Sports Injuries - Treatment

Ankle Sprains- how are they treated?

• Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) and Elevation for 48-72 hours. This is followed by a gentle graded return to activity.
• Physiotherapy is often helpful in regaining strength and balance in particular. The majority of ankle sprains, and even some of the severe sprains, do settle with time and Physiotherapy.
• Upon return to sport it can be useful to use an ankle brace for a short period to decrease the chance of re-injuring the ankle. These should only be used short term.
• If the ankle does not return to normal a few months after the injury then further investigation us necessary. Generally an MRI scan of the ankle is required but occasionally further information is required and stress X-rays or diagnostic ankle arthroscopy (keyhole surgery) can be needed.

Ankle cartilage injuries- how are they treated?

Once the diagnosis has been made treatment may be either non-operative or operative.

Non-operative treatment is unfortunately only appropriate for certain lesions that are picked up earlier and works best in very young patients. It involves immobilisation and strict non-weight bearing for several weeks. This is then followed by gradual progression of weight bearing and Physiotherapy to restore range of motion, strength and proprioception. The goal of non-operative treatment is to allow the injured cartilage and bone to heal.

Often surgery is required when symptoms fail to settle. The exact option depends on several factors including the size and exact location of the cartilage lesion, any associated cystic changes or ankle instability and the age, health and activity levels of the patient. Unfortunately larger lesions and those involving the edge or "shoulder" of the talus are associated with poorer outcomes.

Depending on the characteristics of the cartilage lesion surgery may done arthroscopically or thru a small incision. It is not possible to treat all lesions arthroscopically (keyhole surgery) but the majority can be treated this way. Surgical treatment includes debridement of the lesion removing injured and loose cartilage and bone. Depending on the lesions characteristics fixation of the fragment may be possible or it may be better suited to cartilage regeneration techniques such as micro fracture, drilling of the lesion or chondroplasty. Rarely it may even be necessary to bone graft the defect.

Shin splints- how are they treated?

Surgery is very rarely required and the steps below are generally very helpful-

• For those that are training too hard cut back for a week or two then gradually build back up.
• Try the RICE method: Rest, Ice, Compression (Tubigrip or similar support) Elevation. This is followed by a gentle graded return to activity.
• Physiotherapy.
• In shoe orthotics especially if you over pronate.

True shin splints tend to respond very well to standard non-operative measures. In the rarer causes of shin pain described above periods of strict rest or even surgery can be required.

Stress fractures- how are they treated?

It is important that a detailed training history is undertaken and that any extrinsic and intrinsic risk factors are appropriately identified and corrected where possible.

A period of rest, appropriate immobilization and a gradual return to training is generally all that is required. In complex cases and depending on the bone involved it may be necessary to investigate healing with repeat MRI scans or X-rays.

As symptoms improve cardiovascular fitness can generally be maintained while protecting the healing stress fracture thru swimming, aqua jogging / deep water running and cycling.

Fortunately surgery is only occasionally needed.