Acute ankle sprains should be initially managed with the RICE (rest, ice, compression bandage, elevation) and an inability to weight bear indicates that an examination should be performed to consider the possibility of a fracture. Physiotherapy assessment can determine the type and extent of injury and whether any investigations are required. Rehabilitation is best commenced early and involves education about appropriate activity modification and addressing the loss of movement, weakness and balance deficits that develop as a result of ankle injury, enabling return to full activity as soon as possible.
Ankle pain can also develop without trauma and the key to successful management is correct diagnosis, identifying and then addressing the causative factors that lead to the development of the problem.
Foot pain should not be ignored, as it is a region that is prone to a variety of stress fractures. Some of these are straightforward, but others are more complex and require definitive treatment. Of course, there are also non-bony disorders that exist in the foot. The most common of these is plantar fasciitis, which causes heel pain particularly first thing in the morning, when moving after having sat down for a period of time and when standing, walking or running. Contrary to popular belief, the source of pain is not a “heel spur”, which may or may not be seen in patients with this disorder, but also in those with no history of heel pain.
The key to successful management of foot pain is to establish the reasons why the particular disorder has commenced and to then address these factors.
There are many causes of hip and groin pain, with joint, muscle and tendon disorders, bone stress/stress fractures and referred pain from lower back problems all potential sources. A thorough history and clinical examination are performed to determine the type of disorder and critically; why it may have developed, so that such factors may be addressed. Aberrant muscle function is very common in this region and when correctly identified and managed, can have a large impact on pain and disability. The increasing use of hip arthroscopy has meant that a number of conditions such as femoroacetabular impingement (FAI), labral and ligamentum teres tears can now be better managed. Hip replacement surgery is also highly successful in the treatment of advanced osteoarthritis and physiotherapy rehabilitation helps to ensure return to the highest level of function as quickly as possible.
Acute knee injuries can result in ligament, cartilage or patella (kneecap) disorders. Accurate diagnosis is important in order to determine whether a period of protection/activity modification is required or surgical treatment is necessary. Rehabilitation should commence as soon as possible and involves provision of pain relief, restoration of normal joint and muscle function and advice about what level and type of activity is appropriate for each stage of the recovery process.
Knee pain that occurs without acute injury requires identification of what structure(s) may be generating the symptoms, but more critical is to work out why they have become symptomatic so that the cause(s) of the problem may be addressed. There is strong evidence that physiotherapy intervention is effective for mild to moderate osteoarthritis of the knee, as well as for patellofemoral pain (kneecap disorders). We also manage pre and post-operative rehabilitation for knee replacement surgery which is performed for advanced osteoarthritis.
Not all shin pain is the same and generic terms like “shin splints” mean little more than where the pain is located. Shin pain can result from bone stress/stress fractures, compartment syndromes (escalating pain as pressure builds within the leg during exercise) and irritation of tendon attachments to the tibia (main bone of the lower leg). There are also other, albeit rarer causes of exercise induced shin pain. These different types of disorder behave in characteristic ways and should not all be treated in the same manner; rather the type(s) of problem causing the shin pain needs to be identified along with the reasons for why the problem has commenced in the first place so that the chance of recurrence can be minimised.