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The shoulder is the most common type of dislocation in the human body. They almost always result from a trauma and can cause significant damage to the shoulder joint.

What is a Shoulder Dislocation?

A shoulder dislocation occurs when the humerus (upper arm bone) slides out of place from it’s usual location (the glenoid or “cup side”) on the shoulder blade. For the injury to be considered a dislocation the head of the humerus must slide completely off of the glenoid. In some cases people suffer shoulder subluxations which is when the humerus only slides partially off of the glenoid. Do you need physiotherapy for your dislocated or injured shoulder? Call us at 416-526-6933 or book online!

Three Types of Dislocations

Shoulder dislocations come in three varieties and are named for the direction that the humerus bone goes when it slides out of joint.

Anterior Dislocations – These are the most common type of shoulder dislocations and usually result from an arm that is externally rotated (twisted outward) in an elevated position – think of the position that a pitchers arm is in on a baseball card. In some cases a person will suffer an anterior dislocation from a fall on an outstretched arm. 95% of all shoulder dislocations are anterior dislocations.

Posterior Dislocations – Occur when the humerus slides off the glenoid backwards. These injuries can occur from a fall or from the very strong and unbalanced muscle contraction that happens when a person has a seizure or is electrocuted.

Inferior Dislocations – Occur when the humerus slides off the glenoid in a downward direction. These occur from the arm being pulled in a downward direction and are the most rare type of shoulder dislocation.

Relocating (“Reducing”) a Shoulder Dislocation

Shoulder dislocations must be handled with care by a trained professional. We do not recommend trying to ‘put your shoulder back in’ yourself following a dislocation. Patients can easily sustain further injury if a shoulder is reduced incorrectly. The proper reduction technique involves coaxing the shoulder into the right position using very little force and trying to relax the muscles surrounding the shoulder to allow the humerus to settle back into its proper position.

Injuries That Result From Shoulder Dislocations

Several structures can become injured when a shoulder is dislocated. We will go over the most common ones below;

Labral Tear – the cartilage structure that lines the glenoid (cup) of the shoulder is often damaged by the dislocation.

Bankart Lesion – this is an avulsion of an anterior portion of the bone of the glenoid that occurs as the humerus breaks free of the glenoid.

Hill-Sachs Lesions – this is an injury to the posterior aspect of the humerus bone that occurs from the forceful collision between the glenoid and the head of the humerus directly following an anterior dislocation.

Rotator Cuff Tears – tearing of the tendons that make up the rotator cuff is common as they are stretched forcefully during a dislocation.

Nerve Injuries – The nerves that go into your arm pass through the shoulder and can be damaged as a result of a shoulder dislocation. This is an uncommon but serious side effect. If you suffer a dislocation and you are experiencing a great deal of numbness, tingling and muscle weakness after the shoulder has been reduced, it may indicate some trauma to the nerves.

Do Shoulder Dislocations Need Surgery?

Most first-time shoulder dislocations do not require surgery. They will be able to rehabilitate the joint to regain full function with a well structured physiotherapy plan. However some patients may require a surgical consultation in more severe cases. If the patient experiences recurrent dislocations despite a good physiotherapy plan and those dislocations are occurring with less force each time it is an indication that the shoulder is unstable and may need a surgical procedure to tighten up the joint. A very large rotator cuff that is limiting arm function may also be a reason that a patient would undergo surgery following a dislocation. It is important to note that physiotherapy is the first line of defence in shoulder dislocations.

I Have Dislocated My Shoulder What Should I Do?

After your shoulder has been put back in place (this usually either happens spontaneously or in the emergency room guided by a physician) you will need a plan to get that shoulder back in top shape. Make an appointment to see an experienced physiotherapist as soon as possible to begin your rehab plan. After a dislocation, a shoulder that is left alone can become stiff or ‘frozen’ making it difficult to regain function, and a shoulder that is used too aggressively following dislocation is at risk of being left unstable and resulting in recurrent dislocations. So get that Physiotherapist on board as soon as possible. They are experts at returning patients to normal function after an injury of this type.

In the meantime, follow these tips to ensure the best possible outcome:

  • Gentle movement is a good thing – very gently moving your shoulder through a partial range of motion with little or no force will help to ensure your joint does not become stiff.
  • Ice the shoulder in the first few days to reduce pain and swelling. 2 or 3, 20-minute sessions with 30 min. In between several times per day will be sufficient.
  • If you have numbness, tingling, weakness – go back to see the orthopaedic doctor.
  • Support your arm. When seated have your arm supported by a sling or the armrest of a chair.
  • Use a sling during the day until you see your physiotherapist who will assess the stability of the joint and thus whether or not you need to continue to use the sling.
  • Stop sporting or other high-risk activity (gym workouts or other lifting). It may go without saying, but another fall or trauma to your shoulder at this time would be very bad.
  • Remember that the vast majority of people will do very well if they follow their physiotherapy plan following a shoulder dislocation. Follow the tips above and get that plan started as soon as possible.

Do you need physiotherapy for your dislocated or injured shoulder? Call us at 416-526-6933 or book online!

The post A Patient’s Guide to Shoulder Dislocation appeared first on Therapia :: At Home Physiotherapy.

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Vancouver is a big city with plenty of options to access physiotherapy care. When you are injured it is important to make sure you are getting the BEST care for you. Sometimes too much choice can be a problem. Physiotherapy is not only critical to your recovery, it is also an investment of time, energy and money. Follow these tips to help ensure you make the best choice possible.

1. Look for a “Physiotherapy First” organization.

When you need your car fixed…you do not go to a guy at the back of your bike shop. You should not treat your body any differently. Look for an organization with the primary  focus of delivering the best possible physiotherapy experience for you. This will ensure that they have the appropriate equipment, expertise and administrative processes to make your life easier.

2. Match Your Physiotherapists Expertise to your Problem.

Just as you want the company you choose to be focused on Physiotherapy, you want the Physiotherapist that you are matched with to have specific expertise treating the problem you are suffering from. If you get the impression you are simply getting the therapist with the earliest available assessment slot, you may want to reconsider. An organization with a large roster of therapist, and who interview you to understand the reason you are seeking help, will be able to find you the best person in their organization to help you.

3. Will you be treated by Your Physiotherapist Every Time?

Some organizations will have assistants that deliver care on behalf of the Physiotherapist while the therapists simply supervise and check in periodically. Choose an option that allows you to spend all of your time receiving treatment directly from your physiotherapist.

4. Convenience is Important

Vancouver is a busy place. We have all experienced what it is like to try to cross a bridge at the wrong time, or find a good parking spot in Kits. Following through on a physiotherapy treatment plan requires multiple appointments over time. If the service you choose is inconvenient for you it will be a barrier to your success. At Therapia we understand how difficult it is to work these appointments into an already busy life. That is why all of our physiotherapists come to you! Patients find it much easier to complete the plan and follow home exercise instructions when they are delivered in the comfort of their own home.

 

5. The Best Customer Service

When you call to discuss your problem, evaluate the level of customer service that the administrators are providing. Do they take plenty of time to answer your questions? Do they provide all of the information you need without having to ask for every little thing? You will have a relationship with this organization for long enough that great customer service will have an impact.

 

6. Make sure they are a “Registered Physiotherapist”

Some clinics may claim to provide physiotherapy but not have registered physiotherapists that work with them. Make sure you ask if the therapist is registered and in good standing with the provincial college. Only a Physiotherapist can provide physiotherapy.

Making the best choice is just the beginning of your Physiotherapy journey, but it is a crucial step that should not be taken lightly. If you consider the ‘insider tips’ above you will surely start off on the right foot.

The post 6 Tips on Finding the Best Physiotherapist for you in Vancouver. appeared first on Therapia :: At Home Physiotherapy.

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Physiotherapy after hip arthroscopy for femoroacetabular impingement (FAI or hip impingement) is something that many patients and physiotherapists do not have familiarity with. If you are undergoing this procedure, here are several pearls that will help you progress smoothly and achieve your rehab milestones while also minimizing the risks of any flare-ups or complications.

  1. In the first 2 weeks, the main goal is to protect the hip joint and avoid irritation. In particular, it’s important to avoid hip flexor tendonitis, muscular irritation, and anterior capsular pain/pinching. A few tactics to do so include:
    • Assisting the operative leg by a family member or using the nonoperative limb, avoiding sitting for more than 30 minutes and lying prone for 2-3 hours a day.
    • Avoiding hip flexion more than 90 degrees, internal/external rotation more than 20 degrees, and preventing more than zero degrees prone hip extension for the first 3 weeks
    • Riding a stationary bike with a high seat and low resistance can be started in the first week for 20 min/day.
    • Performing Isometric exercises involving quad sets, gluteal sets, and supine transverse abdominis activation on the first postoperative day
    • Avoid pushing through pain.
  2. Crutches should be used for protected weight bearing for 4-6 weeks
  3. From weeks 2-9, the main goal is to develop a normal gait pattern (i.e. non-compensatory gait and progression)
    • In order to do this, it is important to get normal hip motion, particularly in hip extension
    • Without normal hip extension, it will be difficult to get a normal gait
    • In this phase, working on proximal/core (trunk, lumber, pelvic) motor control and stability is also very important to help develop a normal gait
    • The most challenging part during this timeline is getting off crutches. It is important not to force the timeline. Patients should wean off crutches until they can ambulate without pain using a normal gait pattern
  4. After week 9, assuming the goals of the prior timelines have been met, the aim is to return patients to the pre-injury level
    • This part of the rehab is more individualized. If patient demands are higher, rehab will take longer.
    • Closed chain exercise progression in the form of squats, lunges and rotational movements can be initiated.
    • Treadmill walking often beings around 3 months after surgery and sports specific/functional training can begin
  5. After week 14, the main goal is to return to sports. Introducing exercise for power, skill endurance and agility occurs in this phase. Running is permitted after approximately five months
  6. After six months, patients are usually cleared to go back to full activity

The above phases and timelines are general guidelines. Individual surgeons may have various modifications to the rehab protocol which in turn is determined by the exact operative procedure. Fr example, if a microfracture of the hip is also performed, than protected weight bearing with crutches is often extended to 6 weeks. Furthermore, it is important to look for any flare-ups during the rehab process. If this happens, the key is to shut down activity and rest for at least 24 hours. Another red flag is to progress too quickly in the rehab timelines without achieving a normal gait pattern. This can cause muscular overactivity and subsequent pain and/or inflammation. Pro-actively discussing triggers and aggravating factors with your physiotherapist (e.g. sitting too long, actively lifting the surgical leg too early in the postoperative period, early weight-bearing, sleeping position, etc) will help you stay out of trouble and navigate a smooth recovery process.

The post Physiotherapy After Hip Impingement Surgery appeared first on Therapia :: At Home Physiotherapy.

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Sciatica is brutal. It is one of the most common conditions that we see as Physiotherapists and it has the potential to cause pain that will stop you in your tracks. The good news is that Sciatica is not dangerous and does not generally lead to any serious or life-threatening pathology. But that does not mean that it can not do a fair bit of damage to your life, making it impossible to move around or do your job effectively.

Physiotherapy is the first line of defence for treating and ultimately eliminating sciatica. If you are suffering from this condition, find yourself an experienced orthopaedic physiotherapist as soon as possible. Below are some of the ways that they will help to eliminate your leg pain.

What is sciatica exactly?

Sciatica is not really a specific diagnosis. Rather it is a commonly used term for a number of conditions that can cause nerve pain in your leg, or legs arising from your low back. This nerve pain can come from a herniated or bulging lumbar disc, a section of your back that moves too much (spondylolisthesis) or degenerative changes that have occurred in your spine (spondylolysis or arthritis). One or more of these conditions can create a scenario where a nerve root can become compressed where it exits your lumbar spine. This can create pain, numbness, tingling. The lumbar spine injury may also create a local inflammatory response further sensitizing the nerve root and making things even more painful.

Ways Physiotherapy can Eliminate Sciatica Eliminate Spinal Stiffness

For many people their sciatica comes with injuries to the lumbar discs. In this case the range of motion of their spine will be limited. Often these patients find it difficult to stand up straight after sitting for prolonged periods of time. An experienced Physiotherapist can use hands-on manual therapy and a specific set of exercises to help restore motion in your spine. This is a necessary step for your leg pain to resolve.  

Improve Core Strength

Some patients develop low back injuries that result in sciatica because they do not have the muscular strength to properly support their spine when lifting or doing other active things.  These patients often feel low back pressure and/or leg pain after standing or walking for prolonged periods. Your Physiotherapist can target the muscles that support the spine to develop strength and ensure that it is not undergoing excessive stress while you bend, lift or even walk around.  

Learn to Lift Properly

Poor lifting mechanics are one of the primary ways that people injure their back, triggering an episode of sciatica. When you have sciatica it quickly becomes obvious just how often you need to bend and lift objects. Your Physiotherapist can teach you to lift properly. This will not only protect your back from further injury, it will also help to strengthen those important hip and core muscles we were talking about earlier. 

Get Your Nerves Moving

Often the injuries that lead to sciatica cause the nerves that travel down your leg to become immobile. When nerves have reduced mobility they undergo excess traction (pulling) causing them to become more sensitive and making you experience more pain. A Physiotherapist can help by providing manual therapy techniques and exercises that restore normal mobility in the nerves. 

Reduce Nerve Pain

Often the sciatica pain is just too much for people to begin doing some of the exercises that they need to do to improve. IN this case your Physiotherapist may use some pain relieving modalities like acupuncture or manual therapy techniques like manual traction to reduce the pain so that you can get moving in a way that will benefit your condition.

Change Your Habits

There is a lot less sciatica in the underdeveloped world. The reason for this is that people in these countries are more likely to be spending their time doing physical tasks rather than sitting and staring at a computer screen all day. All that time in front of the computer takes its toll on the discs of your low back, but it also leads to muscular weakness. Your Physiotherapist will show you have to set up a workstation to promote good posture reducing pressure in the discs of your low back. They will also ask you to use a correct back support and show you exactly where to put it when you are sitting. Lastly they may recommend that you set an alarm to get up and walk or stretch regularly or look into getting a sit/stand workstation. Your Physio may also teach you a short stretching routine that you can use before you do any heavy lifting that will help to reduce the likelihood that you will aggravate your sciatica or cause any new injuries to your low back.

There is no question that sciatica can have a profound impact on your quality of life. If you want to eliminate this condition, get yourself an appointment with a Physiotherapist and get it treated. Use this article to ensure you are doing everything possible and you will be on the mend in no time. 

The post How Physiotherapy Can Eliminate Sciatica appeared first on Therapia :: At Home Physiotherapy.

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Vancouver is a big city with plenty of options to access physiotherapy care. When you are injured it is important to make sure you are getting the BEST care for you. Sometimes too much choice can be a problem. Physiotherapy is not only critical to your recovery, it is also an investment of time, energy and money. Follow these tips to help ensure you make the best choice possible.

1. Look for a “Physiotherapy First” organization.

When you need your car fixed…you do not go to a guy at the back of your bike shop. You should not treat your body any differently. Look for an organization with the primary  focus of delivering the best possible physiotherapy experience for you. This will ensure that they have the appropriate equipment, expertise and administrative processes to make your life easier.

2. Match Your Physiotherapists Expertise to your Problem.

Just as you want the company you choose to be focused on Physiotherapy, you want the Physiotherapist that you are matched with to have specific expertise treating the problem you are suffering from. If you get the impression you are simply getting the therapist with the earliest available assessment slot, you may want to reconsider. An organization with a large roster of therapist, and who interview you to understand the reason you are seeking help, will be able to find you the best person in their organization to help you.

3. Will you be treated by Your Physiotherapist Every Time?

Some organizations will have assistants that deliver care on behalf of the Physiotherapist while the therapists simply supervise and check in periodically. Choose an option that allows you to spend all of your time receiving treatment directly from your physiotherapist.

4. Convenience is Important

Vancouver is a busy place. We have all experienced what it is like to try to cross a bridge at the wrong time, or find a good parking spot in Kits. Following through on a physiotherapy treatment plan requires multiple appointments over time. If the service you choose is inconvenient for you it will be a barrier to your success. At Therapia we understand how difficult it is to work these appointments into an already busy life. That is why all of our physiotherapists come to you! Patients find it much easier to complete the plan and follow home exercise instructions when they are delivered in the comfort of their own home.

5. The Best Customer Service

When you call to discuss your problem, evaluate the level of customer service that the administrators are providing. Do they take plenty of time to answer your questions? Do they provide all of the information you need without having to ask for every little thing? You will have a relationship with this organization for long enough that great customer service will have an impact.

6. Make sure they are a “Registered Physiotherapist”

Some clinics may claim to provide physiotherapy but not have registered physiotherapists that work with them. Make sure you ask if the therapist is registered and in good standing with the provincial college. Only a Physiotherapist can provide physiotherapy.

Making the best choice is just the beginning of your Physiotherapy journey, but it is a crucial step that should not be taken lightly. If you consider the ‘insider tips’ above you will surely start off on the right foot.

The post 6 Tips on Finding the Best Physiotherapist for you in Vancouver. appeared first on Therapia :: At Home Physiotherapy.

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Physiotherapy after hip arthroscopy for femoroacetabular impingement (FAI or hip impingement) is something that many patients and physiotherapists do not have familiarity with. If you are undergoing this procedure, here are several pearls that will help you progress smoothly and achieve your rehab milestones while also minimizing the risks of any flare-ups or complications.

  1. In the first 2 weeks, the main goal is to protect the hip joint and avoid irritation. In particular, it’s important to avoid hip flexor tendonitis, muscular irritation, and anterior capsular pain/pinching. A few tactics to do so include:
    • Assisting the operative leg by a family member or using the nonoperative limb, avoiding sitting for more than 30 minutes and lying prone for 2-3 hours a day.
    • Avoiding hip flexion more than 90 degrees, internal/external rotation more than 20 degrees, and preventing more than zero degrees prone hip extension for the first 3 weeks
    • Riding a stationary bike with a high seat and low resistance can be started in the first week for 20 min/day.
    • Performing Isometric exercises involving quad sets, gluteal sets, and supine transverse abdominis activation on the first postoperative day
    • Avoid pushing through pain.
  2. Crutches should be used for protected weight bearing for 4-6 weeks
  3. From weeks 2-9, the main goal is to develop a normal gait pattern (i.e. non-compensatory gait and progression)
    • In order to do this, it is important to get normal hip motion, particularly in hip extension
    • Without normal hip extension, it will be difficult to get a normal gait
    • In this phase, working on proximal/core (trunk, lumber, pelvic) motor control and stability is also very important to help develop a normal gait
    • The most challenging part during this timeline is getting off crutches. It is important not to force the timeline. Patients should wean off crutches until they can ambulate without pain using a normal gait pattern
  4. After week 9, assuming the goals of the prior timelines have been met, the aim is to return patients to the pre-injury level
    • This part of the rehab is more individualized. If patient demands are higher, rehab will take longer.
    • Closed chain exercise progression in the form of squats, lunges and rotational movements can be initiated.
    • Treadmill walking often beings around 3 months after surgery and sports specific/functional training can begin
  5. After week 14, the main goal is to return to sports. Introducing exercise for power, skill endurance and agility occurs in this phase. Running is permitted after approximately five months
  6. After six months, patients are usually cleared to go back to full activity

The above phases and timelines are general guidelines. Individual surgeons may have various modifications to the rehab protocol which in turn is determined by the exact operative procedure. Fr example, if a microfracture of the hip is also performed, than protected weight bearing with crutches is often extended to 6 weeks. Furthermore, it is important to look for any flare-ups during the rehab process. If this happens, the key is to shut down activity and rest for at least 24 hours. Another red flag is to progress too quickly in the rehab timelines without achieving a normal gait pattern. This can cause muscular overactivity and subsequent pain and/or inflammation. Pro-actively discussing triggers and aggravating factors with your physiotherapist (e.g. sitting too long, actively lifting the surgical leg too early in the postoperative period, early weight-bearing, sleeping position, etc) will help you stay out of trouble and navigate a smooth recovery process.

The post Physiotherapy After Hip Impingement Surgery appeared first on Therapia :: At Home Physiotherapy.

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Spring has sprung and with it comes the annual yard work marathons. For Physiotherapists, this is back pain season. Gardening is very physical work, and after a long and indoor winter, many people are ill-equipped for a rapid increase in physical labour.  If you are a “perennials only” sort of person or a serious gardener these tips will help you stave off back pain when you are exercising that green thumb.

1) Keep It Light

Don’t fill that wheelbarrow or bucket to the brim. Many lighter loads may take a little more time but the heavier loads are much more risky for those precious discs in your spine.

2) Vary Your Posture

Try not to do any single activity for more than 20-25 minutes at a time. If you have been bent down getting your hands dirty for 20 minutes, stand up move on to a standing task. Your spine will thank you for the variability, and you can always return to a task to finish it off later.

3) Take Breaks

There are no ribbons for fastest gardener. Take frequent 10 minute breaks to let your muscles recover. Lifting while tired leads to poor form and an inevitable call to the Physiotherapist.

4) Keep Things Close

Whether you are lifting a bag of topsoil or raking up some debris from the long winter. Keep loads close to your body. Holding a weight with outstretched arms is exponentially more challenging for your spine than holding it close to your chest.

5) Hydrate

Gardening is real exercise! So treat it that way. Make sure you have had a good breakfast, and you have water on hand to drink while you work.

TOP TIP – Stay fit all winter long with a program designed by an expert Therapia Physiotherapist. This way you are ready when the snow melts to hit that garden risk free!

Book a physiotherapist here or call us at 416-526-6933

The post April Flowers Bring May Back Pain: Tips to Avoiding Gardening Related Back Pain appeared first on Therapia :: At Home Physiotherapy.

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Composition writing does not really have to be challenging. There are sure conventions for composing openings. Meeting essays permit you to use individuals as your own resources in contrast to novels. Many of all, do not forget that training is as essential as composing the authentic essay. Do not wait to read the webpage and excerpt particulars you discover relevant. Within this portion of the guide, we are going to supply you with some hints for creating an outstanding reflective essay. It doesn’t involve also much study, because write my research paper for me reviews the crux of this form of article may be to write precisely what you feel about a particular subject or issue. This may frequently get one to the website of the journal where you could search to your own subject.

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The post Starbucks President No tolerance for union supporters that are traditional appeared first on Therapia :: At Home Physiotherapy.

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Intelligent studying means having the ability to study various matters differently and according for their own worth. This is crucial because you are needed to present your visitors what they truly deserve. After you begin reading the book, you select to find out more about the author. One of several topics overlooked within this short post is novels published by Black writers. His novel is incredibly interesting and is inclined to those who wish to enrich their writing if not start on creating, particularly fiction writing. You may discuss novels, creating, advertising and additional regions of interest linked to literature on the website’s discussion forum. E-books are not probably to replace novels possibly. State you browse a secondhand book store and pick to purchase a replica of the novel you’ve heard about and have not reached reading.

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It has happened to the best of us. Perhaps you stepped off a curb or came down from a rebound on the basketball court and you felt the piercing pain of an ankle sprain. You will spend the next few moments trying to determine how bad it is. It can be everything from a ‘walk it off’ scenario, or a trip to the emergency room, or worse the operating room.

So how do you know if you should head home and get out the old ice pack, or have a friend take you to the doc for an x-ray? Thankfully there are some well-researched guidelines on whether an ankle sprain should be x-rayed. Apply these guidelines and you might save yourself a lot of time waiting for an x-ray you did not need.

The guidelines are called the Ottawa Ankle Rules. You can see a schematic at the bottom of this post that outlines them nicely.

You will notice, pain alone does not mean you need an x-ray. But you must have pain in either the malleolar zone (the bumps on either side of your ankle where it meets the top edge of a running shoe), or the midfoot zone (the first ⅓ of your foot). If you have pain in either of these areas then you move on to the next questions.

Pain in the Malleolar Zone

If your pain is around the bumps on either side of your ankle you must ask yourself two questions.

  1. Could you bear weight on the ankle right after you sprained it?
  2. Is the back edge of either of your malleoli (A or B in the pic below) tender?

If your answer is YES to EITHER of these questions then you should get an x-ray. If it is no to both then you are very unlikely to have a fracture.

Pain in the Midfoot Zone

If your pain is on the flat part of your foot – near your leg (not out at your toes) you must ask yourself three questions.

  1. Could you weight bear after the sprain?
  2. Do you have tenderness on the base of your fifth metatarsal (C in the picture) or the navicular (D in the picture)

If your answer is YES to EITHER of these questions you should get an x-ray.

If none of these things are true, congratulations, get an ice pack and book an assessment with a physiotherapist.

The post Is My Sprained Ankle Broken? appeared first on Therapia :: At Home Physiotherapy.

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