Carter, sport and exercise medicine specialist, rotates the leg of patient Claire de Ste Croix in a piriformis stretch. *Photo by B. Candace Ray
Dr. Annabel Carter, sport and exercise medicine specialist, rotates the leg of patient Claire de Ste Croix in a piriformis stretch. *Photo by B. Candace Ray
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Picture this: you are out on the soccer pitch, or perhaps just taking a walk along the railway trail. A player comes at you from the side as you go for the ball, or perhaps a momentary distraction has you stepping awkwardly in a pothole on the trail; in both cases it takes but a heartbeat for your world to change for the worse.

The ankle unexpectedly rolls way over, beyond what seems humanly possible, and you find yourself unceremoniously sitting on the ground, your breath taken away by the sheer intensity of the pain.

It takes a few minutes before you gather yourself together and gingerly try a couple of steps on an ankle that is already visibly swollen. Maybe you limp to the Emergency and the staff there X-rays the ankle, telling you it’s “just a sprain” and send you on your way.

What now? If the injury is mild, with no significant tear or rupture of stabilizing ligaments, perhaps you’ll be just fine on your own, following the administration of what you’ve read in the books about R.I.C.E (rest/ice/compression/elevation) over the first few days and then getting going gradually from there.

Perhaps you’ll never even injure that ankle again. But you might not be so lucky. The injury may lead to further injuries down the road, more time out from a normal lifestyle, the ankle becoming more unstable with time and possibly even progressing to having secondary arthritis and potential permanent disability as a consequence.

This can have ramifications not only for your more vigorous sporting days, but also in the simple pleasures of jogging, walking and one day just plain getting about.

This is where physiotherapy steps in. At the very least you can think of your physiotherapist as a guide. Advising you firstly on fine-tuning the RICE, then guiding you through a rehabilitation programme with gradual and progressive exercises.  These typically centre on restoring normal joint and soft tissue range of motion, muscle strength and general stability.

Exercising too hard and too much can be detrimental to an effective injury recovery, yet not doing enough may be just as bad and set you up for future injury.

Depending on the type of injury, some people may benefit from treatment modalities, which include therapeutic ultrasound, laser and interferential therapies, as well as manual therapy.

Straightforward cases may only require one or two visits to the physiotherapist; the more complex and severe may take several weeks or even months to achieve optimal recovery.

The physiotherapist is also in an ideal position monitoring cases with time to judge when those patients who ultimately ‘fail’ physiotherapy may require further investigation or referral on for various other treatment options including injections or surgery.

A recent survey by the Football Association in the U.K. reported that more than half the injuries sustained in soccer were without contacting another player, i.e. during activities such as sprinting, landing, and slowing down.

Gender differences also prevail in that female soccer players are five times more likely than their male counterparts to rupture the main knee stabilizing ligament, the anterior cruciate ligament (ACL).

Recent evidence suggests that this is at least in part due to reduced leg stability and faulty knee alignment particularly in landing from jumps and while turning, which has implications across many sports. Again enter physiotherapy.

A good physiotherapy sports injury rehabilitation programme can help athletes and coaches to address the varying aspects of an injury when it occurs and aid in working out prevention strategies.

Initial focus is made on flexibility, mobility and strengthening where exercises progressively restore pre-injury conditions.

Programmes should be tailored to the individual, working on fitness through alternative training methods and minimizing performance and fitness loss without stressing the injury.

Poor training techniques are common causes of sports injuries and during rehabilitation, exercises can be performed to help correct faulty techniques performed prior to the injury (such as the faulty knee alignment alluded to above), thus working towards future injury prevention.

Some injuries, of course, can never be avoided; with or without the best physiotherapy rehabilitation there is on offer.

But at least having access to good physiotherapy services can offer one of the best ways possible of minimizing recovery time and getting us back out where we want to be, out there on the railway trail or on the field, enjoying what we want to do, and for as long as possible.