I mean, physio exercises are inherently boring.
They're so boring. So can you integrate it
somewhere else so it either feels like you're getting it for
free because you're you're boiling the kettle anyway and
you're climbing the stairs anyway, or can you just put it
in your jib program where you'd be doing a warm up perhaps
Anyway, So I'm fully in with with just adapting and and
playing these tricks on your brain just so it can fit into
your life somehow. Hey, I'm Hyper Mobile and if
you're listening to this, I'm guessing you might be too.
Hi, my name is Alex and I'm your Hyper Mobile host.
And today we are talking all about ankle sprains.
I have on the incredible physiotherapist Charlie.
And Charlie's here to go through everything from what patients
really need to be aware of, people who might even be at risk
for ankle sprains, and kind of all the advice he wishes that
his patients had before they ended up seeing him in clinic.
But first, before we get into all that, Charlie, please tell
me about yourself. Hello, thanks for inviting me
on. Alex, thank you for being.
Here, Well, I'm a physiotherapist by trade.
I probably these days identify more as a physio coach.
I just prefer the the mindset around coaching people towards
their recovery rather than therapying people better.
Not to say that we don't end up doing an element of therapy in
some sessions, but I just really prefer that mindset that you're
facilitating someone to to fix themselves rather than we do the
fixing. But that's semantics I guess.
And I still love my job. I love what I do, fixing
patients, helping them get get better and but these days I run
a business as well, so I run better.
So Better is a physiotherapy clinic in London.
So we've got a team of physios and personal trainers that are
all hopefully doing the same thing I do and helping more
people all at the same time. That's brilliant.
And you also have a podcast, right?
And that's where we met. That is.
Yeah, so, so you were very gracefully a guest on my podcast
telling, telling my audience about hypermobility.
And yeah, so I host a podcast called the Physio Coach Podcast
and we we're really trying to spread that idea about physio
coaching to other physios just to help people see things a
different way and just spread more good news around around the
community. Well, that's incredible.
And I think language is so important.
I think we spoke about how my first degree was in English
literature and words matter in terms of both how we think about
ourselves and how we interact with patients and, you know,
people and broader aspects of life.
So I'm totally here for that. Now I did look you up online to
do a little bit of background research and I saw that you've a
lot of experience in sports specific settings.
Could you tell me a bit more about that?
So my first passion was sports. So as a kid I played sport any
way I could, anytime I could. And I happened to be a quite
good at school. But I I knew that I really
wanted to be involved in sports. You know, that was the main
thing. So when I was getting to the
point of figuring out my career, it was always about how do I
make sport a part of that I wasn't quite good enough to play
from, which I realised fairly early on, but I knew I'd be
involved some somehow. So I did sports science as my
first degree and that took me on a really great learning journey
actually. I really enjoyed the science of,
of sport and the body, but by the end of it, the career
pathway for that just didn't quite feel fit me and what I
wanted to do. You know, sport, the sport
scientist was quite hard to get into.
There weren't that many of those types of jobs around.
You often had to do like a really cheap internship to, to
get into it. And I, I just felt it wasn't
quite me as well. I'd wanted to be a physio as a
teenager. I liked when I was watching
sports, seeing the physio go on the pitch, help people with
injuries that always look quite a cool thing to do.
I was put off it a little bit actually, which is why I didn't
go for it to begin with. But once I'd done my sports
science degree, it just kept coming back to me that it was an
opportunity or an option for me. So I did a physiotherapy as an
MSE and yeah, it start from there.
And because of the sports passion that my idea was always
to be a sports physio. So I went into a normal physio
job to begin with, but always had my eye on sports roles and
was doing some work in in rugby, in amateur rugby and then
managed to get a role with Saracens.
So I did a season with Saracens Academy.
I also worked with the Football Association in disability
football and football as well. And that that was great.
So I've spent most of my career doing sports on the side, I
suppose as like a side career and then musculoskeletal physio
as my main job. And although I thought I'd be a
full time sports physio, I really love the complexity of
treating the everyday patient, the everyday person, because
they just come with so many cool things.
They're just there's, there's so much more interesting about,
about different people. Whereas athletes are athletes,
you know, they. Yeah, I know.
As high performing and as fun as the as the good stuff in match
day can be, sometimes sitting there watching training isn't so
exciting and watching a gym session and isn't so exciting.
So yeah, the everyday person is just way more interesting and
complex. I love the problem solving that
comes with that. I love that and I did notice as
well in your bio, just looking at online, that you love working
with complex and chronic and treatment resistant injuries.
And I found that really interesting that we have that
passion in common. I have to ask you because I had
a similar thing happen with myself.
I didn't want to and I didn't mean to end up in the field I've
ended up in, should I say, for the economic osteopaths.
So osteopaths do manual therapy and rehabilitative exercises.
Physiotherapists are another type of profession we do as a
profession they have more in common than different, although
of course there are sub specialities and there are
specific types of physiotherapists like stroke
rehabilitation, physiotherapist, respiratory physiotherapy
etcetera, which osteopaths are not trained in.
But as someone who was also put off getting into a kind of
similar line of work, what put you off it?
At the early stage, I mean, yeah, well, it was just I didn't
have a huge amount of confidence.
So when someone, when I was a mid teenager, I guess when they
were saying what do you want to do?
And I said I want to be a physio and they said, oh, you need
really good grades for that. And because I wasn't like super
academic, I was, I would pick things up fairly easily.
But my passion was always sports.
So when my grades were like quite good but not amazing, I
just thought, oh, maybe it's not going to be the thing that works
for me. So yeah, I think I was quite
easily swayed. It was quite a flippant comment
I believe, but it was only when I then did pretty well on my
degree that I thought actually when I put my mind to it, I can
I can achieve just fine. So that it was something that
came later in life. It's interesting in those little
comments kind of such big consequences.
And I, I do think sometimes that some of the most incredible
people in this field, they often are people who come to it later.
Like, everyone has their origin story and I always just find it
quite interesting to get into that.
I'm so happy you ended up here. And I, I can't believe as well
that you, you know, had a little bit of challenges from an
academic perspective, given how much of a wealth of knowledge
you have now. And it just goes to show, like,
how people learn and, you know, develop these skills in
different ways. I think some of it was more
apathy than the lack of ability it was.
Maybe. And and I what you say about
coming to it late, more of it was just like wanting to learn.
I didn't really want to learn until I was a bit older than
maybe some others, so much more interested in just playing and
playing sports or whatever else. So, yeah, when I got to
university, I suddenly realized, hang on a minute, no one's going
to do this unless I really knuckle down.
Yeah, yeah, I got to work there. That's that's so cool and I'm so
happy you ended up here. So without further delay, let's
get into why we're here today. So when I was on your podcast,
we talked about the phrase. It somehow came up, I can't
remember, but we talked about how people say it's just an
ankle sprain. And there was like this moment
where I could tell like we were going to have good vibes.
We connected on that. Tell me a bit about the phrase.
It's just an ankle sprain or, or why that was something that kind
of sparked the whole discussion. Wrapping today, Well it hits me
deep and the reason it hits me deep is because when I was 16 I
had just an ankle sprain and I remember.
So this is before my physio journey of course.
So I play rugby, fairly new into rugby and I was running with a
ball, someone tackled me, they landed, they kind of, I was
running that way. They were, they were kind of
behind me and tackling me from behind.
My ankles then stretched into an open position and I felt an
immediate pop in my ankle with the weight coming down on top of
it. The worst pain I probably ever
felt at that point, really, really, really, really sore came
off the pitch. Pain settled down relatively
quick as an ankle sprain can do. So within, you know, 10 minutes
it was like, OK, it's throbbing, but it's, it doesn't feel that
bad. Managed to hobble to the car and
went to the hospital. And then that was where the
phrase just an ankle sprain was presented.
And it's like, oh, it's OK, it's just an ankle sprain.
And I went away with the advice of keep it moving, roll it
around, stretch it, maybe take it easy for a few days.
You'll be fine. You don't need crutches, just
take it easy and then get back to sport when you feel ready.
It's like, oh OK, you know, nodding my head, I feel very
reassured. Thank you.
NHS triage did. They give you the rice.
Thing they gave you the rice thing yeah.
So rest ice compression, elevate, OK, I'll do that so I'm
nodding my head and thinking OK, I feel I feel confident that I
know what to do here. It was really painful for a few
days, maybe a week and very swollen around the outside of my
ankle. So I had definitely had an ankle
sprain so categorized as, you know, the tearing of ligaments
within the, the, the ankle and that, that had happened.
And I remember thinking, I need to keep moving on it.
And I've got this vision in my head of being in college and
like limping down the, the hallways because it was, it was
just so sore. And I, I'm trying to do my
thing, just keep walking on it, keep moving on it.
And then three months goes by and I'm like, just about like, I
think I'm ready to maybe go back to sport again.
So like 3 months. That's not an insignificant
amount of time. I wouldn't say just could be
attached to three months. You know, you're just going to
be out for three months. So that sounds like quite a
major injury to me. It's a lot, especially when
you're young and you know time feels very long back then.
Yeah, and I did get back to playing sport and played sport
another few months and then I had another just an ankle sprain
on the same ankle. Wait, so how long after the
first injury of. That it was certainly within a
year I had it again and it was ironically on the same pitch
against the same opposition playing the same sport in the
same way. So history repeating itself.
It wasn't quite as painful this time around, which I now
understand is because first one's always going to be the
most painful because you've got the most fibres to snap.
So the one after that that the healing was wasn't as good as it
should have been anyway and we'll get to that with time.
So it still sore and I knew what happened this time, but the same
thing had happened again. And I think this time I was at
university. So I missed a really important
chunk of of my rugby at university because I was just
getting into it, really enjoying my sport.
I just got into the first team and, and I was disrupted by this
injury again, this just ankle sprain that just come back.
I had some physio at the university.
It wasn't particularly, I mean now I look back in hindsight,
it's like it wasn't very good, but I paid £5 for it, you know,
that's pretty, pretty cheap, this highly heavily discounted
subsidized physio. And she gave me a bit of advice
about balancing on it and doing some car phrases.
And from that point it was a bit better.
So I remember having another episode relatively short shortly
after that wasn't that painful, but it kind of gave way.
And, but, but I've mostly got back to rugby and for about 20
years my ankle was mostly fine. It would always feel different.
It would always feel a bit less stable and a bit less strong
than the than the other one. But it was mostly fine until a
year and a half ago. And then I went running, was
running on this really uneven ground and I felt my ankle
really give way again. The same one wasn't that painful
again, but I knew I'd done something.
That's how that feels different. From that point onwards, it was
unstable just in daily life. So I would roll my ankle on the
street. I'd, I'd feel nervous when I was
walking, I'd be looking at the floor a lot more.
When I was out for a run, I'd be looking at for all the time and
it'd roll and give way. But because there were no
ligaments left to, to, to hold it, it would be really LAX.
But it would also not really hurt.
So I made the decision to speak to a sports medicine consultant
who did some scans and at that point, so this is now 20 years
after the original injury, we realised that it wasn't just an
ankle sprain, it was a full rupture of my ATFL ligament, one
of the main ligaments on the outside, a full rupture of my
AITFL ligament, which was the one like they, they would call
that a high ankle sprain and a partial tear of the PITFL.
The one on the back, which we surmised is probably the one I
did recently when I rolled it on the when I was running in the
fields. So at that point onwards, I had
a decision to make around getting surgery to reconstruct
the ankle or whether I could carry on living the way I wanted
to live. And with some thought and a
really long hike later where I did 3 days of hiking and
probably rolled it about 30 times, fell on the floor maybe 5
or 6 times. It was that trip where I
suddenly decided this isn't coping, I'm not coping with this
anymore, I need to do something about it and decided to have
stabilization surgery, which was November last year.
Alrighty. So before I ask you about that,
just to clarify for any listeners.
So you injured the ligaments on kind of the outside of the
ankle, is that correct? And you did a few different ones
essentially, which is a very classic thing to see.
It's often not just one ligament, it's often a few
things going on. You ended up having surgery.
How did that go for you? Because I've seen a few patients
who have having surgery. Not everyone needs to or does,
but when it's the right clinical decision, it's the right
clinical decision generally. Exactly.
Yeah. And, and because I'm a physio,
I, I see these a lot too. And I know that some people
don't need it and they could do really well with rehab.
So I did my exercises and I was doing all of my work and I
could, I could do a single leg pistol squat, I could do a
single leg sit to stand, you know, I could do.
But when I was stable and stationary, my stability was
amazing. But as soon as I was moving
around in the world, the structures weren't strong enough
to hold it. So it would give way all the
time and it would collapse in the most ridiculous of moments,
walking in the road, stepping on something in the gym or just
something really menial. So yeah, the surgery itself went
very, very well. And I'm now feel really
confident and I've been on a similar hiking trip since and I
didn't roll my ankle at all and it felt super strong.
So it, it definitely worked for me.
That's fantastic. It's no insignificant thing.
And that's why I really gave it some thought and it really does.
You know, I'm six weeks non weight bearing with that surgery
in particular, So two young kids and a wife who would prefer me
to be weight bearing at home. You know, there's it's a really
important thing to weigh up. Can you handle the recovery
that's attached to the surgery? Is it worth it?
And no surgery comes without risk as well and so it's a lot
to weigh up. But luckily for me it did go
very well and now I'm back doing everything I want to do.
Well, in simple terms for listeners, what did the surgery
involve? Like how did they try and repair
that ankle? So it was a 2 essentially it was
a double surgery because of the different injuries that I had.
So the the ATFL, which is the ligament lower down on the ankle
on the outside that's reconstructed.
They attach the, the outside chin bone to the to the foot.
And then the the other one is more, more like a wrap.
They kind of surround the two shin bones to, to hold them
together. So you're a big shin bone, the
little shin bone on the outside. I like those names.
And they, and they tighten it, yeah.
And they, they tighten it together.
So there's like a wrap around it and they tie some knots to make
sure that stays there. And I was actually quite lucky
that my, the one of the lower ligaments was, was actually
still in there, the flapping around.
So he said we were quite lucky because he then attached that as
well to the bone. So I've got like a double
repair. On the reinforced repair.
Reinforced repair. So he said not everyone has
that, but because you it happened when you were young, he
said. Like you get all this big like
healing response, although it didn't heal fully, all this
healing response happened, so it was still in there.
So that was quite, quite lucky for me.
Well, that's, that's brilliant. You'll have to tell us more a
little bit later about some of the exercises you did after the
surgery. So I'm guessing there was a long
journey even after that six weeks being off weight bearing.
But getting back to ankle sprains in general, let's talk
about like ankle sprains and hypermobility because we know
there are certain risk factors for ankle sprains.
I'm sure you'll be able to tell me about a few of them, but
being hypermobile or having even just an ankle that's
hypermobile, even if you're someone who doesn't have a
connective tissue disorder involving hypermobility, it's
going to be something that puts you at risk for ankle sprains,
right? For sure.
And, and just starting off with my, my journey, I'm on the bendy
end of normal. So I'm not hypermobile, but I,
but I am quite a flexible person naturally.
So I'm at more risk as a result. And, and then you go further
down that continuum and for sure, like when if you're
hypermobile, you have much more movement that happens through
your ankle joint as a result, just the tiniest little kick off
a of a stone is more likely for, for the muscles to not be able
to handle that that force. So then the ligaments are
exposed and those ligaments are strong, but sometimes they're
not strong enough and they, they might fail.
And that's when you get the tearing of the ligament and
therefore the the pain that comes with an ankle sprain.
So in terms of risk factors, are there any other things you look
for in people? I've read that like asymmetry.
So if you have like a, some people see me, they're like
Alex, I have a great right leg, but my left leg is horrible and
stuff. Or any other risk factors you
kind of screen for when you're looking at patients?
I always look at calf strength, so that for me, the best way to
do that is to compare the height of a two leg calf raise.
So how high their heels are off the ground versus their one leg
calf raise height. So I'm measuring that with a,
just a ruler actually straight out the dental case.
And the two leg is their range of movement.
And then the one leg is their strength.
And if they're weak, their single leg is quite a lot lower
than the double leg. If they're strong, then their
single leg stays at pretty much the height.
Maybe it drops by half or 1 centimeter, but with a weak half
you could get as much as a some people can't even do it if
they're really weak, but anywhere in between really.
So I prefer that test to the just measuring how many calf
raises they can do because they might be able to do the same
amount of reps on each side, but how high are they going matters
more to me. So I first check how high they
go, then I'll count how many reps they can do on a capacity
test like a calf raise. I love that and how sensible it
is, and I'm definitely going to be stealing every use of my
patients when it comes to ankle sprains.
Another thing which has come up in your story in particular is
how a previous ankle sprain can potentially increase your future
risk of ankle sprains. How important do you think, like
medical history is in terms of previous injuries?
If someone's listening to this and they're like, I've had two
ankle sprains or I've had 10, like there's someone who should
kind of be starting to prioritize maybe.
Yeah, it's the biggest. Predictor of future ankle sprain
is to having had a previous ankle sprain the, and what you,
what you actually tend to find is not just that the ankle
sprain increase the risk of ankle sprains, it increases the
risk of lower limb problems, full stop.
So it's much harder for the evidence to track the, the
relevance of that because there's so many different
presentations. But I see it in clinics so often
that they've got a knee or a hip or a, maybe even a back problem.
And you ask them and they say, Oh yeah, I had this anchor
sprain when I was younger. And you watch them move and you
can see it. You can see the lack of
stability on one leg. You can see the calf raise isn't
quite so high. You can see that they, they just
don't move quite so confidently on that side.
So yeah, the, the history is super important.
And the other thing that I, I would scream for is how stable
are they on one leg? So just just get them balancing
on one leg and how, how able are they to single leg sit to stand
kind of, I think I mentioned that earlier.
So just getting them to sit down on a chair, stand back up again,
if they can't do it, then raise the chair up because it just
gives you so much information. What does their foot do?
What does the ankle do? What's the knee and the hip
doing? Does the knee drop inwards?
Does the does the arch thing collapse?
So I'm using a lot of these terms here.
But essentially, does it look strong and stable?
Yeah. And you can do this yourself.
Just get in front of a mirror and and observe it and you'll
see yourself that one might look different to the other.
And if it does look different, can you just try and match the
other side? Can you?
Can you change it yourself? I, this is the physio coach for
me. I, I like people to be able to,
to, to figure out the problems themselves.
Oh, I can see that now. Yeah.
I, when I was just feeling it, I couldn't tell.
But now I'm looking at it and observing it in the mirror.
I can see that. So if you if you try and just
mirror the other side, then you can often just do a lot of the
work yourself without necessarily needing to see a
physio. You know, I think looking.
For those little vulnerabilities in terms of movement, you know,
why does my left leg move this way but my right leg moves this
way? I think that's such a big
opportunity not only for people to try and address or decrease
their risk of future injury if they have had a previous injury,
but also if you're someone like me.
So I've never had an ankle sprain as far as I'm aware.
I've fractured my ankle, but as far as I know I've never had an
ankle sprain. But it's something where I never
want that to happen. My partner has had a lot of
ankle sprain. Similar story to yourself
actually, except so far we've been able to manage him non
surgically and knock on wood he hasn't had an ankle sprain in
like 2 years now. But it's it's something where I
think certainly making it almost a part of your way of life of
hey, like this is a vulnerability or a weakness in
how I move. Can I address this?
Can I make it fun? I think, you know, I love fun.
We've talked about exercises and fun on here before, but I really
think that finding as you, you said earlier when we were
talking like your favorite exercise and just saying, hey,
everyday I'm going to do a single leg balance just because
I know my right leg isn't as good as my left.
That might be something that for some patients can help them just
in a preventative for kind of a healthy body development long
term plan. Yeah, body awareness.
I think is huge here and that's kind of what we're touching on
is just learning what your body is doing and, and getting more
information about what that might mean.
So hopefully that this plants the seed for that.
But but then you get the opportunity to physio with for
free within your day. You know, you're waiting for the
kettle to boil and you're balancing on one leg or doing
your car phrases. You know that not everyone wants
to set aside time for, for their physio exercises.
So I'm I'm fine with that. I don't mind find it somewhere
else, integrate it into another part of your life.
Maybe when you're walking, you notice that suddenly 1 foot
doesn't feel the same as the other.
Can you just be a bit more aware of how that feels and, and just
try and change it when you're walking to the station in the
morning? So there's so many ways of
integrating into your life. A lot of people will go to the
gym and can you integrate an exercise into that rather than
it being feeling like separate? I mean, physio exercises are
inherently boring. They're so boring so.
Can you integrate? It somewhere else so it feels
like you're getting it for free because you're, you're boiling
the kettle anyway and you're climbing the stairs anyway.
Or can you just put it in your jib program where you'd be doing
a warm up perhaps anyway, So I, I'm fully in with, with just
adapting and, and playing these tricks on your brain just so it
can fit into your life somehow. So yeah, I I think it's
important I call them microwave. Exercises.
I don't know. Everyone in the UK has a
microwave. Everyone in Canada has a
microwave. But what are what are your or
what is your kettle exercise or microwave exercise?
Do you do you calf raise? Yeah.
Yeah, yeah, because of my mainly because of my surgery last year
and the last year that there is still a small deficit.
We talk about the calf raise height, my right is still about
a centimetre off where I want it to be.
So I'm doing that calf raise height exercise when I'm waiting
for the kettle to boil. I have to be honest if.
You've made me stressed about my calf raise.
Hi, I'm going to be asking that, yeah, after this, we both have
patients after, but after that I'm going to find you.
We're going to do my calf raise, right?
No, that's just fantastic in terms of going back to ankle
sprain kind of management just for the average listener.
So of course, full medical disclaimer, if you're someone
who has any ankle pain for any reason, this is not medical
advice. You need to go speak to your
doctor. OK.
But the reality is a lot of people, when they get ankle
pain, they go speak to their GP in the UK or their Primary
Health care provider, and they're often kind of dismissed
in a way which I think is a huge problem.
And I'm sure you have the same experience as me or I end up
being that person to kind of try and get them listened to or try
and find a path that makes sense to manage this issue.
If someone has, you know, tried to go down that route and they,
you know, they're relying on the NHS and they've been dismissed,
do you have any advice from them on how to manage that?
You will. Well, that's.
The tricky part is that you go to somewhere like A&E or minor
injuries units expecting just to have the worst case scenario
ruled out. Most people will think I
probably haven't broken it, but I'm really struggling to walk
here and I might type it into Google and what could be going
on. You might have a fracture, you
might have an ankle sprain. In that case, you need to go and
have an X-ray and you get there and you often feel as soon as
they've maybe X-rayed it and said there's no fracture, you
immediately feel like they don't care about you anymore.
You immediately feel like you don't.
And that's the just an ankle. It's just an ankle sprain.
And it's almost like they're rolling their eyes because it's
like there's nothing we can do here.
And what they really mean by that.
And I and I have some sympathy for them, by the way.
Right. That what they mean is we can't
help you in this environment. And the GP would probably fit
into that category. We can't help you in this
environment. You need to see someone who can.
OK. Which is physio.
Yeah. What I believe they should do in
that very moment is here is a boot to keep your, your ankle
fixed at an angle that allows it to heal again.
What you must then do is take this boot off after let's say 4
weeks because about four weeks, the healing will be sufficient
to allow you to live your life normally.
And what that then allows to happen is the ligaments that
have torn right? If those that are watching will
be able to see this, the ligament fibres are, are, are
intertwined. They, they, they pull apart and
tear and then they're separate. If your ankle is there moving
around or like like this, then the the fibers that are like
that never get a chance to lay back over the top of themselves
and attach and heal. So as a result, whatever healing
might happen or doesn't happen is is either really long and
LAX. So that's where instability,
long term instability comes from or not there at all.
And again, that that leads to instability in the ankle.
Again, more sympathy. The reason they struggle to to
get on board with this in the NHS as an A&E GP automatic
treatment pathway is that if you just give a boot to everyone in
these situations, many people will maybe keep it on too long,
get really, really stiff. And when they come out of the
boot they actually have different problems.
Their ankle is too stiff and then they can't get it moving
again because maybe their NHS physio isn't for another three
months. But let's say.
So I understand why they have the, the advice they have
because they, they almost make a deal with, with the situation
and say we'd rather have a LAX ankle than an arthritic ankle
that's too stiff and doesn't move.
Because a LAX ankle still allows some function for for most
people and for for many people, by the way, they heal fine.
But it's the ones that don't that I see.
And then they're the frustrating ones, just like me 20 years
later, who's had to have stabilization surgery that would
have been prevented had I've had a boot for the first four weeks
of my injury, right? And I didn't know any different.
I was just doing what I was told.
However, four years ago, five years ago, I injured my left
ankle. It was actually a more
significant injury, a football injury, another sprain.
Like I said, I'm on the bendy end of normal, so I'm more
likely to have these than the most people.
I was a physio at this time. I knew exactly what to do.
I went to the NHS, minor injuries, checked it wasn't
fractured because I had definite Bony tenderness and I was
struggling to wait there. I was 95% sure it wasn't
fractured but I did what I was supposed to do and when I then
challenged the the triage nurse at the time and said I can I
have a boot. She basically said you don't get
boots for these injuries, you just need to get on with it.
The just word again, you just need to get on with it.
Be careful for a few days. Rest, eyes, compression,
elevation. I tried to have a bit of a
negotiation and said, look, I'm a physio.
I deal with these injuries all the time.
I know that I'm supposed to have a boot here and she was having
none of it. Nope, that's not what we do.
And like, that's her training. But yeah, it was quite a
frustrating conversation to have.
I was lucky to be able to go to the clinic I worked at and get a
boot from there and manage it the way I knew I was supposed
to, with an MRI later showing that I had a big significant
rupture of two of my ligaments and a couple of other partial
injuries with a big bone bruise as well, so a major ankle
injury. I wore the boot for the time I
was supposed to. I rehabbed appropriately and my
left ankle has never had a problem.
So it was about four months when I go back to everything I wanted
to do. Feels amazingly stable,
amazingly strong. Five years ago, not even the
hint of instability. And when you test the ligaments
the way that as physios and osteos would like to do, you can
feel the stability of the ligament where they were given a
chance to heal over the top each of each other and heal short and
tight again. So I've got nice stability
through there. And that's why if you can, if
people can, if they have an ankle sprain, which is a
relatively common injury in, in the for everyone, let alone for
hypermobile people, is to, if they can get hold of a boot and,
and immobilize it for a period of three or four weeks to allow
that initial period of healing to happen.
And after that, they then get moving, maybe see a physio who
can help facilitate their recovery from there.
But if not, just make sure that at that point there then
building up some strength, building up some stability,
stretching through range. And it might be sore and it
might be stiff because that's kind of the point of the boot.
But that's a much more, that's a much more likely scenario to
lead to positive outcomes in a nice state with strong ankle in
the future rather than the case where you have the the laxity
that we're describing in my other ankle.
No, absolutely. I.
Love dumb your hand, our description.
No getting those fibers to be approximate.
I think that's what helps so much.
Having this understanding from a professional perspective of what
healing is actually going on and the fact that those fibers need
to find each other again, and if they keep being pulled apart
from each other, there is no chance for them to find each
other and become friends. Actually, I remember my I.
Remember the the nurse saying 20 years ago, just do this with
your ankle moving around and now look back like how on earth are
those fibers going to get anywhere near each other when
you're just pulling them apart at every moment?
So no, that makes complete sense.
Question for you, are there any ankle sprains where you wouldn't
immobilize someone just in terms of management?
Is there a mild enough category where yeah, yeah, yeah, yeah.
And that's a really good point to make because these are the
ones where there's massive swelling that's happened and you
can just see that massive swelling means big injury, which
means bleeding within the joint and, and with and around the
ligaments. They're the ones where, you
know, a significant structural pathology has happened.
If you just tweak it and it looks a little bit like a golf
ball and then it goes down within a day or so, then it's
not quite so important. You maybe you just soft brace it
in those situations. So it's still a bit of support
there, but it's much more of a soft kind of almost like a a
tight sock that you know that that they might be a better in
between happy medium. Yeah, they're on Amazon like.
The figure of a kind of fabric one, that type of thing.
So I think having seen some big ankle sprains, they look like
balloons for anyone listening, if it looks like your ankle is
like literally like a balloon, that's immediately, you know,
make sure you get that medical attention and push for, you
know, that immobilization if that's something that is
appropriate in your discussion with your healthcare provider.
But make sure that those fibers can have a chance of finding
each other again. I feel like that's the key
message here. And they they.
The first one, especially if you, if this is the first injury
that they might have had, they're the ones that are purple
and blue that the bruising is there because that's the bleed
that's happened where the ligament has failed.
You know, that's it's ruptured, so or at least high grade tear.
So if there is bruising for sure a lot of bruising, then what
else could it be other than a bone?
So once you've had the bone ruled out with X-ray, then
you're left with a very, very likely ligament tear, perhaps
muscle tendon ruptures as well. But again, that'd be screened by
a healthcare professional unchecked.
But if they are saying to you, we believe this is a ligament
tear or rupture or sprain, then that should be immobilized if it
is a significant high grade injury.
Yeah, no. Absolutely.
In terms of ankle sprains, what does long term kind of
management look like because we talked about that, you know, we
have that injury occur, that person who goes to seek care,
hopefully get some appropriate health care, What needs to
happen from there because I find a lot of times it seems like the
ball kind of gets dropped. Yeah, well.
I think in general, physio management can be highly
simplified into these two categories.
So our first job is to calm stuff down.
So that's the protection phase. That's what we're talking about
here. Allow the body to do its thing.
The body is evolutionarily designed to be amazingly good at
healing. It's really good at that.
That's, that's how we are here today and doing what we do.
But what it's not so good at is getting us back to performance
and, and function necessarily unless, unless you're a highly
active person naturally. So that's our job really.
So, so that's the second part of physio's job, which is to build
things back up again. So we calm things down, build,
build them back up again. So we've spoken a bit about the
calming down phase of protection and allowing the body to do it's
thing. And maybe there's there's some
argument for things like rice or as we now use, Yeah, we have to
talk. About right, yeah, there's lots
of. Different acronyms, but
essentially it kind of means the acute management stage is
managed and then you're onto the the recovery part, rehab part.
And because we spoke about the immobilization, you are left
then with muscle atrophy because the muscle will waste away
because if you don't use it, you lose it.
You're left with joint stiffness because if you're immobilizing a
joint deliberately, then it's going to get stiff.
You're left with muscle tightness and tendon tightness,
you're left with a lack of stability.
So the skill of stability is lost.
So you have to learn that again. And and you're left with with a
less fit person as well. So there's even a bit, these are
all the things where we say build things back up again,
although we simplify the, the concept, that's the bit where
your physio needs to be able to do those things with you and
help you to, to navigate whatever you're left with.
So the longer term recovery evolves, making sure you cover
all those bases. So measuring where you're at,
how stiff is it, how tight is it, how big is it?
How big is the muscle? How strong is the muscle?
How stable are you versus the other side?
Lots of different factors that that you would consider how and
not just the muscles are in and around the ankle, but further up
the chain. What the quadriceps, hamstrings,
glutes, what are they all doing? And you don't necessarily have
to have an individual exercise for each of these problems.
You. I'm a big fan of efficiency
within my sessions Yeah, group stuff together, you're good bang
for buck exercises that you can cover lots of different things
all in the same exercise. But there is a process and the
people who follow it and do well, then they're the ones that
have less chance, less risk of injury.
There's a great study from many years ago that I quote all the
time that still seems relevant to me today.
People who don't do any physical rehab after ankle sprain have
about 45 to 50% chance of re injury.
People who do have around 10%. It's a massive difference.
I didn't know that 10. Percent number I knew about the
RE injury risk and chronic ankle and stability.
Before we get on to that, we have to touch on RICE for a
second because there's been this whole thing there was, you know,
RICE. I don't know what is up with
RICE as an acronym, but no acronym has ever been as sticky
as RICE. It is here and it's hard to get
rid of or change. What do you think of RICE for
ankle sprains and is it something that you advise your
patients to do or should they be kind of, you know, you talked
about how the body is good at healing in some ways.
Should we do a bit of a lesser interventional approach for mild
mild ankle sprain, Mild ankle sprain?
OK, well, a mild ankle sprain. Let's go through what it is
Rest, ice, compression, elevation.
So my understanding is that complete rest is bad for
everyone. OK, so relative rest, OK is when
we'll come back to like a slight nuance on that relative rest
That's fine. Do a bit less ice.
If your pain is so bad that you want to take painkillers but
maybe don't want to take painkillers, like we're going to
have to go on a tangent. I hope you don't mind.
OK, I love the tangent. OK, well.
Anti inflammatories very commonly prescribed for people
with musculoskeletal injuries and sprains, especially to help
bring the swelling down. But the evolutionary process is
designed for swelling to support recovery.
Yep. So if you take anti
inflammatories in the in the early stages, and we're talking
about the early days and maybe the first week, then you are
disrupting the healing of the structures.
You're getting in the way of the natural healing.
So when I think about, you know, optimal management and
protection of that early phase, try to avoid anti inflammatories
if you can. And the only reason I would say
that sometimes people need them is if they're not sleeping.
Yeah, so if you're not sleeping because the pain is so bad in
that situation, it makes sense that you would then take anti
inflammatories because sleep overrides it altogether.
You know, that is our superpower for recovery.
So you do need the sleep in order to recover.
But if you could sleep well without anti inflammatories, try
not to take them in the first week, especially after a major
injury. Minor injuries I'm not so
bothered about because it's probably going to heal anyway
regardless of what you do. But just have it in your mind
that it might not be a blanket answer.
And by the way, this is another the ripe of the healthcare.
They they, the healthcare profession in general, the acute
management is here's some anti inflammatories, take them.
Yeah, again, I understand they probably don't have many other
options to help people in pain, but but hopefully the nuance
I've given you there gives some people an option.
And this is where ice does help. If you are struggling with pain
and you have sensibly listened to what I'm saying here and have
decided not to take anti inflammatories, ice is great
pain reliever. Yeah.
What it probably isn't is an anti-inflammatory itself.
So people think of ICE as something that brings swelling
down. The evidence is pretty
unconvinced about that nowadays that it maybe doesn't act as an
anti-inflammatory the way we used to think it does.
What does act as an anti-inflammatory is
compression. That's the C for RICE.
So compress it with some kind of tubi grip bandage wrap.
Not too tight so you cut off the blood circulation, but tight
enough to feel like you've got a compression going on.
That should help with with swelling.
The other thing that is believed to help is elevation and that's
purely physics. You know, gravity will help to
drag the the excess swelling that's maybe not needed for
healing. It will bring it back and also
just optimize the blood flow to the injured area.
Yeah. No, absolutely.
I I was reading too about how important it is to have
elevation. If you're going to do it really
up higher than most people think it is.
It needs to be above the heart to have any effect based on what
I've looked at. I know it's funny.
I'm sure for you growing up too is always like getting.
I was just having bags of peas thrown at me and like ice packs
and I was in a lot of discomfort.
It was making my symptoms worse and it was deeply unpleasant and
not helping me. So, so I think totally it, it
depends on the injury, how it's affecting that person's symptoms
and and what you know the actual presentation is.
And This is why it's key. For, for the explanation here,
It's for pain relief, Yeah. So if it's not giving you pain
relief and it's too cold and it's hurting, then take it off.
Yeah. It's not doing its job.
Don't get an ice burn as well or like 15 minutes, 20 minutes, you
know that definitely no more than that.
Like maybe not even that. So I know people who have had
ice burns and they're not fun. That's why I tell my.
Patients, I'm like do not burn yourself, do not injure yourself
with heat and with ice application.
I say that they think I'm joking.
No, I'm being incredibly serious about this.
Can we go deeper on the? Acronym, Yeah.
So of course we can. So we evolved into from rice
into price. So they added the P, which is
protect. I really like that because we
should be protecting the injury. And that's the bit that I prefer
is is around allowing the injury to do its thing and allow the
body to do its thing. They then got clever and did
police. So police, which is protect OL
optimally load and then the ICE on the end.
So I like the the optimally load rather than rest because it then
suggests that a minor injury, you can still move it.
You don't have to rest, but you're just being sensible.
It gives it the coach of me again, it gives the person.
A decision to make for themselves what feels like the
right amount of load for this, for this injury and for some
injuries is different to others. And then they did Peace of Love,
which I can't even remember all of them.
It's too many letters. Because it gets.
Confusing. And if you look at it, if you
read it, you're like, oh, that's quite cute and that's quite
nice, but I think it gets a little confused.
No one can remember. The V is vascularisation.
I don't know the rest of them, but peace and love.
Is it empathy? Yeah.
So yeah, I think it gets a bit much going back to like the.
Coach and you in mindset, I do have to say, you know, you and I
see people who are down and I think after an ankle sprain in
particular because of how dismissed it can be as an injury
because it's just an ankle sprain, which it's not.
People often have this perspective.
I think that, you know, they're never going to get better and
it's injured. And although the, you know,
general management can be quite poor when patients are
interacting in environments where they're not able to access
care that's appropriate, as your, you know, your personal
story has demonstrated. And as you know, your work with
patients shows they're highly treatable injuries that kind of
good outcomes if we do the right thing.
How do you kind of coach or physio coach your patients in
mindset when they're dealing with an ankle sprain?
Well? I can't help but just lean on my
story again. And it's for 20 years, my ankle
was fine, you know, like it, it recovered well enough to to for
me to play rugby for 15 years, for me to run marathons, for me
to lift heavy weights, you know, to do what I wanted to do and,
you know, climb mountain. So it was coping just fine.
I just knew it was a bit different.
And I think we even mentioned this offline as well, that we
sometimes do have these forever injuries when they're major,
they they, they can't just leave their mark a bit.
And you might just have to do something to keep on top of
those forever. But I was still highly
functioning. It was only that most recent
sprain that I had where I described it running that that
led to me not coping. So that's the key, like are you
coping or not coping? But you're absolutely correct
that the vast majority of these are highly treatable, highly
rehab able. And it's just about identifying
the deficits that are attached to the reason someone is not
able to do what they want to do. And often it's the deficit, the
secondary part of the injury that the weakness, the the lack
of muscular stability or the loss of the skill that happened
after the injury that's more of a problem than the the structure
itself. And they're the bits that are
really treatable. So that's what I'm doing in my
assessments. I'm looking for reasons that
explain the person's symptom and I'm looking for the stability of
the ligament. Has, has it healed long or has
it healed nice and tight and short?
Do they have good stability on one leg?
Do they have all those things we mentioned earlier, calf
strength, range of movement? So that's sufficient for it.
I think we sometimes make a little too much of range of
movement to some degree. You know, most people just need
adequate flexibility. Yeah, you just need enough.
If anything, most people need a bit less if possible.
That's what we're speaking about with people who are hyper mobile
and have lots of flexibility. If anything, a bit stiffer
wouldn't wouldn't be a problem. Yeah, more range.
Means more when you have to be responsible for.
Can you control that, you know, getting to shoulders in a
second? For me, I have very hypermobile
shoulders and I had to build up so much muscle mass just to be
able to control that range of motion.
And the amount of work and rehab it takes is, is huge, I think
for people who are hypermobile getting into kind of long term
management, you know, these people who get chronic ankle and
stability. Could you tell me a little bit
about that? I assume it's something you see
in hyper law patients. I know certainly something I
see. And how do you have any tips on
managing that or when people might need to be aware of that
if I just finish? The final part, then we'll kind
of walk me through. Sorry, please go back.
Because. Because it sort of.
Goes through to it perfect. One of one of our superpowers I
think is healthcare professionals is our ability to
confidently assess and support someone in that listen to them,
understand their problem, confidently assess, give them a
diagnosis and reassure. It is one of our most powerful
treatments to reassure someone with confidence, not just to
flippantly say you'll be fine. You know, it's just an ankle
sprain, you'll be fine. That's not reassurance, that's
dismissing. So if, if we can reassure
someone that here's the right plan for you, we can look after
you, then we move into that kind of long term management of
someone who's had, he's got chronic ankle instability that
we've maybe picking up a little later then they, they need.
But all the stuff we've said already.
So identifying the, the main problems that are leading to
that chronic ankle instability. But most of those do do well.
They do still do well. They don't all need surgery.
In fact, most of them don't. If anything, it's the other way
around. The key is like, are you coping
in your life with what you have? Let's identify the problems,
let's try and solve those problems.
So are you strong enough? Are you stable enough?
Or are you well balanced enough, should we say, to compensate for
the lack of ligament stability? Do you have sufficient range of
movement? Do you have the right level of
muscle power to do the thing that you might be doing?
Are your tendons springy enough? If our physio journey can solve
all of those things and then they don't have instability
episodes anymore, job done. We don't need, we don't need
surgery. I've had many patients though,
and unfortunately it's probably, I say many, I'm thinking of
probably about a dozen patients in my career where we go through
all of those things, they solve all those problems and it still
lacks and they're still having instability moments, me
included. So sometimes there's no failure
of the physio. It's just that your ankle was,
was never quite going to make it really.
And you can't tell which ones they're going to be.
But sometimes the the the ligament or the structural
pathology wins in the end. Yeah, and that's the shame of
it. But there is still a solution
for those people. And surgery can work very, very
well even when your physio rehab hasn't quite done the job, you
know? Absolutely.
I'm. Always shocked at how many
people I see who've had, you know, multiple ankle sprains and
a history of chronic ankle injury where they haven't had
sensible imaging either. So they've just been told, you
know, without any investigations, it's an ankle
sprain. And it's like, you get them
imaged and there's something really serious.
Look at me. 20 years later and I, I didn't really need it prior
to that other than at the the original injury.
And they're, they're really just like, wow, that's worse than I
thought it was. Yeah, I thought I probably had
an ATFL injury. And then there's two others that
had picked up. I do have.
To say for me, this is just one of my clinical management
decisions, but a traumatic onset plus noise.
Like for me it's instant. Pretty much do not pass go like
we're getting. Also, I do work with people who
are hyper mobile, so my threshold for imaging is much
lower. I would say I'm very careful
with that I I nowadays. I'll do the same, yeah.
We do not mess around. I have a question for you.
So an analogy I use with my patients, I try to describe to
them. I say, look, when it comes to
your ankle, like I think of it there as being a structural
component, like a race car, for example.
And then there's you, the race car driver, there's how you
control the joint and the neurological function basically
of it. And then there's the actual, you
know, the ligaments and the bones and the tissues that make
up the joint. And although we can do a lot of
exercises where we're trying to develop better a neuromuscular
control, in some cases that ankle, that race car might be
so, you know, poorly built or just not functional that even
with the best race car driver in the world, it's not going to go.
Are there any like analogies or descriptions or ways that you
describe things to your patients when it comes to ankles that
you'd like to share well? I'll use my analogy that I like
for the body and and pain and injury in general, which I I
like the garden mentality garden.
Yeah, so. I sometimes I and I like how
you've connected to the, the mechanical car to the, to the,
the biological person, because that's, that's the key.
And sometimes people think of their bodies as purely
mechanical. Any pain or any problem I have
can be fixed or, or not fixed. And if it, if I am still in
pain, it must be a mechanical problem.
We won't get into the weeds of chronic pain necessarily here.
But, but, but it is more complex than that.
There's it's way more varied as to how pain can present
absolutely. So hence why I like the garden
metaphor because I do treat a lot of people with chronic pain
and it helps people to see that there's so many factors involved
and you need to have all the right ingredients in order to
optimize healing. You might.
So let's try it, let's say. So when I moved into my new
build house 1314 years ago, we were left with a pile of mud.
We didn't get grass. We decided we'll, we'll just
figure that out when we can afford it, right?
We'll so we didn't get the lawn put down.
We just had a pile of mud in the garden and I didn't know
anything about it. So I had to learn and I thought,
well, we'll just buy some grass seed and we'll just throw the
grass seed on there. And we had mixed results with
that. Some grass grew through, some
didn't. And then we got a load of weeds
that came through. So we had scratch our heads.
OK, what do we do next? OK, so some parts of the grass
are getting loads of sunlight and some are not because of the
wall in the way. So I'll tell you what, we'll
just we'll, we'll stop trying to grow grass there and we'll grow
plants there. So there's some different ones
there and then we have to figure out a different way.
OK, They need to be watered. Now we can't just expect them to
grow. So we have to water them.
So we need sunlight, the right amount of sunlight, we need
water and the right amount of water.
Not too much, not too little. We need the seeds to, to grow.
We need the plant. Maybe we need to go and manage
it. We need to go and cut the grass.
Sometimes we need to trim back some of the plants because
they're a bit big. Some of it dies because we don't
quite get it right. So that's, this is part of that
structural. Sometimes you try your best with
it and it still doesn't work out.
You know, I've had many plants that we've bought that have died
and there's bits of the grass that seem to get more wheat than
others. So there's it, it needs some
attention and it, and it needs an awareness that there's so
many factors involved that we don't, we're not always
conscious of that. We have to let things happen to
some degree, the way they're supposed to happen, the way
biology designed it to happen. But the more we learn about it
and the more we try to, to learn and get feedback from these
things, the better we get. So by the time we left that
house, the grass was pretty good.
Actually. We had some thriving flowers on
the, on the outside and the borders because they did well
in, in slightly sheltered areas. So 10 years later and our garden
was way better than when we turned up with our mud.
And I think that's the way we should think about our bodies in
general, that we have to nurture them.
We have to accept those things that happen that we don't always
understand, but if we're mindful of it, we can learn from it and
we can figure out strategy to solve it.
I'm just trying to help be the, the gardening expert for
people's ankles here, right? Just shortcut some of those
decisions that it took me 20 years to some degree to figure
out, certainly for my own one, but certainly my physio career
even that's, that there's a process of trial and error.
So it's just, and I'm still not done learning with this stuff,
right? There's still more I can learn,
both with the garden and ankle sprains.
I think I'll be coming to you for some gardening tips in the
future. But you know, I love that
analogy. I think that idea of looking at
a failure as an opportunity in a way, and sometimes different
interventions will be needed. You know, maybe there had been
something really messed up going off your soil or your pile of
mud and maybe you needed some new soil brought in.
You know, some interventions are much more large scale than
others, but I think that idea of looking at opportunities for
improvement and, and scope of improvement is key.
And I think again, that's where a physiotherapist or another
healthcare provider can come in and say like, Hey, you know, I
know this injury, this is how we can manage this and, and
prognosis. I think that's the one thing I'm
really a stickler for too. I hate when patients get told,
you know, come once a week for forever and there's no outcome
measures. Like if you weren't growing
flowers in that area after three years, you're, you're going to
be like, what's going on? And you know, you'd probably
said after one year I'd probably hired.
Yeah, and be. Sensible.
Yeah. Sack myself as.
The gardener and I'll hire another one.
Yeah, absolutely. Sometimes you have to sack
yourself question for you when it comes to chronic ankle
instability and people who are hyper mobile.
And I guess I, I know you're, you know, you, you're not
technically as expert specifically in hyper mobility,
but you see every physio, every osteopath, everyone's seen hyper
mobile patients. Are there any interventions you
like to try and just support them in feeling their ankles
better? Obviously there's exercises, We
love exercises, but are you a fan of anything like patients
using tape maybe or other things there, I think.
Tape is a is a hugely valuable way of supporting the, the, the
ankle recovery journey in different ways.
So firstly, if someone comes in to me and they have just
sprained their ankle, then I mean the just in a different
way, like literally just, it's just happened.
Yep, if they come in with a fresh ankle sprain and they
don't have a boot and I've we've not got one in clinic then I
will tape it as the immobilisation and I will say
this, I want you to keep this on for a few days and try and get
yourself a boot in the meantime. Rigid tape.
Or OK, OK, cool. Love it.
Zinc X Zinc. Oxide and this is where my this
is where my pitch side. Yeah, my sports background
really helps. So I, I've strapped hundreds of
ankles in my time so I can fantastic.
Just just yeah, it should, should be it's tricky to do
actually, it's quite a difficult technique because you can over
tighten and and miss the right angles.
But anyway, that's what one thing I really love doing is
just helping someone immediately go right.
This is now protected and safe. Yeah.
The other end of it if they're getting back into exercise
again. And I think this is especially
relevant to people who have more flexibility than the average.
No matter how much rehab they do, they'll probably still feel
a bit wobbly and a bit uncertain.
I think TAPE is a really valuable way of building their
confidence. I think it's it's especially
important again, if someone is sporty and it's like a change of
direction of sport of some sort. I will encourage them.
I'll either do it for them if I'm seeing them often enough or
or or teach them how to self tape again.
That coach again is coming in. Teach them how to self tape and
say please take for the first month or so of you returning
into sport or exercise just to reduce that risk of of it
rolling spraining again in a in a perfectly innocuous way that
just I just don't want that re injury to happen.
So the best way to do it is to tape it freely.
I love how much you. Care about FIFA's ankles, by the
way, I'm like, if someone of those sprains ankle, you need to
contact Charlie. You have a deep, I think, a lot
of empathy. Comes when you've struggled
yourself, I think, in the expertise plus the empathy.
Comes when I know how tough it can be.
And yeah, that's why we're here today.
I love that you teach. People how to tape, because I
see so many patients going to have seen other people in this
field and they haven't been taught how to tape.
And this is someone who's getting really, really mild
ankle sprains regularly. Nothing major.
They're getting some ankle pain or they feel unstable, even if
the ankles are not actually on unstable.
And I'm a big fan of saying, you know, we can use this tape to
give you some more proprioceptive feedback.
Even if it's not from a, you know, trying to make the joint
more stable. I want them to be able to better
feel what's going on in the ankle.
Do you ever use tape just for kind of proprioceptive purposes?
Yeah, I. And I just get them to video me
applying on them and talk. Through it's.
Like a very simple thing to to do and helps them to go away and
manage it better. Yeah, I think that if they are
worried, not sure, not confident than anything to build their
confidence to be active. You know, ultimately that's the
headline. In the end, he's like, I want
people to be active and healthy. So anything that builds
confidence for that I'm happy about.
South Kinesia tape is another type of tape which I don't tend
to use much for ankles. I I just don't think there is
enough to add to the stability that I'm keen to get.
But there are still some people that say they like the feeling.
Yeah of it. A lot of my hypervolpations.
They they love it. I get hives from say so I'm so.
Even though I I wouldn't use it as a structural limitation, if
someone says it feels good, yeah, I'm cool with that.
That's good enough for me as well.
So yeah, I don't mind. And even if it's placebo?
Effect, you know, too, I know I love placebo.
Effect people always really quick to put things down because
that powerful placebo it's. Superpowerful.
They use placebo. To measure drugs against.
Yeah, They don't say no drug. They use placebo because they
know that that placebo is a drug in itself.
Yeah, 20 to 50%. And even when we know it's a
placebo, it still works. Yeah, those are powerful
placebos. No.
Absolutely. When it comes to a flying tape,
what I will say real quick, just for any hyper mobile listeners,
is you have to be careful with wounds.
You don't need puckering of the skin.
And again, here I'm talking KT tape application.
I'm not talking rigid tape, I'm talking stretchy tape for
proprioceptive feedback. But these are people who are
generally a bit more prone to having things like hives occur
in different things. So be cautious, talk with your
healthcare providers and just make sure that you're taping in
a way that's safe. Also, I'm pretty strict on
anchors. So that piece of tape that's not
stretched, a little bit of stretch and then some stretch.
So I've seen people just yank it and apply it on videos online,
and I'm just like, Oh my gosh, yeah, that's going to lead to
bad things. The other thing is the adhesive.
Is some people are allergic to that and they get real bad
reactions to it, both the zinc oxide of the rigid stuff and and
the K tape. If you get a reaction, just take
it off. It's worth it because it's it
can really, really scar. So it's not wounds are.
Wounds are serious stuff. I have a colleague in the field
who finds Coloplast. It's like a spray that's used
for colostomy bags. He swears by it.
I haven't yet tried it, but maybe one day you or I will get
around to trying it and see if it helps.
I use the under wrap a lot. For the for the zinc oxide tape,
just to try and protect the skin as much as I can that the
hyperfix that that works really well that you can't use it on
every single part because of that, the tape doesn't do its
job, but I try and protect it as best as possible.
One other weird thing I'll. Say is have you ever seen four
way stretch tape? It's not K tape, it's different.
I have seen it, yeah. So I do find that some patients
will get hives to they'll react to K tape and they'll react to
zinc oxide tape. They won't react to the four way
stretch tape. I wonder if it's cuz of how it
moves more with the scan. I have no idea.
It's expensive, but sometimes I'll just like triple layer,
double layer it for people where that's appropriate.
But it's the one type of tape I don't hate or if I should say my
body doesn't hate when it comes to exercises.
Just in brief and really simple terms.
Are there any things you like to think about with patients in, in
terms of that long term management?
So you know, there's like 2 footed exercises, 1 foot
exercises. Any basic kind of thoughts there
if? If we're thinking really about
ankle stability and strength here, you develop that, you
develop stability in particular on, on one leg, it's very two
leg stuff doesn't really do it because the other leg stabilizes
for you. So it's like a, it's perfectly
fine for general strength, but not so much for ankle.
So you need to be on one leg or at least in split stance.
You know, split stance can offer some good stability too.
So I probably start with a split stance exercise actually, and
then develop into a single leg. I mean the best exercise for it?
And what's your favorite? Like I'm going.
To put it out there, I don't really don't like these, but the
best exercise, the one I give to everyone who has ankle
instability is a single leg sit to stand.
How often, Because you can modify it to the person.
You can. It's always going to be a
stability challenge and you can modify it to the person.
You can make it a really high seat, you can make it a really
low seat. You can get them to hold the
weight. They can be on a slightly
unstable surface. It's the best exercise because I
can modify it to the person and to the demands of their exercise
goals. So single leg, sit to stand.
You heard it here. Now that's the best one.
I love it. And I feel so chuffed.
I call it a single leg partial death squad.
Your name is much better than my name.
But yeah, you can't hide from it.
All the vulnerabilities show up in regardless of what joint
they're in. Charlie, this has been
fantastic. I've kept you for so long.
Thank you for being on here today.
Is there any final tip you want to give people?
If you can go back in time to little Charlie with his first
ankle sprain. And he's been told it's just an
ankle sprain. What would you want to tell
them? Just don't tolerate.
It just don't. If someone tries to minimize it,
don't allow it and find someone who's willing to give you the
time of day for it. And it's up to that person that
you then go find to solve the problem with you.
But yeah, don't tolerate someone minimizing an ankle sprain
because it could be a serious, serious injury.
Thank you so much. Again, Charlie, and if you're
looking to find Charlie, we will put all of his details in the
show notes. He's here in London like me, and
hopefully we'll be able to have you back another time, maybe to
talk about chronic pain or something else, who knows.
You're welcome. Thanks.
Baby, thank you again, Charlie.