Physio Edge podcast

Ankle syndesmosis injuries following forced ankle dorsiflexion and lateral rotation of the foot require very specific management and rehabilitation to achieve great treatment outcomes. If you approach management of ankle syndesmosis injuries in the same manner as a lateral ankle ligament injury it will likely result in long term pain and dysfunction for your patients.

In the previous episode of the Physio Edge podcast - How to assess ankle syndesmosis injuriesChris Morgan and David Pope explored how to assess and diagnose ankle syndesmosis injuries (ASI).

In this new Physio Edge podcast - "How to treat ankle syndesmosis injuries with Chris Morgan (Arsenal 1st Team Physiotherapist in the English Premier League), you will discover how to manage different grades of ASI, including:

Grade 1 syndesmosis injury management

  • Initial injury management
  • How long should you immobilise a Grade 1 injury for?
  • What weight bearing should be allowed in the initial stages?
  • Taping techniques that can be utilised during return to running, training and play
    • Rehab - initial exercises and progressions
  • How much pain is acceptable during return to training?
  • Return to sport timeframes & how you and your athlete can decide when RTP is appropriate
  • When can contact be initiated?

Grade 2 syndesmosis injuries

  • Grade 2 injury management and immobilisation
  • Which players are likely to require arthroscopy to confirm instability, and subsequent stabilisation surgery?
  • Why rehabilitation of stable grade 2 injuries is different from grade 1 injuries
  • Which movements you need to restrict
  • How to maintain lower limb musculature and minimise muscle atrophy should be performed
  • Additional general conditioning your patient should perform during the early phase of rehab
  • How to incorporate an Alter G treadmill into rehab
  • Occlusion training for lower limb conditioning
  • How to modify rehab if you do not have access to an Alter G
  • Timeframes and criteria to assess when your patient can remove their immobilisation boot
  • Tests to perform at each stage of rehab
  • When and how should dorsiflexion range be improved?
  • Timeframes and criteria to meet prior to return to running
  • Exercise progressions and variations
  • Return to play markers and tests you can use
  • What to do when a player still reports a ‘nipping’ at the front of the ankle after 6 weeks and is having difficultly achieving full dorsiflexion

Unstable injuries - Grades 2b, 3 and 4

  • Management of unstable injuries
  • Post-surgical immobilisation and management
  • Common return to play timeframes

Click here to download your podcast handout

To accurately grade your patients ASI and prescribe the most appropriate rehab I strongly recommend listening to Physio Edge podcast episode 80 – How to assess ankle syndesmosis injuries with Chris Morgan prior to this podcast

CLICK HERE to register for the free webinar - Medial knee injuries with Chris Morgan

Medial knee injuries often occur in snow sports, or other sports when landing or being tackled. Different areas of the medial knee can be injured, including the deep, superficial, proximal or distal fibres of the MCL and medial knee. Depending on the injured structures, patients will either cope with a more aggressive treatment approach and early return to sport, or require a more conservative approach. How can you know the rehab approach your individual patient requires?

In this free webinar with Chris Morgan (1st Team Physiotherapist with Arsenal FC), you will explore:

  • Applied anatomy of the medial knee
  • Mechanism of injury, presentation and diagnosis of medial knee injuries
  • How you can differentiate between deep, superficial, proximal, distal and Grade 1, 2 and 3 clinical injuries
  • How imaging findings correlate with your clinical findings
  • MRI grading (radiological versus clinical)
  • How you can perform an objective assessment
  • How function, pain and instability impact your treatment
  • Accelerated vs more conservative treatment - how can you choose the ideal approach for your patient?
  • Are PRP injections appropriate?
  • Rehabilitation principles you can use with your medial knee injury patients
  • Ligament loading
  • Which bracing and weight bearing regime should you utilise?
  • What should you do when your patient has joint laxity?
  • Is pain during rehab acceptable?
  • Should you overload OR "under load to overcome"?

You can CLICK HERE to access this free webinar

Articles associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_081_How_to_treat_ankle_syndesmosis_injuries_with_Chris_Morgan.mp3
Category:general -- posted at: 12:15pm AEST

Ankle syndesmosis injuries, also known as a high ankle sprain, commonly occur during high impact tackles or collisions that involve forced lateral rotation of the foot in ankle dorsiflexion. Syndesmosis injuries can be missed in the early stages as the degree of pain and swelling may not reflect the severity of the injury. Early diagnosis of syndesmosis injuries is key in preventing persistent pain, disability and limited ability to return to play or activity.

In Physio Edge podcast episode 80, English Premier League Physiotherapist Chris Morgan, and David Pope explore how to assess and diagnose ankle syndesmosis injuries (ASI), including:

  • Questions you need to ask when your patient has had an ankle injury
  • What is an ASI?
  • What symptoms will your patient report following ASI?
  • Ligaments and structures that are often involved in an ASI
  • What is a "peeling injury", and how does this influence the structures that are injured?
  • Common mechanism of injury
  • How to assess, diagnose, classify and grade ASI
  • How to differentiate between stable and unstable ASI
  • Which tests can you perform to accurately diagnose ASI?
  • Differential diagnosis
  • Which injuries are likely to require surgical intervention, and which injuries may be managed conservatively?
  • When imaging is useful
  • What type of imaging to perform
  • Identifying underlying chondral lesions
  • Early management strategies

CLICK HERE to download your podcast handout

Upcoming podcast - How to treat ankle syndesmosis injuries with Chris Morgan

A subsequent podcast with Chris Morgan will discuss in detail how to treat ankle syndesmosis injuries . Download this podcast now to improve your assessment and diagnosis of ankle syndesmosis injuries.

Free webinar - Medial knee injuries with Chris Morgan

Chris Morgan's Physiotherapy roles in English Premier League with Liverpool and Crystal Palace have provided him with a lot of experience treating acute injuries, including the ankle and knee. To help you take advantage of this experience, Chris is presenting a Clinical Edge webinar on medial knee injuries. In his webinar Chris will discuss:

• Presentation of medial knee injuries
• How imaging findings correlate with clinical findings
• How to progress your rehabilitation and return players to performance
• Incorporating change of direction and trunk control into rehabilitation

You can CLICK HERE to access this free webinar

Articles associated with this episode:

Morgan et al. 2014. Conservative management of syndesmosis injuries in elite football

Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, Fischer DA. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot & ankle international. 2012 May;33(5):371-8.

Sman AD, Hiller CE, Rae K, Linklater J, Black DA, Nicholson LL, Burns J, Refshauge KM. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med. 2015 Mar 1;49(5):323-9.

Other episodes of interest:

PE 017 - Injury reduction with Dr Peter Brukner

PE 027 - Sports injury management with Dr Nathan Gibbs