Vernon is the perfect place to live for the active person who loves participating in outdoor activities! The close proximity of the mountains and the water allows for easy access to so many sports. Snowboarding, skiing, mountain biking and running to swimming, kayaking and paddle boarding in the water are just a few great options to choose from. Even though the fun factor is large, there is also present the risk of injury. Working as a physiotherapist in Vernon allows me to see many activity related injuries and I definitely see more of some than others. This article showcases the six most common injuries I see practicing physiotherapy.
ANKLE SPRAINS
More specifically, I see lateral ankle sprains; spraining the anterior talofibular ligament (ATFL). This ligament lives on the outside of your ankle. Trail runners and hikers who either lose their footing or go sideways with their ankle over a rock are the ones to suffer this particular injury. Once out of the actute stage and ready for active rehab, there are a few things to highlight.
You want to train:
Proprioception
This is the ability of the body, and the ankle joint in particular in this case, to know where it is in space at any given time. Knowing this allows your body to adapt to changing weight shifting when changing the position of your body.
Use:
- balance boards
- bosu
- single leg balancing
- stepping/hopping over cones
Strengthen further up the chain
The buttock muscles (gluteus maximus) will inevitably atrophy following an ankle sprain so this muscle is important to strengthen. Exercises such as squats, lunges, various forms of bridges, single leg press on hands and knees are to name just a few. Do exercises both in weight bearing and non weight bearing. The hip muscles such as the gluteus medius are notoriously weak on most people and will weaken even further following an ankle sprain. Exercises such as side lying leg raises, lateral steps with theraband around knees and sideways single leg squats with a ball against a wall will target these muscles.
Foot intrinsic muscles
These little muscles around the foot and ankle are like your central core muscles that everyone is trying to strengthen. The foot muscles are equally important as they aid in stability around the ankle. Exercises such as doming (being able to lift the inside arch of your foot up without bending the toes), foot mobility using a theraband through dorsiflexion and plantar flexion, eversion and inversion and calf raises keeping weight through the big toe are a few that will help keep these muscles engaged.
DISTAL RADIUS FRACTURE
This happens most often from falling on your hands when your arm is straight which occurs in sports such as snowboarding, skateboarding and extreme mountain biking. The radius is the bone that lays on the thumb side of your forearm. The fracture happens most often about an inch up from the wrist. Although there are many different types of fractures treated in different ways, I see the type more often that does not require surgery. The bone will be realigned and the arm will be immobilized for around 6 weeks.
Physio can begin at this point to help regain movement and strength. An important point to remember is that it is not only necessary to strengthen the hand, wrist and fingers, but pay attention to the shoulder muscles as well. These will atrophy and will need to be strengthened. Exercises involving movements which take your arms out in front of you, out to the side, behind you and above your shoulders should be included. If you are a skateboarder, it is important to learn how to fall well. Most of us automatically put our hands out in front to catch ourselves from falling, but this is also the #1 way to break your wrists, Instead, work on learning to roll to land on your shoulder or side keeping your elbows tucked in. If you are skateboarding on ramps, practice by falling onto your knees (wearing your kneepads) and then sliding down the ramp without using your hands.
SKIERS THUMB
As the name implies, skiers are the people who are most likely to experience this injury. This happens when a skier falls and does not release their ski pole from their hand. The thumb then suffers a stress from being both abducted and radially deviated (bent backwards) and a force is applied across the MCP joint (base of thumb) damaging the UCL (ulnar collateral ligament). Using either a smaller ski pole or poles without saber handles or platforms may decrease the risk for this injury to occur. Generally, there is tenderness at the base of the thumb and over the MCP joint and more specifically over the UCL. There may be swelling and bruising as well. Treatment consists of immobilizing the wrist and using a thumb brace for a few weeks.
Physio can begin to help regain any lost movement and strength. Even though the injury is in the thumb, it is important to take into consideration the whole upper limb during treatment. Due to the lack of use this hand will have experienced, there will be muscle atrophy through the upper arm and shoulder muscles as well. Muscle groups that need to be strengthened are biceps, triceps, deltoids, lats, traps,ect. All of these exercises can be done at the gym or at home using therabands or weights.
MCL INJURIES
A common injury in skiers, both on the snow and on the water, is where one ski may stay straight, but the other deviates out to the side. This results in a valgus stress (stress to the inside) of the knee. I see grade I and II medial collateral ligament (MCL) sprains most commonly, where once out of the acute stage, gentle exercise can begin, Although some injuries are unavoidable, making sure that all the proper muscles groups are working as efficiently as possible can only help. Keeping the adductor (inner thigh) muscles strong to help keep the skis in line. Positioning the femur bone properly by strengthening the gluteus medius and maximus muscles will help with tracking from the top of the hip down to the kneecap. Standing well through your feet so they aren’t tending to roll inwards by keeping the calves stretched and the peroneals (muscles on the ouside of the lower leg) strong. Staying out of knee hyper-extension by keeping your quads strong and always keeping your central core strong so you are able to handle different stresses to your body like change in speed, direction, waves and moguls.
SACRAL FRACTURE
In addition to the many post natal women I have seen with fractures to their tailbones, I also see the snowboarders and skateboarders who have suffered this injury. The sacrum, a triangular shaped bone sitting between either side of your pelvic bones moves in multiple directions. A tailbone fracture may cause bruising through the buttock region with swelling and pain over the tailbone. Initially, ice and an inflatable pillow (the donut) that takes the weight off your sacrum are the best choices. Pain will be very acute during bowel movements so make sure you don’t become constipated (possibly from pain medication) by taking in enough fibre and drinking enough water. Like all bones that experience a fracture, the tailbone must be mobilized to ensure full movement returns. If this isn’t part of the treatment, the SIJ (sacroiliac joint) or lumbar spine segments will have to move more to make up for the lack of movement in the sacrum. This will only lead to more imbalances as time goes on. Once the tailbone is aligned, core work is important to add to the exercise program to keep it there. Before returning to the mountains, check into the available options for a sacral pad or padded clothing to help protect your tailbone.
ROTATOR CUFF STRAINS
Injuries to the shoulder region are common and include clavicle fractures, acromioclavicular joint dislocations, proximal humeral fractures, shoulder dislocations and many others. One injury in particular I see often as a North Shore physio is a strain to the rotator cuff muscles. This happens often from either flying over the handlebars of a mountain bike or falling incorrectly during a paintball game. The rotator cuff is made up of 4 muscles; supraspinatus, subscapularis, infraspinatus and teres minor. The most common muscle to tear is the supraspinatus. Landing on the outside of a shoulder may tear the tendon off where it inserts. Sometimes there may be a significant tear that needs arthroscopic surgery but other times conservative therapy may be all that is needed. Symptoms of pain, bruising and swelling can be managed with ice packs and physiotherapy modalities. Manual therapy involving glenohumeral (top of the arm joint), scapular and clavicle (collar bone) joint mobilizations as well as gentle pectoral and latissimus muscle stretching will help increase the ability of the arm to move through its full range of motion. Standard rotator cuff strengthening and stability exercises are encouraged early on. During the time that the shoulder is not being used normally, other areas may begin to feel weak or achey due either to lack of movement or too much movement. Making sure the neck can move freely and the forearm and hand muscles are strengthened will ensure a positive outcome when rehabilitating the shoulder.