Prevention is Key with Recurrent Ankle Injuries

Key To Avoiding Ankle Re-Injury May Be In The Hips And Knees Suggests UGA Study

Nearly all active people suffer ankle sprains at some point in their lives, and a new University of Georgia study suggests that the different ways people move their hip and knee joints may influence the risk of re-injury.

In the past, sports medicine therapists prescribed strengthening and stretching exercises that targeted only ankle joints after a sprain. The study by UGA kinesiology researchers, published in the early online edition of the journal Clinical Biomechanics, suggests that movements at the knee and hip joints may play a role in ankle sprains as well.

"If you have ankle sprains, you may have a problem with the way you move, and we think we can change movement through rehabilitation," said Cathleen Brown, lead author of the study and assistant professor in the department of kinesiology in the College of Education.

Past studies on ankle sprains have shown that some people are able to return to sports or physical activities without a problem. Brown and her team, which includes associate professor Kathy J. Simpson, also in the kinesiology department, want to know why some recover completely.

"One theory for explaining those divergent paths is that a person comes up with good strategies to move, land, balance and not get re-injured," Brown said.

For the study, 88 participants were divided into three groups: an uninjured control group, active people who still experienced problems after an ankle sprain and "copers," or people who had been injured but no longer felt pain or weakness in their ankle. Participants dressed in an Avatar-like body suit that sent data to cameras and computers detailing the exact position of ankle, knee and hip joints. Each person stood 27.5 inches away from an in-ground metal platform and jumped to reach a target, then landed on one foot without assistance.

Of the three groups, the uninjured group bent their knees and swayed their hips side-to-side more often than either of the other groups. However, the "copers" also showed differences in those joint movements. The injured group with lingering ankle pain appeared unable to use their knee and hip joints as well when landing on the metal surface.

"Maybe the injured people don't use the same landing strategies, or their strategies aren't as effective," Brown said, adding that the study was a snapshot in time, not a long-term follow-up. By the time subjects were included in the research study, they have usually already injured themselves. "We don't know if they are this way because of the injury, or if they got this injury because they land this way."

The current study looked at the knees, hips and ankles in isolation, and the next step for the team will be to examine the joints in combination. If future studies allow the researchers to identify particular movement patterns as helpful, the research could be directly translated into new techniques for rehabilitation therapists and the public in general.

Brown said the current study builds on a similar study published in June 2011 that examined ankle injuries based on the amount of clearance between the foot and the ground. In that study, she found that participants with previous ankle injuries kept their feet closer to the ground, with their toes pointing downward, while running.

"I always try to encourage people who are having a lot of problems with their ankle to see a health care professional who would be able to help them," she said. "There are negative long-term consequences to ankle instability, such as ankle osteoarthritis, that may be preventable with treatment."

Article adapted by Medical News Today from original press release:
      University of Georgia. (2011, October 19). "Key To Avoiding Ankle Re-Injury May Be In The Hips And Knees Suggests UGA Study." Medical News Today. Retrieved fromhttp://www.medicalnewstoday.com/releases/236142.php.

Barefoot Shoes More Effective When Running Style Is Correct

Barefoot Shoes More Effective When Running Style Is Correct

Adopting the correct foot-to-ground strike style can help runners who suffer from chronic running injuries who are using barefoot-style shoes avoid additional risks. These are the findings of new research on Vibram FiveFingers, a sock-style shoe that simulates the effect of running barefoot while protecting the foot.

The American Council on Exercise (ACE), is the largest nonprofit fitness certification, education and training organization in the world and also America's leading authority on fitness. They announced the result of the research, by the University of Wisconsin, La Crosse, Exercise and Health Program, and led by Dr John Porcari, and Caitlin McCarthy, in a statement at the end of September.

The research is not published in a peer-reviewed journal, but you can download a copy of the report from the ACE website.ACE's Chief Science Officer, Dr Cedric X. Bryant, said:"We've seen an increasing number of individuals using barefoot-style running shoes, and felt it critical to examine this trend.""The bottom line is that runners must first and foremost modify their running style for ultimate safety and benefit, and this should be done gradually through regular practice. Once that is achieved, Vibram FiveFingers can be a safe and effective shoe for those who want to experience the feel of barefoot running," he explained.

Promoters of barefoot running say it is safer because it reduces the risk of injury compared to running in traditional shoes. They say this is because running shoes encourage runners to strike with their heels first, which causes more pounding and stress.

Running barefoot, conversely, encourages the foot to land near the ball, resulting in less pounding and less risk of injury. Vibram say their product helps runners achieve the safer forefoot-strike of barefoot running while avoiding the abrasion on the soles.

ACE asked the researchers to look into what happens when runners switch from traditional running shoes to minimalist shoes like Vibram FiveFingers, which they describe on their website as "a quirky-looking sock-style shoe with separate compartments for each toe".For the study, the researchers recruited 16 healthy, injury-free, female "recreational joggers", aged from 19 to 25.Before the evaluation, each jogger was fitted with a pair of Vibram FiveFingers Bikila which are designed for running.For two weeks before the test, to get used to their new shoes, the volunteers wore them when they went out running, for 20 minutes at a time, three times a week.After this two-week acclimatization, the researchers carried out lab evaluations of the volunteers' running style as they were invited to run on a on a 20m runway under three different conditions: (1) wearing the Vibrams; (2) wearing a pair of traditional running shoes; and running truly barefoot.

The researchers evaluated a 3-D motion analysis and took measures of ground-reaction forces as the runners completed seven trials for each of the three conditions. The order of the trials for the Vibrams and the running shoes was random, but the barefoot trial was always measured last.The results showed that:

· All the runners were rear-foot strikers when they ran in traditional shoes.
· Half of them switched to fore-foot strike when they ran in Vibrams or barefoot.
· The other half kept to the same rear-foot strike style through all of the conditions.
· Those who switched to fore-foot style, showed greater "plantar flexion" (pointing the foot away from the leg, as when you step on the gas pedal), which seemed to allow
better absorption of the forces of impact.
· Those who continued with rear-strike style when running in Vibrams or barefoot, had a higher rate of loading, and their loads were higher, than when they ran in
traditional shoes.
· When they ran in Vibrams or barefoot, all runners showed reduced knee flexion, which is usually linked to lower rates of injury.
· But, when runners wore Vibrams, they showed more pronation, similar to when running in regular shoes, which could increase the risks of injury in the lower limbs that
can come from overuse.

Porcari said the bottom line is:"Just because you put the Vibrams on your feet doesn't mean you'll automatically adopt the correct running stride."Pete McCall, an ACE exercise physiologist, who has been exercising (but not running) in Vibrams since mid-2009 said:"If you want to run in the Vibrams, you should be prepared to change your gait pattern."You need to give yourself time adapt to them, he added.Porcari agreed: "Running in Vibrams could be good for some if they adopt the appropriate running style."He advised people to get "explicit" instruction and spend time practising how to land on the ball of the foot, as opposed to the heel. Otherwise people could do themselves more harm than good:"Simply switching to Vibrams doesn't guarantee that a person is not going to experience more injuries," he cautioned.

Written by Catharine Paddock PhD
Copyright: Medical News Today

Joint Replacements and the Baby Boomer Generation: How Progressive Physical Therapy can help you!

Today in the U.S. our Baby Boomer generation is reaching an average age of 65.  With this comes the changes in lifestyles due to pain or limited mobility which ultimately will affect the ability to live independently.  Physical therapists are playing an ever important role in the lives of Baby Boomers as advocates as well as healthcare experts who hold the unique skill of helping to promote and maintain mobility and independence. 

Thanks to many medical advances in joint replacement procedures there are numerous options available to people who may be living with chronic joint pain/stiffness.  Physical therapists play a vital role in the overall outcome and success of joint replacement patients.  The actual joint replacement procedure is only the first step.  Physical therapy is ultimately what will determine the success of the procedure.

Boomers are expected to need rehab after hip and knee replacements in record numbers, according to a study in The Journal of Bone and Joint Surgery. By 2015, the demand for total knee arthroplasties is expected to double over 2005 levels, according to the study. The demand for hip revision procedures is projected to double by the year 2026.

Those numbers are slated to rise further as baby boomers continue to age. By 2030, boomers are expected to have 3.48 million total knee replacements (up 673% over today’s levels) and 572,000 total hip replacements (up 174%).

In addition to larger health needs, this generation is known for its independence. “In general terms, this generation is highly educated, has a desire to be in control, and wants to maintain their activity level,” she said. “These characteristics are sometimes difficult to reconcile with the trends we are seeing in inactivity and chronic disease, however I do think we will be dealing with a generation that has great access to information, wants the best provider, will be demanding, and will expect to get the best quality for the best price.” (Alice Bell, PT, GCS, director of physical therapy clinical services at Genesis Rehabilitation Services in Kennett Square, Pa.)

Physical therapists play an important role to all patients requiring therapy for post-surgical procedures and it is imperitive they stay up-to-date on the ever changing world of insurance and Medicare.

You can rest assured that the physical therapists at Progressive Physical Therapy stay current on the rapidly changing healthcare environment to bring you the best outpatient physical therapy care possible.  Our therapists are members of the APTA (American Physical Therapy Association) and read the national publications and journals regularly. 

Call today if you or someone you know is planning a joint replacement in the near future.  We will give you a tour and explain what therapy will entail once you are cleared for therapy from your surgeon.

Please also read the article on the following link: (this article was referenced in this post)
http://news.todayinpt.com/article/20110606/TODAYINPT0105/110603005