1 00:00:00,040 --> 00:00:01,800 I mean, physio exercises are inherently boring. 2 00:00:01,800 --> 00:00:04,400 They're so boring. So can you integrate it 3 00:00:04,400 --> 00:00:07,240 somewhere else so it either feels like you're getting it for 4 00:00:07,240 --> 00:00:09,400 free because you're you're boiling the kettle anyway and 5 00:00:09,400 --> 00:00:11,920 you're climbing the stairs anyway, or can you just put it 6 00:00:11,920 --> 00:00:15,320 in your jib program where you'd be doing a warm up perhaps 7 00:00:15,320 --> 00:00:19,400 Anyway, So I'm fully in with with just adapting and and 8 00:00:19,520 --> 00:00:21,800 playing these tricks on your brain just so it can fit into 9 00:00:21,800 --> 00:00:32,320 your life somehow. Hey, I'm Hyper Mobile and if 10 00:00:32,320 --> 00:00:35,040 you're listening to this, I'm guessing you might be too. 11 00:00:35,480 --> 00:00:37,600 Hi, my name is Alex and I'm your Hyper Mobile host. 12 00:00:37,640 --> 00:00:41,040 And today we are talking all about ankle sprains. 13 00:00:41,440 --> 00:00:45,360 I have on the incredible physiotherapist Charlie. 14 00:00:45,360 --> 00:00:48,960 And Charlie's here to go through everything from what patients 15 00:00:48,960 --> 00:00:51,480 really need to be aware of, people who might even be at risk 16 00:00:51,480 --> 00:00:54,840 for ankle sprains, and kind of all the advice he wishes that 17 00:00:54,840 --> 00:00:57,960 his patients had before they ended up seeing him in clinic. 18 00:00:58,320 --> 00:01:01,560 But first, before we get into all that, Charlie, please tell 19 00:01:01,560 --> 00:01:04,120 me about yourself. Hello, thanks for inviting me 20 00:01:04,120 --> 00:01:05,200 on. Alex, thank you for being. 21 00:01:05,440 --> 00:01:08,000 Here, Well, I'm a physiotherapist by trade. 22 00:01:08,200 --> 00:01:11,040 I probably these days identify more as a physio coach. 23 00:01:11,440 --> 00:01:15,000 I just prefer the the mindset around coaching people towards 24 00:01:15,000 --> 00:01:17,520 their recovery rather than therapying people better. 25 00:01:18,080 --> 00:01:20,560 Not to say that we don't end up doing an element of therapy in 26 00:01:20,560 --> 00:01:23,920 some sessions, but I just really prefer that mindset that you're 27 00:01:23,920 --> 00:01:27,320 facilitating someone to to fix themselves rather than we do the 28 00:01:27,320 --> 00:01:30,560 fixing. But that's semantics I guess. 29 00:01:30,560 --> 00:01:34,000 And I still love my job. I love what I do, fixing 30 00:01:34,000 --> 00:01:37,760 patients, helping them get get better and but these days I run 31 00:01:37,760 --> 00:01:39,560 a business as well, so I run better. 32 00:01:39,560 --> 00:01:42,200 So Better is a physiotherapy clinic in London. 33 00:01:42,200 --> 00:01:44,800 So we've got a team of physios and personal trainers that are 34 00:01:45,240 --> 00:01:47,600 all hopefully doing the same thing I do and helping more 35 00:01:47,600 --> 00:01:49,720 people all at the same time. That's brilliant. 36 00:01:49,720 --> 00:01:50,880 And you also have a podcast, right? 37 00:01:51,160 --> 00:01:53,080 And that's where we met. That is. 38 00:01:53,960 --> 00:01:57,880 Yeah, so, so you were very gracefully a guest on my podcast 39 00:01:57,880 --> 00:02:00,200 telling, telling my audience about hypermobility. 40 00:02:00,600 --> 00:02:04,800 And yeah, so I host a podcast called the Physio Coach Podcast 41 00:02:05,200 --> 00:02:08,280 and we we're really trying to spread that idea about physio 42 00:02:08,280 --> 00:02:11,039 coaching to other physios just to help people see things a 43 00:02:11,039 --> 00:02:14,120 different way and just spread more good news around around the 44 00:02:14,120 --> 00:02:15,720 community. Well, that's incredible. 45 00:02:15,720 --> 00:02:17,280 And I think language is so important. 46 00:02:17,360 --> 00:02:19,480 I think we spoke about how my first degree was in English 47 00:02:19,480 --> 00:02:23,520 literature and words matter in terms of both how we think about 48 00:02:23,520 --> 00:02:26,520 ourselves and how we interact with patients and, you know, 49 00:02:26,640 --> 00:02:28,240 people and broader aspects of life. 50 00:02:28,240 --> 00:02:31,880 So I'm totally here for that. Now I did look you up online to 51 00:02:31,880 --> 00:02:34,800 do a little bit of background research and I saw that you've a 52 00:02:34,800 --> 00:02:38,400 lot of experience in sports specific settings. 53 00:02:38,400 --> 00:02:39,800 Could you tell me a bit more about that? 54 00:02:39,960 --> 00:02:44,880 So my first passion was sports. So as a kid I played sport any 55 00:02:44,880 --> 00:02:50,240 way I could, anytime I could. And I happened to be a quite 56 00:02:50,240 --> 00:02:52,160 good at school. But I I knew that I really 57 00:02:52,160 --> 00:02:54,240 wanted to be involved in sports. You know, that was the main 58 00:02:54,240 --> 00:02:56,080 thing. So when I was getting to the 59 00:02:56,080 --> 00:03:00,000 point of figuring out my career, it was always about how do I 60 00:03:00,000 --> 00:03:03,400 make sport a part of that I wasn't quite good enough to play 61 00:03:04,200 --> 00:03:06,360 from, which I realised fairly early on, but I knew I'd be 62 00:03:06,360 --> 00:03:09,360 involved some somehow. So I did sports science as my 63 00:03:09,360 --> 00:03:14,080 first degree and that took me on a really great learning journey 64 00:03:14,080 --> 00:03:16,080 actually. I really enjoyed the science of, 65 00:03:16,120 --> 00:03:18,760 of sport and the body, but by the end of it, the career 66 00:03:18,760 --> 00:03:22,680 pathway for that just didn't quite feel fit me and what I 67 00:03:22,680 --> 00:03:24,240 wanted to do. You know, sport, the sport 68 00:03:24,240 --> 00:03:27,000 scientist was quite hard to get into. 69 00:03:27,000 --> 00:03:28,920 There weren't that many of those types of jobs around. 70 00:03:28,920 --> 00:03:31,760 You often had to do like a really cheap internship to, to 71 00:03:31,760 --> 00:03:34,640 get into it. And I, I just felt it wasn't 72 00:03:34,640 --> 00:03:36,760 quite me as well. I'd wanted to be a physio as a 73 00:03:36,760 --> 00:03:39,960 teenager. I liked when I was watching 74 00:03:39,960 --> 00:03:42,080 sports, seeing the physio go on the pitch, help people with 75 00:03:42,080 --> 00:03:44,240 injuries that always look quite a cool thing to do. 76 00:03:45,200 --> 00:03:47,160 I was put off it a little bit actually, which is why I didn't 77 00:03:47,160 --> 00:03:49,400 go for it to begin with. But once I'd done my sports 78 00:03:49,400 --> 00:03:52,240 science degree, it just kept coming back to me that it was an 79 00:03:52,240 --> 00:03:55,800 opportunity or an option for me. So I did a physiotherapy as an 80 00:03:55,800 --> 00:03:58,160 MSE and yeah, it start from there. 81 00:03:58,160 --> 00:04:01,920 And because of the sports passion that my idea was always 82 00:04:01,920 --> 00:04:07,360 to be a sports physio. So I went into a normal physio 83 00:04:07,360 --> 00:04:10,120 job to begin with, but always had my eye on sports roles and 84 00:04:10,120 --> 00:04:14,240 was doing some work in in rugby, in amateur rugby and then 85 00:04:14,240 --> 00:04:16,360 managed to get a role with Saracens. 86 00:04:16,360 --> 00:04:18,680 So I did a season with Saracens Academy. 87 00:04:19,120 --> 00:04:21,680 I also worked with the Football Association in disability 88 00:04:21,680 --> 00:04:25,760 football and football as well. And that that was great. 89 00:04:25,760 --> 00:04:30,120 So I've spent most of my career doing sports on the side, I 90 00:04:30,120 --> 00:04:33,720 suppose as like a side career and then musculoskeletal physio 91 00:04:33,720 --> 00:04:38,000 as my main job. And although I thought I'd be a 92 00:04:38,000 --> 00:04:40,840 full time sports physio, I really love the complexity of 93 00:04:40,840 --> 00:04:43,560 treating the everyday patient, the everyday person, because 94 00:04:44,080 --> 00:04:45,720 they just come with so many cool things. 95 00:04:45,720 --> 00:04:48,080 They're just there's, there's so much more interesting about, 96 00:04:48,240 --> 00:04:51,920 about different people. Whereas athletes are athletes, 97 00:04:51,920 --> 00:04:53,920 you know, they. Yeah, I know. 98 00:04:54,400 --> 00:04:57,120 As high performing and as fun as the as the good stuff in match 99 00:04:57,120 --> 00:05:00,760 day can be, sometimes sitting there watching training isn't so 100 00:05:00,760 --> 00:05:03,800 exciting and watching a gym session and isn't so exciting. 101 00:05:04,360 --> 00:05:07,440 So yeah, the everyday person is just way more interesting and 102 00:05:07,440 --> 00:05:09,200 complex. I love the problem solving that 103 00:05:09,200 --> 00:05:12,280 comes with that. I love that and I did notice as 104 00:05:12,280 --> 00:05:15,240 well in your bio, just looking at online, that you love working 105 00:05:15,240 --> 00:05:17,640 with complex and chronic and treatment resistant injuries. 106 00:05:17,640 --> 00:05:19,680 And I found that really interesting that we have that 107 00:05:19,760 --> 00:05:22,400 passion in common. I have to ask you because I had 108 00:05:22,400 --> 00:05:23,840 a similar thing happen with myself. 109 00:05:23,920 --> 00:05:26,720 I didn't want to and I didn't mean to end up in the field I've 110 00:05:26,720 --> 00:05:29,680 ended up in, should I say, for the economic osteopaths. 111 00:05:29,680 --> 00:05:32,800 So osteopaths do manual therapy and rehabilitative exercises. 112 00:05:32,800 --> 00:05:36,720 Physiotherapists are another type of profession we do as a 113 00:05:36,720 --> 00:05:39,560 profession they have more in common than different, although 114 00:05:39,560 --> 00:05:41,400 of course there are sub specialities and there are 115 00:05:41,400 --> 00:05:43,480 specific types of physiotherapists like stroke 116 00:05:43,480 --> 00:05:46,440 rehabilitation, physiotherapist, respiratory physiotherapy 117 00:05:46,440 --> 00:05:49,200 etcetera, which osteopaths are not trained in. 118 00:05:49,680 --> 00:05:52,520 But as someone who was also put off getting into a kind of 119 00:05:52,520 --> 00:05:55,280 similar line of work, what put you off it? 120 00:05:58,000 --> 00:06:01,280 At the early stage, I mean, yeah, well, it was just I didn't 121 00:06:01,280 --> 00:06:02,320 have a huge amount of confidence. 122 00:06:02,320 --> 00:06:06,560 So when someone, when I was a mid teenager, I guess when they 123 00:06:06,560 --> 00:06:07,480 were saying what do you want to do? 124 00:06:07,480 --> 00:06:09,360 And I said I want to be a physio and they said, oh, you need 125 00:06:09,360 --> 00:06:14,400 really good grades for that. And because I wasn't like super 126 00:06:14,400 --> 00:06:16,680 academic, I was, I would pick things up fairly easily. 127 00:06:16,680 --> 00:06:18,800 But my passion was always sports. 128 00:06:19,240 --> 00:06:21,760 So when my grades were like quite good but not amazing, I 129 00:06:21,760 --> 00:06:24,080 just thought, oh, maybe it's not going to be the thing that works 130 00:06:24,080 --> 00:06:26,480 for me. So yeah, I think I was quite 131 00:06:26,480 --> 00:06:28,640 easily swayed. It was quite a flippant comment 132 00:06:28,640 --> 00:06:32,280 I believe, but it was only when I then did pretty well on my 133 00:06:32,280 --> 00:06:35,360 degree that I thought actually when I put my mind to it, I can 134 00:06:35,720 --> 00:06:38,800 I can achieve just fine. So that it was something that 135 00:06:38,800 --> 00:06:40,960 came later in life. It's interesting in those little 136 00:06:40,960 --> 00:06:43,280 comments kind of such big consequences. 137 00:06:43,280 --> 00:06:47,080 And I, I do think sometimes that some of the most incredible 138 00:06:47,080 --> 00:06:49,880 people in this field, they often are people who come to it later. 139 00:06:49,880 --> 00:06:52,840 Like, everyone has their origin story and I always just find it 140 00:06:52,840 --> 00:06:54,360 quite interesting to get into that. 141 00:06:54,360 --> 00:06:57,920 I'm so happy you ended up here. And I, I can't believe as well 142 00:06:57,920 --> 00:07:00,000 that you, you know, had a little bit of challenges from an 143 00:07:00,000 --> 00:07:03,320 academic perspective, given how much of a wealth of knowledge 144 00:07:03,320 --> 00:07:05,040 you have now. And it just goes to show, like, 145 00:07:05,040 --> 00:07:07,080 how people learn and, you know, develop these skills in 146 00:07:07,080 --> 00:07:09,280 different ways. I think some of it was more 147 00:07:09,280 --> 00:07:11,320 apathy than the lack of ability it was. 148 00:07:12,640 --> 00:07:14,560 Maybe. And and I what you say about 149 00:07:14,560 --> 00:07:17,080 coming to it late, more of it was just like wanting to learn. 150 00:07:17,080 --> 00:07:19,560 I didn't really want to learn until I was a bit older than 151 00:07:19,560 --> 00:07:23,680 maybe some others, so much more interested in just playing and 152 00:07:23,680 --> 00:07:26,400 playing sports or whatever else. So, yeah, when I got to 153 00:07:26,400 --> 00:07:29,000 university, I suddenly realized, hang on a minute, no one's going 154 00:07:29,000 --> 00:07:30,760 to do this unless I really knuckle down. 155 00:07:31,000 --> 00:07:34,200 Yeah, yeah, I got to work there. That's that's so cool and I'm so 156 00:07:34,200 --> 00:07:39,080 happy you ended up here. So without further delay, let's 157 00:07:39,080 --> 00:07:42,040 get into why we're here today. So when I was on your podcast, 158 00:07:42,320 --> 00:07:44,240 we talked about the phrase. It somehow came up, I can't 159 00:07:44,240 --> 00:07:47,360 remember, but we talked about how people say it's just an 160 00:07:47,360 --> 00:07:49,600 ankle sprain. And there was like this moment 161 00:07:49,880 --> 00:07:51,880 where I could tell like we were going to have good vibes. 162 00:07:51,880 --> 00:07:56,240 We connected on that. Tell me a bit about the phrase. 163 00:07:56,240 --> 00:07:58,760 It's just an ankle sprain or, or why that was something that kind 164 00:07:58,760 --> 00:08:01,000 of sparked the whole discussion. Wrapping today, Well it hits me 165 00:08:01,000 --> 00:08:04,600 deep and the reason it hits me deep is because when I was 16 I 166 00:08:04,600 --> 00:08:08,920 had just an ankle sprain and I remember. 167 00:08:08,960 --> 00:08:10,800 So this is before my physio journey of course. 168 00:08:10,800 --> 00:08:15,800 So I play rugby, fairly new into rugby and I was running with a 169 00:08:15,800 --> 00:08:18,680 ball, someone tackled me, they landed, they kind of, I was 170 00:08:18,680 --> 00:08:19,800 running that way. They were, they were kind of 171 00:08:19,800 --> 00:08:21,040 behind me and tackling me from behind. 172 00:08:21,160 --> 00:08:24,440 My ankles then stretched into an open position and I felt an 173 00:08:24,440 --> 00:08:27,000 immediate pop in my ankle with the weight coming down on top of 174 00:08:27,000 --> 00:08:29,560 it. The worst pain I probably ever 175 00:08:29,560 --> 00:08:33,280 felt at that point, really, really, really, really sore came 176 00:08:33,280 --> 00:08:36,039 off the pitch. Pain settled down relatively 177 00:08:36,039 --> 00:08:39,880 quick as an ankle sprain can do. So within, you know, 10 minutes 178 00:08:39,880 --> 00:08:42,799 it was like, OK, it's throbbing, but it's, it doesn't feel that 179 00:08:42,799 --> 00:08:45,360 bad. Managed to hobble to the car and 180 00:08:45,680 --> 00:08:48,240 went to the hospital. And then that was where the 181 00:08:48,240 --> 00:08:50,440 phrase just an ankle sprain was presented. 182 00:08:50,440 --> 00:08:53,160 And it's like, oh, it's OK, it's just an ankle sprain. 183 00:08:54,480 --> 00:08:57,640 And I went away with the advice of keep it moving, roll it 184 00:08:57,640 --> 00:09:00,520 around, stretch it, maybe take it easy for a few days. 185 00:09:01,040 --> 00:09:02,960 You'll be fine. You don't need crutches, just 186 00:09:04,160 --> 00:09:06,360 take it easy and then get back to sport when you feel ready. 187 00:09:07,000 --> 00:09:09,360 It's like, oh OK, you know, nodding my head, I feel very 188 00:09:09,360 --> 00:09:10,280 reassured. Thank you. 189 00:09:10,280 --> 00:09:13,480 NHS triage did. They give you the rice. 190 00:09:13,800 --> 00:09:15,800 Thing they gave you the rice thing yeah. 191 00:09:15,960 --> 00:09:18,880 So rest ice compression, elevate, OK, I'll do that so I'm 192 00:09:18,880 --> 00:09:21,360 nodding my head and thinking OK, I feel I feel confident that I 193 00:09:21,360 --> 00:09:25,520 know what to do here. It was really painful for a few 194 00:09:25,520 --> 00:09:28,480 days, maybe a week and very swollen around the outside of my 195 00:09:28,480 --> 00:09:31,520 ankle. So I had definitely had an ankle 196 00:09:31,520 --> 00:09:35,160 sprain so categorized as, you know, the tearing of ligaments 197 00:09:35,160 --> 00:09:38,120 within the, the, the ankle and that, that had happened. 198 00:09:40,240 --> 00:09:41,960 And I remember thinking, I need to keep moving on it. 199 00:09:41,960 --> 00:09:44,320 And I've got this vision in my head of being in college and 200 00:09:44,320 --> 00:09:47,600 like limping down the, the hallways because it was, it was 201 00:09:47,600 --> 00:09:49,480 just so sore. And I, I'm trying to do my 202 00:09:49,480 --> 00:09:51,040 thing, just keep walking on it, keep moving on it. 203 00:09:52,520 --> 00:09:55,560 And then three months goes by and I'm like, just about like, I 204 00:09:55,560 --> 00:09:57,680 think I'm ready to maybe go back to sport again. 205 00:09:57,680 --> 00:09:59,560 So like 3 months. That's not an insignificant 206 00:09:59,560 --> 00:10:02,360 amount of time. I wouldn't say just could be 207 00:10:02,360 --> 00:10:04,520 attached to three months. You know, you're just going to 208 00:10:04,520 --> 00:10:06,240 be out for three months. So that sounds like quite a 209 00:10:06,240 --> 00:10:08,200 major injury to me. It's a lot, especially when 210 00:10:08,200 --> 00:10:11,520 you're young and you know time feels very long back then. 211 00:10:11,760 --> 00:10:15,480 Yeah, and I did get back to playing sport and played sport 212 00:10:15,480 --> 00:10:18,960 another few months and then I had another just an ankle sprain 213 00:10:18,960 --> 00:10:21,200 on the same ankle. Wait, so how long after the 214 00:10:21,200 --> 00:10:23,160 first injury of. That it was certainly within a 215 00:10:23,160 --> 00:10:28,160 year I had it again and it was ironically on the same pitch 216 00:10:28,160 --> 00:10:30,640 against the same opposition playing the same sport in the 217 00:10:30,640 --> 00:10:34,480 same way. So history repeating itself. 218 00:10:35,200 --> 00:10:37,720 It wasn't quite as painful this time around, which I now 219 00:10:37,720 --> 00:10:40,320 understand is because first one's always going to be the 220 00:10:40,320 --> 00:10:42,440 most painful because you've got the most fibres to snap. 221 00:10:42,480 --> 00:10:45,800 So the one after that that the healing was wasn't as good as it 222 00:10:45,800 --> 00:10:47,880 should have been anyway and we'll get to that with time. 223 00:10:48,560 --> 00:10:50,920 So it still sore and I knew what happened this time, but the same 224 00:10:50,920 --> 00:10:52,680 thing had happened again. And I think this time I was at 225 00:10:52,680 --> 00:10:55,200 university. So I missed a really important 226 00:10:55,200 --> 00:10:58,480 chunk of of my rugby at university because I was just 227 00:10:58,480 --> 00:11:00,240 getting into it, really enjoying my sport. 228 00:11:00,240 --> 00:11:03,120 I just got into the first team and, and I was disrupted by this 229 00:11:03,120 --> 00:11:05,680 injury again, this just ankle sprain that just come back. 230 00:11:07,000 --> 00:11:09,240 I had some physio at the university. 231 00:11:09,320 --> 00:11:12,000 It wasn't particularly, I mean now I look back in hindsight, 232 00:11:12,000 --> 00:11:14,560 it's like it wasn't very good, but I paid £5 for it, you know, 233 00:11:14,600 --> 00:11:18,080 that's pretty, pretty cheap, this highly heavily discounted 234 00:11:18,080 --> 00:11:22,200 subsidized physio. And she gave me a bit of advice 235 00:11:22,200 --> 00:11:24,480 about balancing on it and doing some car phrases. 236 00:11:24,480 --> 00:11:27,680 And from that point it was a bit better. 237 00:11:27,680 --> 00:11:32,080 So I remember having another episode relatively short shortly 238 00:11:32,080 --> 00:11:34,240 after that wasn't that painful, but it kind of gave way. 239 00:11:34,240 --> 00:11:39,120 And, but, but I've mostly got back to rugby and for about 20 240 00:11:39,120 --> 00:11:43,520 years my ankle was mostly fine. It would always feel different. 241 00:11:43,520 --> 00:11:45,880 It would always feel a bit less stable and a bit less strong 242 00:11:45,880 --> 00:11:49,600 than the than the other one. But it was mostly fine until a 243 00:11:49,600 --> 00:11:53,440 year and a half ago. And then I went running, was 244 00:11:53,440 --> 00:11:55,760 running on this really uneven ground and I felt my ankle 245 00:11:55,760 --> 00:11:58,440 really give way again. The same one wasn't that painful 246 00:11:58,440 --> 00:12:00,040 again, but I knew I'd done something. 247 00:12:00,160 --> 00:12:03,240 That's how that feels different. From that point onwards, it was 248 00:12:04,040 --> 00:12:07,080 unstable just in daily life. So I would roll my ankle on the 249 00:12:07,080 --> 00:12:10,120 street. I'd, I'd feel nervous when I was 250 00:12:10,120 --> 00:12:11,880 walking, I'd be looking at the floor a lot more. 251 00:12:12,040 --> 00:12:14,280 When I was out for a run, I'd be looking at for all the time and 252 00:12:14,280 --> 00:12:16,880 it'd roll and give way. But because there were no 253 00:12:16,880 --> 00:12:21,960 ligaments left to, to, to hold it, it would be really LAX. 254 00:12:21,960 --> 00:12:23,240 But it would also not really hurt. 255 00:12:24,160 --> 00:12:28,880 So I made the decision to speak to a sports medicine consultant 256 00:12:28,880 --> 00:12:31,960 who did some scans and at that point, so this is now 20 years 257 00:12:31,960 --> 00:12:35,200 after the original injury, we realised that it wasn't just an 258 00:12:35,200 --> 00:12:39,360 ankle sprain, it was a full rupture of my ATFL ligament, one 259 00:12:39,360 --> 00:12:41,360 of the main ligaments on the outside, a full rupture of my 260 00:12:41,360 --> 00:12:44,520 AITFL ligament, which was the one like they, they would call 261 00:12:44,520 --> 00:12:48,400 that a high ankle sprain and a partial tear of the PITFL. 262 00:12:48,400 --> 00:12:51,520 The one on the back, which we surmised is probably the one I 263 00:12:51,520 --> 00:12:54,200 did recently when I rolled it on the when I was running in the 264 00:12:54,200 --> 00:12:56,040 fields. So at that point onwards, I had 265 00:12:56,040 --> 00:12:58,640 a decision to make around getting surgery to reconstruct 266 00:12:58,640 --> 00:13:01,400 the ankle or whether I could carry on living the way I wanted 267 00:13:01,400 --> 00:13:04,160 to live. And with some thought and a 268 00:13:04,160 --> 00:13:07,760 really long hike later where I did 3 days of hiking and 269 00:13:08,040 --> 00:13:11,440 probably rolled it about 30 times, fell on the floor maybe 5 270 00:13:11,440 --> 00:13:13,080 or 6 times. It was that trip where I 271 00:13:13,080 --> 00:13:15,680 suddenly decided this isn't coping, I'm not coping with this 272 00:13:15,680 --> 00:13:18,640 anymore, I need to do something about it and decided to have 273 00:13:18,880 --> 00:13:22,760 stabilization surgery, which was November last year. 274 00:13:23,200 --> 00:13:24,440 Alrighty. So before I ask you about that, 275 00:13:24,440 --> 00:13:25,800 just to clarify for any listeners. 276 00:13:25,800 --> 00:13:28,520 So you injured the ligaments on kind of the outside of the 277 00:13:28,520 --> 00:13:30,840 ankle, is that correct? And you did a few different ones 278 00:13:30,840 --> 00:13:32,680 essentially, which is a very classic thing to see. 279 00:13:32,680 --> 00:13:35,360 It's often not just one ligament, it's often a few 280 00:13:35,360 --> 00:13:38,280 things going on. You ended up having surgery. 281 00:13:38,520 --> 00:13:40,560 How did that go for you? Because I've seen a few patients 282 00:13:40,560 --> 00:13:43,720 who have having surgery. Not everyone needs to or does, 283 00:13:43,720 --> 00:13:46,200 but when it's the right clinical decision, it's the right 284 00:13:46,280 --> 00:13:48,200 clinical decision generally. Exactly. 285 00:13:48,560 --> 00:13:50,000 Yeah. And, and because I'm a physio, 286 00:13:50,000 --> 00:13:52,960 I, I see these a lot too. And I know that some people 287 00:13:52,960 --> 00:13:55,080 don't need it and they could do really well with rehab. 288 00:13:55,440 --> 00:13:59,320 So I did my exercises and I was doing all of my work and I 289 00:13:59,320 --> 00:14:02,240 could, I could do a single leg pistol squat, I could do a 290 00:14:02,240 --> 00:14:04,120 single leg sit to stand, you know, I could do. 291 00:14:04,480 --> 00:14:06,920 But when I was stable and stationary, my stability was 292 00:14:06,920 --> 00:14:09,000 amazing. But as soon as I was moving 293 00:14:09,000 --> 00:14:12,680 around in the world, the structures weren't strong enough 294 00:14:12,680 --> 00:14:14,280 to hold it. So it would give way all the 295 00:14:14,280 --> 00:14:16,880 time and it would collapse in the most ridiculous of moments, 296 00:14:16,880 --> 00:14:20,240 walking in the road, stepping on something in the gym or just 297 00:14:20,240 --> 00:14:23,600 something really menial. So yeah, the surgery itself went 298 00:14:23,600 --> 00:14:26,920 very, very well. And I'm now feel really 299 00:14:26,920 --> 00:14:30,040 confident and I've been on a similar hiking trip since and I 300 00:14:30,040 --> 00:14:32,400 didn't roll my ankle at all and it felt super strong. 301 00:14:32,400 --> 00:14:33,960 So it, it definitely worked for me. 302 00:14:34,400 --> 00:14:36,520 That's fantastic. It's no insignificant thing. 303 00:14:36,640 --> 00:14:39,560 And that's why I really gave it some thought and it really does. 304 00:14:40,520 --> 00:14:42,800 You know, I'm six weeks non weight bearing with that surgery 305 00:14:42,800 --> 00:14:47,760 in particular, So two young kids and a wife who would prefer me 306 00:14:47,760 --> 00:14:50,960 to be weight bearing at home. You know, there's it's a really 307 00:14:50,960 --> 00:14:53,560 important thing to weigh up. Can you handle the recovery 308 00:14:53,560 --> 00:14:55,480 that's attached to the surgery? Is it worth it? 309 00:14:56,440 --> 00:15:00,280 And no surgery comes without risk as well and so it's a lot 310 00:15:00,280 --> 00:15:02,520 to weigh up. But luckily for me it did go 311 00:15:02,520 --> 00:15:05,640 very well and now I'm back doing everything I want to do. 312 00:15:05,920 --> 00:15:08,720 Well, in simple terms for listeners, what did the surgery 313 00:15:08,720 --> 00:15:10,280 involve? Like how did they try and repair 314 00:15:10,280 --> 00:15:13,920 that ankle? So it was a 2 essentially it was 315 00:15:13,920 --> 00:15:16,120 a double surgery because of the different injuries that I had. 316 00:15:16,120 --> 00:15:19,640 So the the ATFL, which is the ligament lower down on the ankle 317 00:15:19,840 --> 00:15:22,400 on the outside that's reconstructed. 318 00:15:24,640 --> 00:15:27,520 They attach the, the outside chin bone to the to the foot. 319 00:15:28,520 --> 00:15:31,280 And then the the other one is more, more like a wrap. 320 00:15:31,280 --> 00:15:34,120 They kind of surround the two shin bones to, to hold them 321 00:15:34,120 --> 00:15:36,080 together. So you're a big shin bone, the 322 00:15:36,080 --> 00:15:38,200 little shin bone on the outside. I like those names. 323 00:15:38,200 --> 00:15:40,080 And they, and they tighten it, yeah. 324 00:15:40,080 --> 00:15:41,280 And they, they tighten it together. 325 00:15:41,280 --> 00:15:44,480 So there's like a wrap around it and they tie some knots to make 326 00:15:44,480 --> 00:15:46,360 sure that stays there. And I was actually quite lucky 327 00:15:46,360 --> 00:15:50,000 that my, the one of the lower ligaments was, was actually 328 00:15:50,000 --> 00:15:51,360 still in there, the flapping around. 329 00:15:52,640 --> 00:15:55,440 So he said we were quite lucky because he then attached that as 330 00:15:55,440 --> 00:15:57,240 well to the bone. So I've got like a double 331 00:15:57,920 --> 00:15:59,440 repair. On the reinforced repair. 332 00:15:59,440 --> 00:16:01,760 Reinforced repair. So he said not everyone has 333 00:16:01,760 --> 00:16:03,480 that, but because you it happened when you were young, he 334 00:16:03,480 --> 00:16:05,120 said. Like you get all this big like 335 00:16:05,120 --> 00:16:07,680 healing response, although it didn't heal fully, all this 336 00:16:07,680 --> 00:16:09,280 healing response happened, so it was still in there. 337 00:16:09,280 --> 00:16:10,840 So that was quite, quite lucky for me. 338 00:16:11,000 --> 00:16:13,800 Well, that's, that's brilliant. You'll have to tell us more a 339 00:16:13,800 --> 00:16:16,120 little bit later about some of the exercises you did after the 340 00:16:16,120 --> 00:16:17,600 surgery. So I'm guessing there was a long 341 00:16:17,600 --> 00:16:20,600 journey even after that six weeks being off weight bearing. 342 00:16:20,880 --> 00:16:23,200 But getting back to ankle sprains in general, let's talk 343 00:16:23,200 --> 00:16:25,880 about like ankle sprains and hypermobility because we know 344 00:16:25,880 --> 00:16:28,000 there are certain risk factors for ankle sprains. 345 00:16:28,000 --> 00:16:30,440 I'm sure you'll be able to tell me about a few of them, but 346 00:16:30,440 --> 00:16:33,840 being hypermobile or having even just an ankle that's 347 00:16:33,840 --> 00:16:36,160 hypermobile, even if you're someone who doesn't have a 348 00:16:36,160 --> 00:16:39,120 connective tissue disorder involving hypermobility, it's 349 00:16:39,120 --> 00:16:41,200 going to be something that puts you at risk for ankle sprains, 350 00:16:41,200 --> 00:16:42,240 right? For sure. 351 00:16:42,240 --> 00:16:46,520 And, and just starting off with my, my journey, I'm on the bendy 352 00:16:46,520 --> 00:16:48,480 end of normal. So I'm not hypermobile, but I, 353 00:16:48,560 --> 00:16:50,680 but I am quite a flexible person naturally. 354 00:16:50,680 --> 00:16:55,240 So I'm at more risk as a result. And, and then you go further 355 00:16:55,240 --> 00:16:57,360 down that continuum and for sure, like when if you're 356 00:16:57,360 --> 00:17:01,120 hypermobile, you have much more movement that happens through 357 00:17:01,120 --> 00:17:04,359 your ankle joint as a result, just the tiniest little kick off 358 00:17:04,359 --> 00:17:07,720 a of a stone is more likely for, for the muscles to not be able 359 00:17:07,720 --> 00:17:09,760 to handle that that force. So then the ligaments are 360 00:17:09,760 --> 00:17:13,119 exposed and those ligaments are strong, but sometimes they're 361 00:17:13,119 --> 00:17:14,839 not strong enough and they, they might fail. 362 00:17:14,839 --> 00:17:16,800 And that's when you get the tearing of the ligament and 363 00:17:16,800 --> 00:17:19,200 therefore the the pain that comes with an ankle sprain. 364 00:17:20,440 --> 00:17:22,680 So in terms of risk factors, are there any other things you look 365 00:17:22,680 --> 00:17:24,920 for in people? I've read that like asymmetry. 366 00:17:24,920 --> 00:17:26,440 So if you have like a, some people see me, they're like 367 00:17:26,440 --> 00:17:29,560 Alex, I have a great right leg, but my left leg is horrible and 368 00:17:29,560 --> 00:17:31,000 stuff. Or any other risk factors you 369 00:17:31,000 --> 00:17:33,360 kind of screen for when you're looking at patients? 370 00:17:33,480 --> 00:17:39,200 I always look at calf strength, so that for me, the best way to 371 00:17:39,200 --> 00:17:42,840 do that is to compare the height of a two leg calf raise. 372 00:17:42,840 --> 00:17:45,400 So how high their heels are off the ground versus their one leg 373 00:17:45,400 --> 00:17:47,960 calf raise height. So I'm measuring that with a, 374 00:17:48,120 --> 00:17:50,640 just a ruler actually straight out the dental case. 375 00:17:50,640 --> 00:17:52,920 And the two leg is their range of movement. 376 00:17:53,120 --> 00:17:54,640 And then the one leg is their strength. 377 00:17:54,720 --> 00:17:57,160 And if they're weak, their single leg is quite a lot lower 378 00:17:57,160 --> 00:17:59,120 than the double leg. If they're strong, then their 379 00:17:59,120 --> 00:18:01,360 single leg stays at pretty much the height. 380 00:18:01,360 --> 00:18:05,080 Maybe it drops by half or 1 centimeter, but with a weak half 381 00:18:05,120 --> 00:18:07,680 you could get as much as a some people can't even do it if 382 00:18:07,680 --> 00:18:09,720 they're really weak, but anywhere in between really. 383 00:18:10,200 --> 00:18:13,440 So I prefer that test to the just measuring how many calf 384 00:18:13,440 --> 00:18:16,040 raises they can do because they might be able to do the same 385 00:18:16,040 --> 00:18:19,480 amount of reps on each side, but how high are they going matters 386 00:18:19,480 --> 00:18:21,360 more to me. So I first check how high they 387 00:18:21,360 --> 00:18:24,360 go, then I'll count how many reps they can do on a capacity 388 00:18:24,360 --> 00:18:27,240 test like a calf raise. I love that and how sensible it 389 00:18:27,240 --> 00:18:30,000 is, and I'm definitely going to be stealing every use of my 390 00:18:30,040 --> 00:18:33,400 patients when it comes to ankle sprains. 391 00:18:33,600 --> 00:18:36,600 Another thing which has come up in your story in particular is 392 00:18:36,600 --> 00:18:39,760 how a previous ankle sprain can potentially increase your future 393 00:18:39,760 --> 00:18:42,600 risk of ankle sprains. How important do you think, like 394 00:18:42,680 --> 00:18:44,800 medical history is in terms of previous injuries? 395 00:18:44,800 --> 00:18:47,520 If someone's listening to this and they're like, I've had two 396 00:18:47,520 --> 00:18:50,880 ankle sprains or I've had 10, like there's someone who should 397 00:18:50,880 --> 00:18:52,320 kind of be starting to prioritize maybe. 398 00:18:53,240 --> 00:18:55,440 Yeah, it's the biggest. Predictor of future ankle sprain 399 00:18:55,440 --> 00:19:01,160 is to having had a previous ankle sprain the, and what you, 400 00:19:01,160 --> 00:19:03,440 what you actually tend to find is not just that the ankle 401 00:19:03,440 --> 00:19:05,840 sprain increase the risk of ankle sprains, it increases the 402 00:19:05,840 --> 00:19:07,960 risk of lower limb problems, full stop. 403 00:19:07,960 --> 00:19:11,480 So it's much harder for the evidence to track the, the 404 00:19:11,480 --> 00:19:13,280 relevance of that because there's so many different 405 00:19:13,560 --> 00:19:16,640 presentations. But I see it in clinics so often 406 00:19:16,640 --> 00:19:20,480 that they've got a knee or a hip or a, maybe even a back problem. 407 00:19:21,000 --> 00:19:22,880 And you ask them and they say, Oh yeah, I had this anchor 408 00:19:22,880 --> 00:19:24,600 sprain when I was younger. And you watch them move and you 409 00:19:24,600 --> 00:19:26,080 can see it. You can see the lack of 410 00:19:26,080 --> 00:19:28,680 stability on one leg. You can see the calf raise isn't 411 00:19:28,680 --> 00:19:31,200 quite so high. You can see that they, they just 412 00:19:31,200 --> 00:19:33,040 don't move quite so confidently on that side. 413 00:19:33,040 --> 00:19:35,560 So yeah, the, the history is super important. 414 00:19:35,600 --> 00:19:38,880 And the other thing that I, I would scream for is how stable 415 00:19:38,880 --> 00:19:41,080 are they on one leg? So just just get them balancing 416 00:19:41,080 --> 00:19:44,480 on one leg and how, how able are they to single leg sit to stand 417 00:19:44,480 --> 00:19:45,680 kind of, I think I mentioned that earlier. 418 00:19:45,680 --> 00:19:49,920 So just getting them to sit down on a chair, stand back up again, 419 00:19:50,600 --> 00:19:53,000 if they can't do it, then raise the chair up because it just 420 00:19:53,000 --> 00:19:54,840 gives you so much information. What does their foot do? 421 00:19:54,840 --> 00:19:56,880 What does the ankle do? What's the knee and the hip 422 00:19:56,880 --> 00:19:58,120 doing? Does the knee drop inwards? 423 00:19:58,120 --> 00:19:59,600 Does the does the arch thing collapse? 424 00:19:59,600 --> 00:20:00,760 So I'm using a lot of these terms here. 425 00:20:00,760 --> 00:20:03,400 But essentially, does it look strong and stable? 426 00:20:03,760 --> 00:20:05,240 Yeah. And you can do this yourself. 427 00:20:05,280 --> 00:20:08,560 Just get in front of a mirror and and observe it and you'll 428 00:20:08,560 --> 00:20:11,320 see yourself that one might look different to the other. 429 00:20:11,560 --> 00:20:13,920 And if it does look different, can you just try and match the 430 00:20:13,920 --> 00:20:14,720 other side? Can you? 431 00:20:14,960 --> 00:20:17,880 Can you change it yourself? I, this is the physio coach for 432 00:20:17,880 --> 00:20:20,080 me. I, I like people to be able to, 433 00:20:20,080 --> 00:20:21,880 to, to figure out the problems themselves. 434 00:20:21,880 --> 00:20:23,040 Oh, I can see that now. Yeah. 435 00:20:23,040 --> 00:20:24,920 I, when I was just feeling it, I couldn't tell. 436 00:20:24,920 --> 00:20:27,000 But now I'm looking at it and observing it in the mirror. 437 00:20:27,000 --> 00:20:31,600 I can see that. So if you if you try and just 438 00:20:31,600 --> 00:20:34,600 mirror the other side, then you can often just do a lot of the 439 00:20:34,600 --> 00:20:37,040 work yourself without necessarily needing to see a 440 00:20:37,040 --> 00:20:38,480 physio. You know, I think looking. 441 00:20:38,480 --> 00:20:41,600 For those little vulnerabilities in terms of movement, you know, 442 00:20:41,600 --> 00:20:45,160 why does my left leg move this way but my right leg moves this 443 00:20:45,160 --> 00:20:46,640 way? I think that's such a big 444 00:20:46,640 --> 00:20:51,880 opportunity not only for people to try and address or decrease 445 00:20:51,880 --> 00:20:54,440 their risk of future injury if they have had a previous injury, 446 00:20:54,800 --> 00:20:56,600 but also if you're someone like me. 447 00:20:56,680 --> 00:20:59,360 So I've never had an ankle sprain as far as I'm aware. 448 00:20:59,360 --> 00:21:02,240 I've fractured my ankle, but as far as I know I've never had an 449 00:21:02,240 --> 00:21:05,320 ankle sprain. But it's something where I never 450 00:21:05,320 --> 00:21:07,520 want that to happen. My partner has had a lot of 451 00:21:07,520 --> 00:21:09,280 ankle sprain. Similar story to yourself 452 00:21:09,280 --> 00:21:11,920 actually, except so far we've been able to manage him non 453 00:21:11,920 --> 00:21:14,760 surgically and knock on wood he hasn't had an ankle sprain in 454 00:21:14,760 --> 00:21:19,080 like 2 years now. But it's it's something where I 455 00:21:19,080 --> 00:21:22,080 think certainly making it almost a part of your way of life of 456 00:21:22,080 --> 00:21:24,760 hey, like this is a vulnerability or a weakness in 457 00:21:24,760 --> 00:21:26,240 how I move. Can I address this? 458 00:21:26,240 --> 00:21:28,360 Can I make it fun? I think, you know, I love fun. 459 00:21:28,400 --> 00:21:32,080 We've talked about exercises and fun on here before, but I really 460 00:21:32,080 --> 00:21:35,400 think that finding as you, you said earlier when we were 461 00:21:35,400 --> 00:21:37,680 talking like your favorite exercise and just saying, hey, 462 00:21:37,680 --> 00:21:40,480 everyday I'm going to do a single leg balance just because 463 00:21:40,480 --> 00:21:42,280 I know my right leg isn't as good as my left. 464 00:21:42,520 --> 00:21:45,760 That might be something that for some patients can help them just 465 00:21:45,760 --> 00:21:49,320 in a preventative for kind of a healthy body development long 466 00:21:49,320 --> 00:21:50,960 term plan. Yeah, body awareness. 467 00:21:50,960 --> 00:21:53,080 I think is huge here and that's kind of what we're touching on 468 00:21:53,080 --> 00:21:55,480 is just learning what your body is doing and, and getting more 469 00:21:55,480 --> 00:21:57,240 information about what that might mean. 470 00:21:57,840 --> 00:22:00,000 So hopefully that this plants the seed for that. 471 00:22:00,360 --> 00:22:03,440 But but then you get the opportunity to physio with for 472 00:22:03,440 --> 00:22:06,240 free within your day. You know, you're waiting for the 473 00:22:06,240 --> 00:22:08,600 kettle to boil and you're balancing on one leg or doing 474 00:22:08,600 --> 00:22:11,080 your car phrases. You know that not everyone wants 475 00:22:11,080 --> 00:22:14,040 to set aside time for, for their physio exercises. 476 00:22:14,040 --> 00:22:17,680 So I'm I'm fine with that. I don't mind find it somewhere 477 00:22:17,680 --> 00:22:19,520 else, integrate it into another part of your life. 478 00:22:19,520 --> 00:22:22,440 Maybe when you're walking, you notice that suddenly 1 foot 479 00:22:22,440 --> 00:22:23,520 doesn't feel the same as the other. 480 00:22:23,520 --> 00:22:27,320 Can you just be a bit more aware of how that feels and, and just 481 00:22:27,320 --> 00:22:29,640 try and change it when you're walking to the station in the 482 00:22:29,640 --> 00:22:31,040 morning? So there's so many ways of 483 00:22:31,040 --> 00:22:34,080 integrating into your life. A lot of people will go to the 484 00:22:34,080 --> 00:22:37,960 gym and can you integrate an exercise into that rather than 485 00:22:37,960 --> 00:22:41,360 it being feeling like separate? I mean, physio exercises are 486 00:22:41,360 --> 00:22:43,240 inherently boring. They're so boring so. 487 00:22:43,800 --> 00:22:46,520 Can you integrate? It somewhere else so it feels 488 00:22:46,520 --> 00:22:48,880 like you're getting it for free because you're, you're boiling 489 00:22:48,880 --> 00:22:50,920 the kettle anyway and you're climbing the stairs anyway. 490 00:22:51,400 --> 00:22:53,760 Or can you just put it in your jib program where you'd be doing 491 00:22:53,760 --> 00:22:58,720 a warm up perhaps anyway, So I, I'm fully in with, with just 492 00:22:58,720 --> 00:23:01,520 adapting and, and playing these tricks on your brain just so it 493 00:23:01,520 --> 00:23:04,520 can fit into your life somehow. So yeah, I I think it's 494 00:23:04,520 --> 00:23:07,680 important I call them microwave. Exercises. 495 00:23:07,680 --> 00:23:08,880 I don't know. Everyone in the UK has a 496 00:23:08,880 --> 00:23:10,160 microwave. Everyone in Canada has a 497 00:23:10,160 --> 00:23:12,160 microwave. But what are what are your or 498 00:23:12,160 --> 00:23:14,840 what is your kettle exercise or microwave exercise? 499 00:23:14,840 --> 00:23:16,400 Do you do you calf raise? Yeah. 500 00:23:16,520 --> 00:23:20,520 Yeah, yeah, because of my mainly because of my surgery last year 501 00:23:20,720 --> 00:23:23,240 and the last year that there is still a small deficit. 502 00:23:23,240 --> 00:23:25,680 We talk about the calf raise height, my right is still about 503 00:23:25,920 --> 00:23:27,200 a centimetre off where I want it to be. 504 00:23:27,200 --> 00:23:30,720 So I'm doing that calf raise height exercise when I'm waiting 505 00:23:30,720 --> 00:23:32,400 for the kettle to boil. I have to be honest if. 506 00:23:32,400 --> 00:23:34,040 You've made me stressed about my calf raise. 507 00:23:34,040 --> 00:23:37,040 Hi, I'm going to be asking that, yeah, after this, we both have 508 00:23:37,040 --> 00:23:39,160 patients after, but after that I'm going to find you. 509 00:23:39,160 --> 00:23:40,360 We're going to do my calf raise, right? 510 00:23:41,040 --> 00:23:44,000 No, that's just fantastic in terms of going back to ankle 511 00:23:44,000 --> 00:23:46,640 sprain kind of management just for the average listener. 512 00:23:46,640 --> 00:23:49,400 So of course, full medical disclaimer, if you're someone 513 00:23:49,400 --> 00:23:51,520 who has any ankle pain for any reason, this is not medical 514 00:23:51,520 --> 00:23:52,680 advice. You need to go speak to your 515 00:23:52,680 --> 00:23:53,480 doctor. OK. 516 00:23:53,520 --> 00:23:56,680 But the reality is a lot of people, when they get ankle 517 00:23:56,680 --> 00:23:59,800 pain, they go speak to their GP in the UK or their Primary 518 00:23:59,800 --> 00:24:02,760 Health care provider, and they're often kind of dismissed 519 00:24:02,760 --> 00:24:04,920 in a way which I think is a huge problem. 520 00:24:04,920 --> 00:24:07,320 And I'm sure you have the same experience as me or I end up 521 00:24:07,320 --> 00:24:10,600 being that person to kind of try and get them listened to or try 522 00:24:10,600 --> 00:24:13,200 and find a path that makes sense to manage this issue. 523 00:24:13,920 --> 00:24:17,280 If someone has, you know, tried to go down that route and they, 524 00:24:17,280 --> 00:24:19,400 you know, they're relying on the NHS and they've been dismissed, 525 00:24:19,400 --> 00:24:22,120 do you have any advice from them on how to manage that? 526 00:24:22,320 --> 00:24:23,080 You will. Well, that's. 527 00:24:24,160 --> 00:24:27,440 The tricky part is that you go to somewhere like A&E or minor 528 00:24:27,440 --> 00:24:33,000 injuries units expecting just to have the worst case scenario 529 00:24:33,000 --> 00:24:35,440 ruled out. Most people will think I 530 00:24:35,440 --> 00:24:37,720 probably haven't broken it, but I'm really struggling to walk 531 00:24:37,720 --> 00:24:40,760 here and I might type it into Google and what could be going 532 00:24:40,760 --> 00:24:42,520 on. You might have a fracture, you 533 00:24:42,520 --> 00:24:45,440 might have an ankle sprain. In that case, you need to go and 534 00:24:45,440 --> 00:24:48,280 have an X-ray and you get there and you often feel as soon as 535 00:24:48,280 --> 00:24:50,720 they've maybe X-rayed it and said there's no fracture, you 536 00:24:50,720 --> 00:24:52,680 immediately feel like they don't care about you anymore. 537 00:24:52,840 --> 00:24:54,840 You immediately feel like you don't. 538 00:24:54,840 --> 00:24:56,880 And that's the just an ankle. It's just an ankle sprain. 539 00:24:56,920 --> 00:24:59,000 And it's almost like they're rolling their eyes because it's 540 00:24:59,000 --> 00:25:00,880 like there's nothing we can do here. 541 00:25:00,880 --> 00:25:02,440 And what they really mean by that. 542 00:25:02,440 --> 00:25:04,440 And I and I have some sympathy for them, by the way. 543 00:25:04,600 --> 00:25:07,560 Right. That what they mean is we can't 544 00:25:07,560 --> 00:25:10,880 help you in this environment. And the GP would probably fit 545 00:25:10,880 --> 00:25:13,080 into that category. We can't help you in this 546 00:25:13,080 --> 00:25:15,200 environment. You need to see someone who can. 547 00:25:15,360 --> 00:25:16,800 OK. Which is physio. 548 00:25:17,200 --> 00:25:20,800 Yeah. What I believe they should do in 549 00:25:20,800 --> 00:25:26,040 that very moment is here is a boot to keep your, your ankle 550 00:25:26,040 --> 00:25:29,160 fixed at an angle that allows it to heal again. 551 00:25:31,040 --> 00:25:34,520 What you must then do is take this boot off after let's say 4 552 00:25:34,520 --> 00:25:37,600 weeks because about four weeks, the healing will be sufficient 553 00:25:37,600 --> 00:25:38,800 to allow you to live your life normally. 554 00:25:40,560 --> 00:25:43,080 And what that then allows to happen is the ligaments that 555 00:25:43,080 --> 00:25:44,760 have torn right? If those that are watching will 556 00:25:44,760 --> 00:25:47,520 be able to see this, the ligament fibres are, are, are 557 00:25:47,520 --> 00:25:50,080 intertwined. They, they, they pull apart and 558 00:25:50,080 --> 00:25:53,680 tear and then they're separate. If your ankle is there moving 559 00:25:53,680 --> 00:25:58,720 around or like like this, then the the fibers that are like 560 00:25:58,720 --> 00:26:01,760 that never get a chance to lay back over the top of themselves 561 00:26:01,960 --> 00:26:05,920 and attach and heal. So as a result, whatever healing 562 00:26:06,160 --> 00:26:09,560 might happen or doesn't happen is is either really long and 563 00:26:09,560 --> 00:26:11,000 LAX. So that's where instability, 564 00:26:11,000 --> 00:26:13,720 long term instability comes from or not there at all. 565 00:26:14,440 --> 00:26:17,280 And again, that that leads to instability in the ankle. 566 00:26:18,640 --> 00:26:22,320 Again, more sympathy. The reason they struggle to to 567 00:26:22,320 --> 00:26:26,760 get on board with this in the NHS as an A&E GP automatic 568 00:26:27,240 --> 00:26:30,880 treatment pathway is that if you just give a boot to everyone in 569 00:26:30,880 --> 00:26:34,160 these situations, many people will maybe keep it on too long, 570 00:26:34,240 --> 00:26:38,080 get really, really stiff. And when they come out of the 571 00:26:38,080 --> 00:26:40,440 boot they actually have different problems. 572 00:26:40,440 --> 00:26:44,280 Their ankle is too stiff and then they can't get it moving 573 00:26:44,280 --> 00:26:46,720 again because maybe their NHS physio isn't for another three 574 00:26:46,720 --> 00:26:48,440 months. But let's say. 575 00:26:49,280 --> 00:26:52,360 So I understand why they have the, the advice they have 576 00:26:52,360 --> 00:26:56,640 because they, they almost make a deal with, with the situation 577 00:26:56,640 --> 00:27:00,600 and say we'd rather have a LAX ankle than an arthritic ankle 578 00:27:00,600 --> 00:27:01,920 that's too stiff and doesn't move. 579 00:27:02,160 --> 00:27:05,200 Because a LAX ankle still allows some function for for most 580 00:27:05,200 --> 00:27:08,160 people and for for many people, by the way, they heal fine. 581 00:27:09,000 --> 00:27:10,760 But it's the ones that don't that I see. 582 00:27:10,960 --> 00:27:13,440 And then they're the frustrating ones, just like me 20 years 583 00:27:13,440 --> 00:27:16,480 later, who's had to have stabilization surgery that would 584 00:27:16,480 --> 00:27:20,680 have been prevented had I've had a boot for the first four weeks 585 00:27:20,680 --> 00:27:22,960 of my injury, right? And I didn't know any different. 586 00:27:22,960 --> 00:27:24,040 I was just doing what I was told. 587 00:27:24,600 --> 00:27:27,360 However, four years ago, five years ago, I injured my left 588 00:27:27,360 --> 00:27:28,720 ankle. It was actually a more 589 00:27:28,720 --> 00:27:32,640 significant injury, a football injury, another sprain. 590 00:27:32,880 --> 00:27:35,160 Like I said, I'm on the bendy end of normal, so I'm more 591 00:27:35,160 --> 00:27:36,920 likely to have these than the most people. 592 00:27:38,200 --> 00:27:40,320 I was a physio at this time. I knew exactly what to do. 593 00:27:40,880 --> 00:27:44,040 I went to the NHS, minor injuries, checked it wasn't 594 00:27:44,040 --> 00:27:46,760 fractured because I had definite Bony tenderness and I was 595 00:27:46,760 --> 00:27:50,040 struggling to wait there. I was 95% sure it wasn't 596 00:27:50,040 --> 00:27:54,160 fractured but I did what I was supposed to do and when I then 597 00:27:54,400 --> 00:27:58,000 challenged the the triage nurse at the time and said I can I 598 00:27:58,000 --> 00:27:59,720 have a boot. She basically said you don't get 599 00:27:59,720 --> 00:28:03,680 boots for these injuries, you just need to get on with it. 600 00:28:03,680 --> 00:28:05,280 The just word again, you just need to get on with it. 601 00:28:05,280 --> 00:28:07,760 Be careful for a few days. Rest, eyes, compression, 602 00:28:07,760 --> 00:28:09,720 elevation. I tried to have a bit of a 603 00:28:09,720 --> 00:28:11,520 negotiation and said, look, I'm a physio. 604 00:28:11,720 --> 00:28:13,080 I deal with these injuries all the time. 605 00:28:13,080 --> 00:28:15,840 I know that I'm supposed to have a boot here and she was having 606 00:28:15,840 --> 00:28:17,400 none of it. Nope, that's not what we do. 607 00:28:17,400 --> 00:28:19,760 And like, that's her training. But yeah, it was quite a 608 00:28:19,760 --> 00:28:22,040 frustrating conversation to have. 609 00:28:22,720 --> 00:28:26,680 I was lucky to be able to go to the clinic I worked at and get a 610 00:28:26,680 --> 00:28:29,200 boot from there and manage it the way I knew I was supposed 611 00:28:29,200 --> 00:28:35,000 to, with an MRI later showing that I had a big significant 612 00:28:35,120 --> 00:28:38,280 rupture of two of my ligaments and a couple of other partial 613 00:28:38,280 --> 00:28:42,200 injuries with a big bone bruise as well, so a major ankle 614 00:28:42,200 --> 00:28:43,920 injury. I wore the boot for the time I 615 00:28:43,920 --> 00:28:47,120 was supposed to. I rehabbed appropriately and my 616 00:28:47,120 --> 00:28:49,080 left ankle has never had a problem. 617 00:28:49,360 --> 00:28:51,800 So it was about four months when I go back to everything I wanted 618 00:28:51,800 --> 00:28:54,120 to do. Feels amazingly stable, 619 00:28:54,120 --> 00:28:56,640 amazingly strong. Five years ago, not even the 620 00:28:56,640 --> 00:28:59,640 hint of instability. And when you test the ligaments 621 00:28:59,640 --> 00:29:03,000 the way that as physios and osteos would like to do, you can 622 00:29:03,000 --> 00:29:05,200 feel the stability of the ligament where they were given a 623 00:29:05,200 --> 00:29:09,040 chance to heal over the top each of each other and heal short and 624 00:29:09,040 --> 00:29:10,920 tight again. So I've got nice stability 625 00:29:10,920 --> 00:29:13,960 through there. And that's why if you can, if 626 00:29:13,960 --> 00:29:16,000 people can, if they have an ankle sprain, which is a 627 00:29:16,000 --> 00:29:20,720 relatively common injury in, in the for everyone, let alone for 628 00:29:20,720 --> 00:29:26,800 hypermobile people, is to, if they can get hold of a boot and, 629 00:29:26,840 --> 00:29:29,920 and immobilize it for a period of three or four weeks to allow 630 00:29:29,920 --> 00:29:31,720 that initial period of healing to happen. 631 00:29:32,160 --> 00:29:34,640 And after that, they then get moving, maybe see a physio who 632 00:29:34,640 --> 00:29:37,000 can help facilitate their recovery from there. 633 00:29:37,000 --> 00:29:39,200 But if not, just make sure that at that point there then 634 00:29:39,680 --> 00:29:42,840 building up some strength, building up some stability, 635 00:29:43,440 --> 00:29:45,680 stretching through range. And it might be sore and it 636 00:29:45,680 --> 00:29:47,960 might be stiff because that's kind of the point of the boot. 637 00:29:48,640 --> 00:29:51,920 But that's a much more, that's a much more likely scenario to 638 00:29:51,920 --> 00:29:54,400 lead to positive outcomes in a nice state with strong ankle in 639 00:29:54,400 --> 00:29:57,960 the future rather than the case where you have the the laxity 640 00:29:58,040 --> 00:29:59,520 that we're describing in my other ankle. 641 00:29:59,800 --> 00:30:00,600 No, absolutely. I. 642 00:30:00,640 --> 00:30:04,320 Love dumb your hand, our description. 643 00:30:05,040 --> 00:30:06,600 No getting those fibers to be approximate. 644 00:30:06,600 --> 00:30:08,040 I think that's what helps so much. 645 00:30:08,240 --> 00:30:10,800 Having this understanding from a professional perspective of what 646 00:30:10,800 --> 00:30:14,120 healing is actually going on and the fact that those fibers need 647 00:30:14,120 --> 00:30:17,120 to find each other again, and if they keep being pulled apart 648 00:30:17,120 --> 00:30:19,640 from each other, there is no chance for them to find each 649 00:30:19,640 --> 00:30:22,000 other and become friends. Actually, I remember my I. 650 00:30:22,000 --> 00:30:25,240 Remember the the nurse saying 20 years ago, just do this with 651 00:30:25,240 --> 00:30:28,480 your ankle moving around and now look back like how on earth are 652 00:30:28,480 --> 00:30:30,520 those fibers going to get anywhere near each other when 653 00:30:30,520 --> 00:30:32,240 you're just pulling them apart at every moment? 654 00:30:32,240 --> 00:30:33,720 So no, that makes complete sense. 655 00:30:33,960 --> 00:30:38,520 Question for you, are there any ankle sprains where you wouldn't 656 00:30:38,800 --> 00:30:41,320 immobilize someone just in terms of management? 657 00:30:41,320 --> 00:30:44,600 Is there a mild enough category where yeah, yeah, yeah, yeah. 658 00:30:44,600 --> 00:30:47,560 And that's a really good point to make because these are the 659 00:30:47,560 --> 00:30:50,520 ones where there's massive swelling that's happened and you 660 00:30:50,520 --> 00:30:54,920 can just see that massive swelling means big injury, which 661 00:30:54,920 --> 00:30:58,720 means bleeding within the joint and, and with and around the 662 00:30:58,720 --> 00:31:00,560 ligaments. They're the ones where, you 663 00:31:00,560 --> 00:31:02,840 know, a significant structural pathology has happened. 664 00:31:03,360 --> 00:31:06,040 If you just tweak it and it looks a little bit like a golf 665 00:31:06,040 --> 00:31:08,560 ball and then it goes down within a day or so, then it's 666 00:31:08,560 --> 00:31:11,480 not quite so important. You maybe you just soft brace it 667 00:31:11,480 --> 00:31:14,000 in those situations. So it's still a bit of support 668 00:31:14,000 --> 00:31:17,000 there, but it's much more of a soft kind of almost like a a 669 00:31:17,120 --> 00:31:20,880 tight sock that you know that that they might be a better in 670 00:31:20,880 --> 00:31:22,920 between happy medium. Yeah, they're on Amazon like. 671 00:31:22,920 --> 00:31:25,600 The figure of a kind of fabric one, that type of thing. 672 00:31:25,600 --> 00:31:28,280 So I think having seen some big ankle sprains, they look like 673 00:31:28,280 --> 00:31:30,760 balloons for anyone listening, if it looks like your ankle is 674 00:31:30,760 --> 00:31:33,640 like literally like a balloon, that's immediately, you know, 675 00:31:33,640 --> 00:31:36,560 make sure you get that medical attention and push for, you 676 00:31:36,560 --> 00:31:38,640 know, that immobilization if that's something that is 677 00:31:38,640 --> 00:31:40,800 appropriate in your discussion with your healthcare provider. 678 00:31:41,120 --> 00:31:44,080 But make sure that those fibers can have a chance of finding 679 00:31:44,080 --> 00:31:45,320 each other again. I feel like that's the key 680 00:31:45,320 --> 00:31:46,800 message here. And they they. 681 00:31:46,960 --> 00:31:49,720 The first one, especially if you, if this is the first injury 682 00:31:49,720 --> 00:31:52,080 that they might have had, they're the ones that are purple 683 00:31:52,080 --> 00:31:54,880 and blue that the bruising is there because that's the bleed 684 00:31:54,880 --> 00:31:56,360 that's happened where the ligament has failed. 685 00:31:56,400 --> 00:31:59,520 You know, that's it's ruptured, so or at least high grade tear. 686 00:31:59,960 --> 00:32:04,120 So if there is bruising for sure a lot of bruising, then what 687 00:32:04,120 --> 00:32:05,600 else could it be other than a bone? 688 00:32:05,600 --> 00:32:08,360 So once you've had the bone ruled out with X-ray, then 689 00:32:08,400 --> 00:32:12,080 you're left with a very, very likely ligament tear, perhaps 690 00:32:12,080 --> 00:32:15,320 muscle tendon ruptures as well. But again, that'd be screened by 691 00:32:15,320 --> 00:32:16,720 a healthcare professional unchecked. 692 00:32:17,160 --> 00:32:19,760 But if they are saying to you, we believe this is a ligament 693 00:32:19,760 --> 00:32:24,000 tear or rupture or sprain, then that should be immobilized if it 694 00:32:24,000 --> 00:32:25,520 is a significant high grade injury. 695 00:32:25,720 --> 00:32:27,680 Yeah, no. Absolutely. 696 00:32:28,640 --> 00:32:32,280 In terms of ankle sprains, what does long term kind of 697 00:32:32,280 --> 00:32:34,200 management look like because we talked about that, you know, we 698 00:32:34,200 --> 00:32:37,480 have that injury occur, that person who goes to seek care, 699 00:32:37,480 --> 00:32:40,800 hopefully get some appropriate health care, What needs to 700 00:32:40,800 --> 00:32:43,760 happen from there because I find a lot of times it seems like the 701 00:32:43,760 --> 00:32:45,840 ball kind of gets dropped. Yeah, well. 702 00:32:46,120 --> 00:32:49,760 I think in general, physio management can be highly 703 00:32:49,760 --> 00:32:51,600 simplified into these two categories. 704 00:32:51,920 --> 00:32:54,120 So our first job is to calm stuff down. 705 00:32:54,680 --> 00:32:56,880 So that's the protection phase. That's what we're talking about 706 00:32:56,880 --> 00:32:58,600 here. Allow the body to do its thing. 707 00:32:59,040 --> 00:33:02,920 The body is evolutionarily designed to be amazingly good at 708 00:33:02,920 --> 00:33:04,520 healing. It's really good at that. 709 00:33:04,520 --> 00:33:06,560 That's, that's how we are here today and doing what we do. 710 00:33:07,800 --> 00:33:10,760 But what it's not so good at is getting us back to performance 711 00:33:10,760 --> 00:33:15,000 and, and function necessarily unless, unless you're a highly 712 00:33:15,000 --> 00:33:17,600 active person naturally. So that's our job really. 713 00:33:17,600 --> 00:33:20,360 So, so that's the second part of physio's job, which is to build 714 00:33:20,360 --> 00:33:22,880 things back up again. So we calm things down, build, 715 00:33:22,880 --> 00:33:24,960 build them back up again. So we've spoken a bit about the 716 00:33:24,960 --> 00:33:27,600 calming down phase of protection and allowing the body to do it's 717 00:33:27,600 --> 00:33:29,640 thing. And maybe there's there's some 718 00:33:29,640 --> 00:33:34,320 argument for things like rice or as we now use, Yeah, we have to 719 00:33:34,320 --> 00:33:36,000 talk. About right, yeah, there's lots 720 00:33:36,000 --> 00:33:36,840 of. Different acronyms, but 721 00:33:36,840 --> 00:33:39,080 essentially it kind of means the acute management stage is 722 00:33:39,080 --> 00:33:43,800 managed and then you're onto the the recovery part, rehab part. 723 00:33:44,520 --> 00:33:48,200 And because we spoke about the immobilization, you are left 724 00:33:48,200 --> 00:33:50,480 then with muscle atrophy because the muscle will waste away 725 00:33:50,480 --> 00:33:51,840 because if you don't use it, you lose it. 726 00:33:52,040 --> 00:33:55,080 You're left with joint stiffness because if you're immobilizing a 727 00:33:55,080 --> 00:33:56,920 joint deliberately, then it's going to get stiff. 728 00:33:57,160 --> 00:33:59,320 You're left with muscle tightness and tendon tightness, 729 00:34:00,120 --> 00:34:01,880 you're left with a lack of stability. 730 00:34:01,880 --> 00:34:03,600 So the skill of stability is lost. 731 00:34:03,600 --> 00:34:06,560 So you have to learn that again. And and you're left with with a 732 00:34:06,760 --> 00:34:09,719 less fit person as well. So there's even a bit, these are 733 00:34:09,719 --> 00:34:11,880 all the things where we say build things back up again, 734 00:34:11,880 --> 00:34:15,040 although we simplify the, the concept, that's the bit where 735 00:34:15,040 --> 00:34:18,560 your physio needs to be able to do those things with you and 736 00:34:18,560 --> 00:34:20,960 help you to, to navigate whatever you're left with. 737 00:34:21,880 --> 00:34:25,080 So the longer term recovery evolves, making sure you cover 738 00:34:25,080 --> 00:34:28,280 all those bases. So measuring where you're at, 739 00:34:28,320 --> 00:34:30,480 how stiff is it, how tight is it, how big is it? 740 00:34:31,320 --> 00:34:33,760 How big is the muscle? How strong is the muscle? 741 00:34:34,480 --> 00:34:36,560 How stable are you versus the other side? 742 00:34:37,440 --> 00:34:40,639 Lots of different factors that that you would consider how and 743 00:34:40,639 --> 00:34:43,480 not just the muscles are in and around the ankle, but further up 744 00:34:43,480 --> 00:34:45,199 the chain. What the quadriceps, hamstrings, 745 00:34:45,199 --> 00:34:47,840 glutes, what are they all doing? And you don't necessarily have 746 00:34:47,840 --> 00:34:50,000 to have an individual exercise for each of these problems. 747 00:34:50,000 --> 00:34:51,920 You. I'm a big fan of efficiency 748 00:34:51,920 --> 00:34:55,199 within my sessions Yeah, group stuff together, you're good bang 749 00:34:55,199 --> 00:34:57,720 for buck exercises that you can cover lots of different things 750 00:34:57,720 --> 00:35:00,960 all in the same exercise. But there is a process and the 751 00:35:00,960 --> 00:35:03,840 people who follow it and do well, then they're the ones that 752 00:35:03,840 --> 00:35:05,360 have less chance, less risk of injury. 753 00:35:05,880 --> 00:35:08,840 There's a great study from many years ago that I quote all the 754 00:35:08,840 --> 00:35:11,400 time that still seems relevant to me today. 755 00:35:12,240 --> 00:35:15,280 People who don't do any physical rehab after ankle sprain have 756 00:35:16,120 --> 00:35:18,520 about 45 to 50% chance of re injury. 757 00:35:18,760 --> 00:35:22,080 People who do have around 10%. It's a massive difference. 758 00:35:22,240 --> 00:35:24,440 I didn't know that 10. Percent number I knew about the 759 00:35:24,440 --> 00:35:26,920 RE injury risk and chronic ankle and stability. 760 00:35:27,280 --> 00:35:29,800 Before we get on to that, we have to touch on RICE for a 761 00:35:29,800 --> 00:35:32,040 second because there's been this whole thing there was, you know, 762 00:35:32,040 --> 00:35:33,680 RICE. I don't know what is up with 763 00:35:33,680 --> 00:35:36,440 RICE as an acronym, but no acronym has ever been as sticky 764 00:35:36,440 --> 00:35:39,360 as RICE. It is here and it's hard to get 765 00:35:39,360 --> 00:35:42,720 rid of or change. What do you think of RICE for 766 00:35:42,720 --> 00:35:45,800 ankle sprains and is it something that you advise your 767 00:35:45,800 --> 00:35:48,160 patients to do or should they be kind of, you know, you talked 768 00:35:48,160 --> 00:35:50,240 about how the body is good at healing in some ways. 769 00:35:50,240 --> 00:35:54,440 Should we do a bit of a lesser interventional approach for mild 770 00:35:54,440 --> 00:35:56,320 mild ankle sprain, Mild ankle sprain? 771 00:35:56,320 --> 00:36:00,440 OK, well, a mild ankle sprain. Let's go through what it is 772 00:36:00,440 --> 00:36:03,000 Rest, ice, compression, elevation. 773 00:36:03,160 --> 00:36:06,960 So my understanding is that complete rest is bad for 774 00:36:06,960 --> 00:36:11,320 everyone. OK, so relative rest, OK is when 775 00:36:11,320 --> 00:36:14,320 we'll come back to like a slight nuance on that relative rest 776 00:36:14,440 --> 00:36:16,680 That's fine. Do a bit less ice. 777 00:36:17,480 --> 00:36:21,880 If your pain is so bad that you want to take painkillers but 778 00:36:21,880 --> 00:36:24,320 maybe don't want to take painkillers, like we're going to 779 00:36:24,320 --> 00:36:25,800 have to go on a tangent. I hope you don't mind. 780 00:36:26,000 --> 00:36:27,920 OK, I love the tangent. OK, well. 781 00:36:29,160 --> 00:36:32,560 Anti inflammatories very commonly prescribed for people 782 00:36:32,560 --> 00:36:38,240 with musculoskeletal injuries and sprains, especially to help 783 00:36:38,240 --> 00:36:41,960 bring the swelling down. But the evolutionary process is 784 00:36:41,960 --> 00:36:44,840 designed for swelling to support recovery. 785 00:36:45,200 --> 00:36:47,560 Yep. So if you take anti 786 00:36:47,560 --> 00:36:49,840 inflammatories in the in the early stages, and we're talking 787 00:36:49,840 --> 00:36:52,920 about the early days and maybe the first week, then you are 788 00:36:52,920 --> 00:36:55,240 disrupting the healing of the structures. 789 00:36:55,400 --> 00:36:57,080 You're getting in the way of the natural healing. 790 00:36:57,480 --> 00:37:00,760 So when I think about, you know, optimal management and 791 00:37:00,760 --> 00:37:04,440 protection of that early phase, try to avoid anti inflammatories 792 00:37:04,440 --> 00:37:06,480 if you can. And the only reason I would say 793 00:37:06,480 --> 00:37:09,120 that sometimes people need them is if they're not sleeping. 794 00:37:09,440 --> 00:37:12,280 Yeah, so if you're not sleeping because the pain is so bad in 795 00:37:12,280 --> 00:37:15,120 that situation, it makes sense that you would then take anti 796 00:37:15,120 --> 00:37:17,640 inflammatories because sleep overrides it altogether. 797 00:37:17,840 --> 00:37:19,600 You know, that is our superpower for recovery. 798 00:37:19,600 --> 00:37:21,680 So you do need the sleep in order to recover. 799 00:37:21,880 --> 00:37:24,440 But if you could sleep well without anti inflammatories, try 800 00:37:24,440 --> 00:37:28,360 not to take them in the first week, especially after a major 801 00:37:28,360 --> 00:37:30,760 injury. Minor injuries I'm not so 802 00:37:30,760 --> 00:37:32,920 bothered about because it's probably going to heal anyway 803 00:37:32,920 --> 00:37:35,280 regardless of what you do. But just have it in your mind 804 00:37:35,280 --> 00:37:37,120 that it might not be a blanket answer. 805 00:37:37,520 --> 00:37:40,320 And by the way, this is another the ripe of the healthcare. 806 00:37:40,760 --> 00:37:43,160 They they, the healthcare profession in general, the acute 807 00:37:43,160 --> 00:37:45,160 management is here's some anti inflammatories, take them. 808 00:37:45,320 --> 00:37:48,600 Yeah, again, I understand they probably don't have many other 809 00:37:48,600 --> 00:37:51,160 options to help people in pain, but but hopefully the nuance 810 00:37:51,160 --> 00:37:53,200 I've given you there gives some people an option. 811 00:37:53,200 --> 00:37:57,240 And this is where ice does help. If you are struggling with pain 812 00:37:57,240 --> 00:37:59,720 and you have sensibly listened to what I'm saying here and have 813 00:37:59,800 --> 00:38:02,600 decided not to take anti inflammatories, ice is great 814 00:38:02,600 --> 00:38:03,560 pain reliever. Yeah. 815 00:38:04,000 --> 00:38:06,800 What it probably isn't is an anti-inflammatory itself. 816 00:38:07,680 --> 00:38:09,400 So people think of ICE as something that brings swelling 817 00:38:09,400 --> 00:38:11,160 down. The evidence is pretty 818 00:38:11,160 --> 00:38:15,440 unconvinced about that nowadays that it maybe doesn't act as an 819 00:38:15,440 --> 00:38:17,320 anti-inflammatory the way we used to think it does. 820 00:38:17,720 --> 00:38:19,600 What does act as an anti-inflammatory is 821 00:38:19,600 --> 00:38:22,320 compression. That's the C for RICE. 822 00:38:22,440 --> 00:38:25,880 So compress it with some kind of tubi grip bandage wrap. 823 00:38:25,920 --> 00:38:28,240 Not too tight so you cut off the blood circulation, but tight 824 00:38:28,240 --> 00:38:31,200 enough to feel like you've got a compression going on. 825 00:38:31,680 --> 00:38:33,960 That should help with with swelling. 826 00:38:34,840 --> 00:38:37,560 The other thing that is believed to help is elevation and that's 827 00:38:37,560 --> 00:38:40,720 purely physics. You know, gravity will help to 828 00:38:40,760 --> 00:38:43,960 drag the the excess swelling that's maybe not needed for 829 00:38:43,960 --> 00:38:45,720 healing. It will bring it back and also 830 00:38:45,720 --> 00:38:48,080 just optimize the blood flow to the injured area. 831 00:38:48,640 --> 00:38:50,040 Yeah. No, absolutely. 832 00:38:50,040 --> 00:38:52,080 I I was reading too about how important it is to have 833 00:38:52,080 --> 00:38:53,800 elevation. If you're going to do it really 834 00:38:53,800 --> 00:38:55,520 up higher than most people think it is. 835 00:38:55,640 --> 00:38:58,520 It needs to be above the heart to have any effect based on what 836 00:38:58,520 --> 00:39:00,320 I've looked at. I know it's funny. 837 00:39:00,320 --> 00:39:01,960 I'm sure for you growing up too is always like getting. 838 00:39:02,040 --> 00:39:05,120 I was just having bags of peas thrown at me and like ice packs 839 00:39:05,120 --> 00:39:07,760 and I was in a lot of discomfort. 840 00:39:07,760 --> 00:39:10,480 It was making my symptoms worse and it was deeply unpleasant and 841 00:39:10,480 --> 00:39:13,760 not helping me. So, so I think totally it, it 842 00:39:13,760 --> 00:39:16,840 depends on the injury, how it's affecting that person's symptoms 843 00:39:16,840 --> 00:39:19,080 and and what you know the actual presentation is. 844 00:39:19,080 --> 00:39:21,520 And This is why it's key. For, for the explanation here, 845 00:39:21,560 --> 00:39:24,120 It's for pain relief, Yeah. So if it's not giving you pain 846 00:39:24,120 --> 00:39:26,680 relief and it's too cold and it's hurting, then take it off. 847 00:39:27,080 --> 00:39:28,520 Yeah. It's not doing its job. 848 00:39:28,840 --> 00:39:31,800 Don't get an ice burn as well or like 15 minutes, 20 minutes, you 849 00:39:31,800 --> 00:39:34,600 know that definitely no more than that. 850 00:39:34,600 --> 00:39:38,320 Like maybe not even that. So I know people who have had 851 00:39:38,320 --> 00:39:40,120 ice burns and they're not fun. That's why I tell my. 852 00:39:40,120 --> 00:39:42,600 Patients, I'm like do not burn yourself, do not injure yourself 853 00:39:42,600 --> 00:39:44,360 with heat and with ice application. 854 00:39:44,360 --> 00:39:45,480 I say that they think I'm joking. 855 00:39:45,480 --> 00:39:47,560 No, I'm being incredibly serious about this. 856 00:39:48,280 --> 00:39:49,960 Can we go deeper on the? Acronym, Yeah. 857 00:39:50,280 --> 00:39:53,200 So of course we can. So we evolved into from rice 858 00:39:53,200 --> 00:39:56,120 into price. So they added the P, which is 859 00:39:56,120 --> 00:39:58,320 protect. I really like that because we 860 00:39:58,320 --> 00:40:01,200 should be protecting the injury. And that's the bit that I prefer 861 00:40:01,200 --> 00:40:04,200 is is around allowing the injury to do its thing and allow the 862 00:40:04,200 --> 00:40:06,600 body to do its thing. They then got clever and did 863 00:40:06,600 --> 00:40:10,040 police. So police, which is protect OL 864 00:40:10,040 --> 00:40:12,360 optimally load and then the ICE on the end. 865 00:40:12,520 --> 00:40:16,200 So I like the the optimally load rather than rest because it then 866 00:40:16,560 --> 00:40:18,840 suggests that a minor injury, you can still move it. 867 00:40:18,840 --> 00:40:21,040 You don't have to rest, but you're just being sensible. 868 00:40:21,240 --> 00:40:24,120 It gives it the coach of me again, it gives the person. 869 00:40:24,360 --> 00:40:26,600 A decision to make for themselves what feels like the 870 00:40:26,600 --> 00:40:29,360 right amount of load for this, for this injury and for some 871 00:40:29,360 --> 00:40:33,880 injuries is different to others. And then they did Peace of Love, 872 00:40:33,880 --> 00:40:35,720 which I can't even remember all of them. 873 00:40:35,720 --> 00:40:37,400 It's too many letters. Because it gets. 874 00:40:37,400 --> 00:40:39,240 Confusing. And if you look at it, if you 875 00:40:39,240 --> 00:40:41,000 read it, you're like, oh, that's quite cute and that's quite 876 00:40:41,000 --> 00:40:43,080 nice, but I think it gets a little confused. 877 00:40:43,080 --> 00:40:45,080 No one can remember. The V is vascularisation. 878 00:40:45,080 --> 00:40:47,640 I don't know the rest of them, but peace and love. 879 00:40:48,840 --> 00:40:50,480 Is it empathy? Yeah. 880 00:40:51,120 --> 00:40:54,120 So yeah, I think it gets a bit much going back to like the. 881 00:40:54,120 --> 00:40:57,240 Coach and you in mindset, I do have to say, you know, you and I 882 00:40:57,320 --> 00:41:00,080 see people who are down and I think after an ankle sprain in 883 00:41:00,080 --> 00:41:03,240 particular because of how dismissed it can be as an injury 884 00:41:03,240 --> 00:41:05,560 because it's just an ankle sprain, which it's not. 885 00:41:06,280 --> 00:41:08,120 People often have this perspective. 886 00:41:08,120 --> 00:41:11,280 I think that, you know, they're never going to get better and 887 00:41:11,280 --> 00:41:14,280 it's injured. And although the, you know, 888 00:41:14,280 --> 00:41:17,160 general management can be quite poor when patients are 889 00:41:17,160 --> 00:41:19,240 interacting in environments where they're not able to access 890 00:41:19,240 --> 00:41:22,360 care that's appropriate, as your, you know, your personal 891 00:41:22,360 --> 00:41:24,560 story has demonstrated. And as you know, your work with 892 00:41:24,560 --> 00:41:28,080 patients shows they're highly treatable injuries that kind of 893 00:41:28,080 --> 00:41:30,040 good outcomes if we do the right thing. 894 00:41:30,280 --> 00:41:34,320 How do you kind of coach or physio coach your patients in 895 00:41:34,320 --> 00:41:36,400 mindset when they're dealing with an ankle sprain? 896 00:41:36,640 --> 00:41:39,240 Well? I can't help but just lean on my 897 00:41:39,240 --> 00:41:42,640 story again. And it's for 20 years, my ankle 898 00:41:42,640 --> 00:41:46,440 was fine, you know, like it, it recovered well enough to to for 899 00:41:46,440 --> 00:41:49,560 me to play rugby for 15 years, for me to run marathons, for me 900 00:41:49,560 --> 00:41:52,560 to lift heavy weights, you know, to do what I wanted to do and, 901 00:41:52,560 --> 00:41:55,520 you know, climb mountain. So it was coping just fine. 902 00:41:55,520 --> 00:41:56,880 I just knew it was a bit different. 903 00:41:56,880 --> 00:41:59,600 And I think we even mentioned this offline as well, that we 904 00:41:59,600 --> 00:42:02,160 sometimes do have these forever injuries when they're major, 905 00:42:02,160 --> 00:42:04,000 they they, they can't just leave their mark a bit. 906 00:42:04,400 --> 00:42:06,800 And you might just have to do something to keep on top of 907 00:42:06,800 --> 00:42:08,800 those forever. But I was still highly 908 00:42:08,800 --> 00:42:11,040 functioning. It was only that most recent 909 00:42:11,040 --> 00:42:14,600 sprain that I had where I described it running that that 910 00:42:14,600 --> 00:42:17,400 led to me not coping. So that's the key, like are you 911 00:42:17,400 --> 00:42:20,040 coping or not coping? But you're absolutely correct 912 00:42:20,040 --> 00:42:22,800 that the vast majority of these are highly treatable, highly 913 00:42:22,800 --> 00:42:25,160 rehab able. And it's just about identifying 914 00:42:25,160 --> 00:42:28,560 the deficits that are attached to the reason someone is not 915 00:42:28,560 --> 00:42:32,600 able to do what they want to do. And often it's the deficit, the 916 00:42:32,600 --> 00:42:35,520 secondary part of the injury that the weakness, the the lack 917 00:42:35,520 --> 00:42:38,880 of muscular stability or the loss of the skill that happened 918 00:42:39,000 --> 00:42:41,720 after the injury that's more of a problem than the the structure 919 00:42:41,720 --> 00:42:43,400 itself. And they're the bits that are 920 00:42:43,400 --> 00:42:45,640 really treatable. So that's what I'm doing in my 921 00:42:45,640 --> 00:42:48,880 assessments. I'm looking for reasons that 922 00:42:48,880 --> 00:42:51,960 explain the person's symptom and I'm looking for the stability of 923 00:42:51,960 --> 00:42:55,560 the ligament. Has, has it healed long or has 924 00:42:55,560 --> 00:42:56,960 it healed nice and tight and short? 925 00:42:58,200 --> 00:42:59,800 Do they have good stability on one leg? 926 00:42:59,800 --> 00:43:01,400 Do they have all those things we mentioned earlier, calf 927 00:43:01,400 --> 00:43:03,600 strength, range of movement? So that's sufficient for it. 928 00:43:04,080 --> 00:43:05,680 I think we sometimes make a little too much of range of 929 00:43:05,680 --> 00:43:08,320 movement to some degree. You know, most people just need 930 00:43:08,440 --> 00:43:11,000 adequate flexibility. Yeah, you just need enough. 931 00:43:11,720 --> 00:43:14,080 If anything, most people need a bit less if possible. 932 00:43:14,080 --> 00:43:16,720 That's what we're speaking about with people who are hyper mobile 933 00:43:16,720 --> 00:43:19,120 and have lots of flexibility. If anything, a bit stiffer 934 00:43:19,120 --> 00:43:21,280 wouldn't wouldn't be a problem. Yeah, more range. 935 00:43:21,280 --> 00:43:23,560 Means more when you have to be responsible for. 936 00:43:23,560 --> 00:43:27,440 Can you control that, you know, getting to shoulders in a 937 00:43:27,440 --> 00:43:28,640 second? For me, I have very hypermobile 938 00:43:28,640 --> 00:43:31,440 shoulders and I had to build up so much muscle mass just to be 939 00:43:31,440 --> 00:43:32,960 able to control that range of motion. 940 00:43:32,960 --> 00:43:36,240 And the amount of work and rehab it takes is, is huge, I think 941 00:43:36,240 --> 00:43:40,440 for people who are hypermobile getting into kind of long term 942 00:43:40,440 --> 00:43:42,400 management, you know, these people who get chronic ankle and 943 00:43:42,400 --> 00:43:43,800 stability. Could you tell me a little bit 944 00:43:43,800 --> 00:43:46,200 about that? I assume it's something you see 945 00:43:46,200 --> 00:43:48,040 in hyper law patients. I know certainly something I 946 00:43:48,040 --> 00:43:50,800 see. And how do you have any tips on 947 00:43:50,800 --> 00:43:53,240 managing that or when people might need to be aware of that 948 00:43:53,720 --> 00:43:55,320 if I just finish? The final part, then we'll kind 949 00:43:55,360 --> 00:43:57,080 of walk me through. Sorry, please go back. 950 00:43:57,080 --> 00:43:58,040 Because. Because it sort of. 951 00:43:58,240 --> 00:44:01,920 Goes through to it perfect. One of one of our superpowers I 952 00:44:01,920 --> 00:44:04,160 think is healthcare professionals is our ability to 953 00:44:04,160 --> 00:44:08,080 confidently assess and support someone in that listen to them, 954 00:44:08,080 --> 00:44:10,440 understand their problem, confidently assess, give them a 955 00:44:10,440 --> 00:44:14,160 diagnosis and reassure. It is one of our most powerful 956 00:44:14,160 --> 00:44:16,880 treatments to reassure someone with confidence, not just to 957 00:44:16,880 --> 00:44:19,800 flippantly say you'll be fine. You know, it's just an ankle 958 00:44:19,800 --> 00:44:22,360 sprain, you'll be fine. That's not reassurance, that's 959 00:44:22,360 --> 00:44:25,480 dismissing. So if, if we can reassure 960 00:44:25,480 --> 00:44:28,360 someone that here's the right plan for you, we can look after 961 00:44:28,360 --> 00:44:31,480 you, then we move into that kind of long term management of 962 00:44:31,480 --> 00:44:34,240 someone who's had, he's got chronic ankle instability that 963 00:44:34,240 --> 00:44:38,160 we've maybe picking up a little later then they, they need. 964 00:44:38,440 --> 00:44:39,920 But all the stuff we've said already. 965 00:44:40,000 --> 00:44:42,960 So identifying the, the main problems that are leading to 966 00:44:42,960 --> 00:44:47,720 that chronic ankle instability. But most of those do do well. 967 00:44:47,720 --> 00:44:49,720 They do still do well. They don't all need surgery. 968 00:44:50,800 --> 00:44:53,480 In fact, most of them don't. If anything, it's the other way 969 00:44:53,480 --> 00:44:55,760 around. The key is like, are you coping 970 00:44:55,760 --> 00:44:59,320 in your life with what you have? Let's identify the problems, 971 00:44:59,320 --> 00:45:00,640 let's try and solve those problems. 972 00:45:00,640 --> 00:45:03,360 So are you strong enough? Are you stable enough? 973 00:45:03,680 --> 00:45:06,840 Or are you well balanced enough, should we say, to compensate for 974 00:45:06,840 --> 00:45:10,080 the lack of ligament stability? Do you have sufficient range of 975 00:45:10,080 --> 00:45:12,440 movement? Do you have the right level of 976 00:45:12,440 --> 00:45:14,360 muscle power to do the thing that you might be doing? 977 00:45:15,000 --> 00:45:19,320 Are your tendons springy enough? If our physio journey can solve 978 00:45:19,320 --> 00:45:23,120 all of those things and then they don't have instability 979 00:45:23,120 --> 00:45:26,760 episodes anymore, job done. We don't need, we don't need 980 00:45:26,760 --> 00:45:29,360 surgery. I've had many patients though, 981 00:45:29,400 --> 00:45:32,440 and unfortunately it's probably, I say many, I'm thinking of 982 00:45:33,240 --> 00:45:35,640 probably about a dozen patients in my career where we go through 983 00:45:35,640 --> 00:45:38,200 all of those things, they solve all those problems and it still 984 00:45:38,200 --> 00:45:40,720 lacks and they're still having instability moments, me 985 00:45:40,720 --> 00:45:43,680 included. So sometimes there's no failure 986 00:45:43,680 --> 00:45:46,320 of the physio. It's just that your ankle was, 987 00:45:46,360 --> 00:45:48,400 was never quite going to make it really. 988 00:45:48,400 --> 00:45:50,080 And you can't tell which ones they're going to be. 989 00:45:51,400 --> 00:45:54,040 But sometimes the the the ligament or the structural 990 00:45:54,080 --> 00:45:57,600 pathology wins in the end. Yeah, and that's the shame of 991 00:45:57,600 --> 00:46:00,040 it. But there is still a solution 992 00:46:00,040 --> 00:46:02,320 for those people. And surgery can work very, very 993 00:46:02,320 --> 00:46:05,160 well even when your physio rehab hasn't quite done the job, you 994 00:46:05,440 --> 00:46:06,040 know? Absolutely. 995 00:46:06,040 --> 00:46:06,960 I'm. Always shocked at how many 996 00:46:06,960 --> 00:46:10,000 people I see who've had, you know, multiple ankle sprains and 997 00:46:10,000 --> 00:46:11,760 a history of chronic ankle injury where they haven't had 998 00:46:11,760 --> 00:46:14,520 sensible imaging either. So they've just been told, you 999 00:46:14,520 --> 00:46:16,880 know, without any investigations, it's an ankle 1000 00:46:16,880 --> 00:46:18,440 sprain. And it's like, you get them 1001 00:46:18,440 --> 00:46:20,120 imaged and there's something really serious. 1002 00:46:20,120 --> 00:46:24,280 Look at me. 20 years later and I, I didn't really need it prior 1003 00:46:24,280 --> 00:46:26,160 to that other than at the the original injury. 1004 00:46:26,480 --> 00:46:28,440 And they're, they're really just like, wow, that's worse than I 1005 00:46:28,440 --> 00:46:30,400 thought it was. Yeah, I thought I probably had 1006 00:46:30,400 --> 00:46:32,960 an ATFL injury. And then there's two others that 1007 00:46:32,960 --> 00:46:34,040 had picked up. I do have. 1008 00:46:34,040 --> 00:46:36,440 To say for me, this is just one of my clinical management 1009 00:46:36,440 --> 00:46:39,200 decisions, but a traumatic onset plus noise. 1010 00:46:39,400 --> 00:46:41,920 Like for me it's instant. Pretty much do not pass go like 1011 00:46:42,240 --> 00:46:43,560 we're getting. Also, I do work with people who 1012 00:46:43,560 --> 00:46:45,760 are hyper mobile, so my threshold for imaging is much 1013 00:46:45,760 --> 00:46:47,600 lower. I would say I'm very careful 1014 00:46:47,600 --> 00:46:49,800 with that I I nowadays. I'll do the same, yeah. 1015 00:46:50,840 --> 00:46:53,160 We do not mess around. I have a question for you. 1016 00:46:53,160 --> 00:46:55,480 So an analogy I use with my patients, I try to describe to 1017 00:46:55,480 --> 00:46:57,080 them. I say, look, when it comes to 1018 00:46:57,080 --> 00:46:59,640 your ankle, like I think of it there as being a structural 1019 00:46:59,640 --> 00:47:01,280 component, like a race car, for example. 1020 00:47:01,280 --> 00:47:03,560 And then there's you, the race car driver, there's how you 1021 00:47:03,560 --> 00:47:06,440 control the joint and the neurological function basically 1022 00:47:06,440 --> 00:47:08,240 of it. And then there's the actual, you 1023 00:47:08,240 --> 00:47:10,480 know, the ligaments and the bones and the tissues that make 1024 00:47:10,480 --> 00:47:13,120 up the joint. And although we can do a lot of 1025 00:47:13,120 --> 00:47:16,720 exercises where we're trying to develop better a neuromuscular 1026 00:47:16,720 --> 00:47:21,120 control, in some cases that ankle, that race car might be 1027 00:47:21,120 --> 00:47:25,480 so, you know, poorly built or just not functional that even 1028 00:47:25,480 --> 00:47:28,720 with the best race car driver in the world, it's not going to go. 1029 00:47:29,040 --> 00:47:31,640 Are there any like analogies or descriptions or ways that you 1030 00:47:31,640 --> 00:47:34,880 describe things to your patients when it comes to ankles that 1031 00:47:34,880 --> 00:47:38,600 you'd like to share well? I'll use my analogy that I like 1032 00:47:38,600 --> 00:47:43,040 for the body and and pain and injury in general, which I I 1033 00:47:43,040 --> 00:47:45,480 like the garden mentality garden. 1034 00:47:46,240 --> 00:47:50,440 Yeah, so. I sometimes I and I like how 1035 00:47:50,440 --> 00:47:54,200 you've connected to the, the mechanical car to the, to the, 1036 00:47:54,560 --> 00:47:57,200 the biological person, because that's, that's the key. 1037 00:47:57,200 --> 00:48:00,040 And sometimes people think of their bodies as purely 1038 00:48:00,040 --> 00:48:02,720 mechanical. Any pain or any problem I have 1039 00:48:02,720 --> 00:48:06,080 can be fixed or, or not fixed. And if it, if I am still in 1040 00:48:06,080 --> 00:48:07,760 pain, it must be a mechanical problem. 1041 00:48:08,400 --> 00:48:11,000 We won't get into the weeds of chronic pain necessarily here. 1042 00:48:11,000 --> 00:48:13,240 But, but, but it is more complex than that. 1043 00:48:13,240 --> 00:48:17,800 There's it's way more varied as to how pain can present 1044 00:48:18,040 --> 00:48:20,640 absolutely. So hence why I like the garden 1045 00:48:20,640 --> 00:48:23,080 metaphor because I do treat a lot of people with chronic pain 1046 00:48:24,080 --> 00:48:26,440 and it helps people to see that there's so many factors involved 1047 00:48:27,080 --> 00:48:29,880 and you need to have all the right ingredients in order to 1048 00:48:29,880 --> 00:48:32,320 optimize healing. You might. 1049 00:48:32,320 --> 00:48:35,320 So let's try it, let's say. So when I moved into my new 1050 00:48:35,320 --> 00:48:38,640 build house 1314 years ago, we were left with a pile of mud. 1051 00:48:38,800 --> 00:48:41,240 We didn't get grass. We decided we'll, we'll just 1052 00:48:41,240 --> 00:48:42,720 figure that out when we can afford it, right? 1053 00:48:42,720 --> 00:48:44,520 We'll so we didn't get the lawn put down. 1054 00:48:44,520 --> 00:48:47,520 We just had a pile of mud in the garden and I didn't know 1055 00:48:47,520 --> 00:48:50,160 anything about it. So I had to learn and I thought, 1056 00:48:50,160 --> 00:48:52,680 well, we'll just buy some grass seed and we'll just throw the 1057 00:48:52,680 --> 00:48:55,240 grass seed on there. And we had mixed results with 1058 00:48:55,240 --> 00:48:57,120 that. Some grass grew through, some 1059 00:48:57,120 --> 00:48:58,320 didn't. And then we got a load of weeds 1060 00:48:58,320 --> 00:49:00,640 that came through. So we had scratch our heads. 1061 00:49:00,880 --> 00:49:04,200 OK, what do we do next? OK, so some parts of the grass 1062 00:49:04,200 --> 00:49:06,320 are getting loads of sunlight and some are not because of the 1063 00:49:06,320 --> 00:49:08,320 wall in the way. So I'll tell you what, we'll 1064 00:49:08,320 --> 00:49:10,920 just we'll, we'll stop trying to grow grass there and we'll grow 1065 00:49:10,920 --> 00:49:12,760 plants there. So there's some different ones 1066 00:49:12,760 --> 00:49:15,040 there and then we have to figure out a different way. 1067 00:49:15,040 --> 00:49:17,760 OK, They need to be watered. Now we can't just expect them to 1068 00:49:17,760 --> 00:49:19,000 grow. So we have to water them. 1069 00:49:19,000 --> 00:49:21,520 So we need sunlight, the right amount of sunlight, we need 1070 00:49:21,520 --> 00:49:22,920 water and the right amount of water. 1071 00:49:22,920 --> 00:49:26,120 Not too much, not too little. We need the seeds to, to grow. 1072 00:49:26,120 --> 00:49:28,600 We need the plant. Maybe we need to go and manage 1073 00:49:28,600 --> 00:49:29,920 it. We need to go and cut the grass. 1074 00:49:29,920 --> 00:49:32,880 Sometimes we need to trim back some of the plants because 1075 00:49:32,880 --> 00:49:34,600 they're a bit big. Some of it dies because we don't 1076 00:49:34,600 --> 00:49:36,920 quite get it right. So that's, this is part of that 1077 00:49:36,920 --> 00:49:38,640 structural. Sometimes you try your best with 1078 00:49:38,640 --> 00:49:40,160 it and it still doesn't work out. 1079 00:49:40,160 --> 00:49:42,560 You know, I've had many plants that we've bought that have died 1080 00:49:42,880 --> 00:49:45,400 and there's bits of the grass that seem to get more wheat than 1081 00:49:45,400 --> 00:49:48,120 others. So there's it, it needs some 1082 00:49:48,120 --> 00:49:50,560 attention and it, and it needs an awareness that there's so 1083 00:49:50,560 --> 00:49:52,240 many factors involved that we don't, we're not always 1084 00:49:52,240 --> 00:49:56,600 conscious of that. We have to let things happen to 1085 00:49:56,600 --> 00:49:58,600 some degree, the way they're supposed to happen, the way 1086 00:49:58,600 --> 00:50:02,280 biology designed it to happen. But the more we learn about it 1087 00:50:02,280 --> 00:50:05,240 and the more we try to, to learn and get feedback from these 1088 00:50:05,240 --> 00:50:07,640 things, the better we get. So by the time we left that 1089 00:50:07,640 --> 00:50:09,400 house, the grass was pretty good. 1090 00:50:09,400 --> 00:50:11,600 Actually. We had some thriving flowers on 1091 00:50:11,600 --> 00:50:14,480 the, on the outside and the borders because they did well 1092 00:50:14,480 --> 00:50:18,680 in, in slightly sheltered areas. So 10 years later and our garden 1093 00:50:18,680 --> 00:50:20,440 was way better than when we turned up with our mud. 1094 00:50:20,800 --> 00:50:22,800 And I think that's the way we should think about our bodies in 1095 00:50:22,800 --> 00:50:24,560 general, that we have to nurture them. 1096 00:50:24,560 --> 00:50:26,640 We have to accept those things that happen that we don't always 1097 00:50:26,640 --> 00:50:29,760 understand, but if we're mindful of it, we can learn from it and 1098 00:50:29,760 --> 00:50:31,760 we can figure out strategy to solve it. 1099 00:50:32,200 --> 00:50:34,400 I'm just trying to help be the, the gardening expert for 1100 00:50:34,400 --> 00:50:36,960 people's ankles here, right? Just shortcut some of those 1101 00:50:36,960 --> 00:50:39,840 decisions that it took me 20 years to some degree to figure 1102 00:50:39,840 --> 00:50:42,920 out, certainly for my own one, but certainly my physio career 1103 00:50:43,000 --> 00:50:45,280 even that's, that there's a process of trial and error. 1104 00:50:45,280 --> 00:50:49,720 So it's just, and I'm still not done learning with this stuff, 1105 00:50:49,720 --> 00:50:50,960 right? There's still more I can learn, 1106 00:50:50,960 --> 00:50:52,440 both with the garden and ankle sprains. 1107 00:50:53,440 --> 00:50:55,640 I think I'll be coming to you for some gardening tips in the 1108 00:50:55,640 --> 00:50:57,240 future. But you know, I love that 1109 00:50:57,240 --> 00:51:00,000 analogy. I think that idea of looking at 1110 00:51:00,000 --> 00:51:03,920 a failure as an opportunity in a way, and sometimes different 1111 00:51:03,920 --> 00:51:06,400 interventions will be needed. You know, maybe there had been 1112 00:51:06,400 --> 00:51:09,000 something really messed up going off your soil or your pile of 1113 00:51:09,000 --> 00:51:10,640 mud and maybe you needed some new soil brought in. 1114 00:51:10,640 --> 00:51:14,600 You know, some interventions are much more large scale than 1115 00:51:14,600 --> 00:51:18,960 others, but I think that idea of looking at opportunities for 1116 00:51:18,960 --> 00:51:21,640 improvement and, and scope of improvement is key. 1117 00:51:21,640 --> 00:51:24,480 And I think again, that's where a physiotherapist or another 1118 00:51:24,480 --> 00:51:27,440 healthcare provider can come in and say like, Hey, you know, I 1119 00:51:27,440 --> 00:51:30,240 know this injury, this is how we can manage this and, and 1120 00:51:30,240 --> 00:51:31,720 prognosis. I think that's the one thing I'm 1121 00:51:31,720 --> 00:51:34,400 really a stickler for too. I hate when patients get told, 1122 00:51:34,400 --> 00:51:37,040 you know, come once a week for forever and there's no outcome 1123 00:51:37,040 --> 00:51:39,080 measures. Like if you weren't growing 1124 00:51:39,080 --> 00:51:42,080 flowers in that area after three years, you're, you're going to 1125 00:51:42,080 --> 00:51:43,640 be like, what's going on? And you know, you'd probably 1126 00:51:43,640 --> 00:51:45,400 said after one year I'd probably hired. 1127 00:51:45,760 --> 00:51:47,560 Yeah, and be. Sensible. 1128 00:51:47,600 --> 00:51:48,680 Yeah. Sack myself as. 1129 00:51:48,680 --> 00:51:50,000 The gardener and I'll hire another one. 1130 00:51:50,080 --> 00:51:51,800 Yeah, absolutely. Sometimes you have to sack 1131 00:51:51,800 --> 00:51:56,520 yourself question for you when it comes to chronic ankle 1132 00:51:56,520 --> 00:52:00,640 instability and people who are hyper mobile. 1133 00:52:00,640 --> 00:52:03,240 And I guess I, I know you're, you know, you, you're not 1134 00:52:03,240 --> 00:52:05,320 technically as expert specifically in hyper mobility, 1135 00:52:05,320 --> 00:52:08,360 but you see every physio, every osteopath, everyone's seen hyper 1136 00:52:08,360 --> 00:52:11,720 mobile patients. Are there any interventions you 1137 00:52:11,720 --> 00:52:14,440 like to try and just support them in feeling their ankles 1138 00:52:14,440 --> 00:52:16,280 better? Obviously there's exercises, We 1139 00:52:16,280 --> 00:52:20,080 love exercises, but are you a fan of anything like patients 1140 00:52:20,080 --> 00:52:23,720 using tape maybe or other things there, I think. 1141 00:52:23,720 --> 00:52:29,480 Tape is a is a hugely valuable way of supporting the, the, the 1142 00:52:29,480 --> 00:52:31,840 ankle recovery journey in different ways. 1143 00:52:31,840 --> 00:52:34,520 So firstly, if someone comes in to me and they have just 1144 00:52:34,520 --> 00:52:37,000 sprained their ankle, then I mean the just in a different 1145 00:52:37,000 --> 00:52:39,160 way, like literally just, it's just happened. 1146 00:52:39,360 --> 00:52:42,440 Yep, if they come in with a fresh ankle sprain and they 1147 00:52:42,440 --> 00:52:45,240 don't have a boot and I've we've not got one in clinic then I 1148 00:52:45,240 --> 00:52:48,240 will tape it as the immobilisation and I will say 1149 00:52:48,240 --> 00:52:51,680 this, I want you to keep this on for a few days and try and get 1150 00:52:51,680 --> 00:52:53,400 yourself a boot in the meantime. Rigid tape. 1151 00:52:53,680 --> 00:52:55,200 Or OK, OK, cool. Love it. 1152 00:52:55,200 --> 00:52:57,400 Zinc X Zinc. Oxide and this is where my this 1153 00:52:57,400 --> 00:53:00,240 is where my pitch side. Yeah, my sports background 1154 00:53:00,240 --> 00:53:02,360 really helps. So I, I've strapped hundreds of 1155 00:53:02,360 --> 00:53:04,360 ankles in my time so I can fantastic. 1156 00:53:04,360 --> 00:53:07,880 Just just yeah, it should, should be it's tricky to do 1157 00:53:07,880 --> 00:53:10,120 actually, it's quite a difficult technique because you can over 1158 00:53:10,120 --> 00:53:12,440 tighten and and miss the right angles. 1159 00:53:12,440 --> 00:53:14,960 But anyway, that's what one thing I really love doing is 1160 00:53:14,960 --> 00:53:16,480 just helping someone immediately go right. 1161 00:53:16,480 --> 00:53:18,200 This is now protected and safe. Yeah. 1162 00:53:19,040 --> 00:53:22,120 The other end of it if they're getting back into exercise 1163 00:53:22,120 --> 00:53:24,600 again. And I think this is especially 1164 00:53:24,600 --> 00:53:27,240 relevant to people who have more flexibility than the average. 1165 00:53:27,640 --> 00:53:30,440 No matter how much rehab they do, they'll probably still feel 1166 00:53:30,440 --> 00:53:31,880 a bit wobbly and a bit uncertain. 1167 00:53:32,160 --> 00:53:34,280 I think TAPE is a really valuable way of building their 1168 00:53:34,280 --> 00:53:36,800 confidence. I think it's it's especially 1169 00:53:36,800 --> 00:53:39,520 important again, if someone is sporty and it's like a change of 1170 00:53:39,520 --> 00:53:42,480 direction of sport of some sort. I will encourage them. 1171 00:53:42,480 --> 00:53:45,120 I'll either do it for them if I'm seeing them often enough or 1172 00:53:45,400 --> 00:53:47,400 or or teach them how to self tape again. 1173 00:53:47,400 --> 00:53:50,160 That coach again is coming in. Teach them how to self tape and 1174 00:53:50,160 --> 00:53:53,920 say please take for the first month or so of you returning 1175 00:53:53,920 --> 00:53:58,760 into sport or exercise just to reduce that risk of of it 1176 00:53:59,800 --> 00:54:04,680 rolling spraining again in a in a perfectly innocuous way that 1177 00:54:04,680 --> 00:54:07,280 just I just don't want that re injury to happen. 1178 00:54:07,760 --> 00:54:09,720 So the best way to do it is to tape it freely. 1179 00:54:10,000 --> 00:54:12,200 I love how much you. Care about FIFA's ankles, by the 1180 00:54:12,200 --> 00:54:14,960 way, I'm like, if someone of those sprains ankle, you need to 1181 00:54:14,960 --> 00:54:18,040 contact Charlie. You have a deep, I think, a lot 1182 00:54:18,040 --> 00:54:19,400 of empathy. Comes when you've struggled 1183 00:54:19,400 --> 00:54:22,040 yourself, I think, in the expertise plus the empathy. 1184 00:54:22,040 --> 00:54:23,840 Comes when I know how tough it can be. 1185 00:54:24,040 --> 00:54:25,720 And yeah, that's why we're here today. 1186 00:54:26,040 --> 00:54:28,800 I love that you teach. People how to tape, because I 1187 00:54:28,800 --> 00:54:30,640 see so many patients going to have seen other people in this 1188 00:54:30,640 --> 00:54:32,080 field and they haven't been taught how to tape. 1189 00:54:32,080 --> 00:54:34,280 And this is someone who's getting really, really mild 1190 00:54:34,280 --> 00:54:36,080 ankle sprains regularly. Nothing major. 1191 00:54:36,400 --> 00:54:38,960 They're getting some ankle pain or they feel unstable, even if 1192 00:54:38,960 --> 00:54:41,080 the ankles are not actually on unstable. 1193 00:54:41,360 --> 00:54:43,520 And I'm a big fan of saying, you know, we can use this tape to 1194 00:54:43,520 --> 00:54:45,360 give you some more proprioceptive feedback. 1195 00:54:45,360 --> 00:54:47,440 Even if it's not from a, you know, trying to make the joint 1196 00:54:47,440 --> 00:54:49,160 more stable. I want them to be able to better 1197 00:54:49,160 --> 00:54:50,560 feel what's going on in the ankle. 1198 00:54:50,840 --> 00:54:54,240 Do you ever use tape just for kind of proprioceptive purposes? 1199 00:54:54,560 --> 00:54:57,200 Yeah, I. And I just get them to video me 1200 00:54:57,200 --> 00:54:59,840 applying on them and talk. Through it's. 1201 00:54:59,840 --> 00:55:03,840 Like a very simple thing to to do and helps them to go away and 1202 00:55:03,840 --> 00:55:10,000 manage it better. Yeah, I think that if they are 1203 00:55:10,880 --> 00:55:14,800 worried, not sure, not confident than anything to build their 1204 00:55:14,800 --> 00:55:16,960 confidence to be active. You know, ultimately that's the 1205 00:55:16,960 --> 00:55:18,400 headline. In the end, he's like, I want 1206 00:55:18,400 --> 00:55:20,560 people to be active and healthy. So anything that builds 1207 00:55:20,560 --> 00:55:22,320 confidence for that I'm happy about. 1208 00:55:22,320 --> 00:55:25,640 South Kinesia tape is another type of tape which I don't tend 1209 00:55:25,640 --> 00:55:28,360 to use much for ankles. I I just don't think there is 1210 00:55:28,360 --> 00:55:32,280 enough to add to the stability that I'm keen to get. 1211 00:55:32,800 --> 00:55:35,400 But there are still some people that say they like the feeling. 1212 00:55:35,440 --> 00:55:37,800 Yeah of it. A lot of my hypervolpations. 1213 00:55:37,800 --> 00:55:40,920 They they love it. I get hives from say so I'm so. 1214 00:55:40,960 --> 00:55:44,800 Even though I I wouldn't use it as a structural limitation, if 1215 00:55:44,800 --> 00:55:47,880 someone says it feels good, yeah, I'm cool with that. 1216 00:55:47,880 --> 00:55:49,080 That's good enough for me as well. 1217 00:55:49,080 --> 00:55:51,640 So yeah, I don't mind. And even if it's placebo? 1218 00:55:51,640 --> 00:55:53,560 Effect, you know, too, I know I love placebo. 1219 00:55:53,560 --> 00:55:55,400 Effect people always really quick to put things down because 1220 00:55:55,400 --> 00:55:57,200 that powerful placebo it's. Superpowerful. 1221 00:55:57,520 --> 00:56:00,000 They use placebo. To measure drugs against. 1222 00:56:00,160 --> 00:56:03,360 Yeah, They don't say no drug. They use placebo because they 1223 00:56:03,360 --> 00:56:05,920 know that that placebo is a drug in itself. 1224 00:56:06,000 --> 00:56:09,480 Yeah, 20 to 50%. And even when we know it's a 1225 00:56:09,480 --> 00:56:11,480 placebo, it still works. Yeah, those are powerful 1226 00:56:11,480 --> 00:56:12,960 placebos. No. 1227 00:56:13,440 --> 00:56:15,720 Absolutely. When it comes to a flying tape, 1228 00:56:15,720 --> 00:56:17,800 what I will say real quick, just for any hyper mobile listeners, 1229 00:56:17,800 --> 00:56:19,440 is you have to be careful with wounds. 1230 00:56:19,600 --> 00:56:20,960 You don't need puckering of the skin. 1231 00:56:20,960 --> 00:56:23,080 And again, here I'm talking KT tape application. 1232 00:56:23,080 --> 00:56:25,520 I'm not talking rigid tape, I'm talking stretchy tape for 1233 00:56:25,520 --> 00:56:28,440 proprioceptive feedback. But these are people who are 1234 00:56:28,440 --> 00:56:31,040 generally a bit more prone to having things like hives occur 1235 00:56:31,040 --> 00:56:32,880 in different things. So be cautious, talk with your 1236 00:56:32,880 --> 00:56:35,120 healthcare providers and just make sure that you're taping in 1237 00:56:35,120 --> 00:56:37,160 a way that's safe. Also, I'm pretty strict on 1238 00:56:37,160 --> 00:56:38,880 anchors. So that piece of tape that's not 1239 00:56:38,880 --> 00:56:41,000 stretched, a little bit of stretch and then some stretch. 1240 00:56:41,040 --> 00:56:44,760 So I've seen people just yank it and apply it on videos online, 1241 00:56:44,760 --> 00:56:47,360 and I'm just like, Oh my gosh, yeah, that's going to lead to 1242 00:56:47,360 --> 00:56:48,960 bad things. The other thing is the adhesive. 1243 00:56:48,960 --> 00:56:52,600 Is some people are allergic to that and they get real bad 1244 00:56:52,600 --> 00:56:57,000 reactions to it, both the zinc oxide of the rigid stuff and and 1245 00:56:57,280 --> 00:57:01,360 the K tape. If you get a reaction, just take 1246 00:57:01,360 --> 00:57:03,200 it off. It's worth it because it's it 1247 00:57:03,280 --> 00:57:06,960 can really, really scar. So it's not wounds are. 1248 00:57:07,000 --> 00:57:09,440 Wounds are serious stuff. I have a colleague in the field 1249 00:57:09,440 --> 00:57:12,080 who finds Coloplast. It's like a spray that's used 1250 00:57:12,080 --> 00:57:13,880 for colostomy bags. He swears by it. 1251 00:57:14,040 --> 00:57:17,840 I haven't yet tried it, but maybe one day you or I will get 1252 00:57:17,840 --> 00:57:19,360 around to trying it and see if it helps. 1253 00:57:19,360 --> 00:57:21,840 I use the under wrap a lot. For the for the zinc oxide tape, 1254 00:57:21,840 --> 00:57:24,160 just to try and protect the skin as much as I can that the 1255 00:57:24,160 --> 00:57:27,680 hyperfix that that works really well that you can't use it on 1256 00:57:27,680 --> 00:57:29,720 every single part because of that, the tape doesn't do its 1257 00:57:29,720 --> 00:57:32,360 job, but I try and protect it as best as possible. 1258 00:57:32,520 --> 00:57:34,560 One other weird thing I'll. Say is have you ever seen four 1259 00:57:34,560 --> 00:57:37,640 way stretch tape? It's not K tape, it's different. 1260 00:57:37,760 --> 00:57:41,040 I have seen it, yeah. So I do find that some patients 1261 00:57:41,040 --> 00:57:44,920 will get hives to they'll react to K tape and they'll react to 1262 00:57:44,920 --> 00:57:46,640 zinc oxide tape. They won't react to the four way 1263 00:57:46,640 --> 00:57:48,760 stretch tape. I wonder if it's cuz of how it 1264 00:57:48,760 --> 00:57:51,640 moves more with the scan. I have no idea. 1265 00:57:52,080 --> 00:57:54,840 It's expensive, but sometimes I'll just like triple layer, 1266 00:57:54,840 --> 00:57:57,520 double layer it for people where that's appropriate. 1267 00:57:57,520 --> 00:58:00,840 But it's the one type of tape I don't hate or if I should say my 1268 00:58:00,840 --> 00:58:05,000 body doesn't hate when it comes to exercises. 1269 00:58:05,000 --> 00:58:07,040 Just in brief and really simple terms. 1270 00:58:07,320 --> 00:58:10,640 Are there any things you like to think about with patients in, in 1271 00:58:10,640 --> 00:58:11,920 terms of that long term management? 1272 00:58:11,920 --> 00:58:14,280 So you know, there's like 2 footed exercises, 1 foot 1273 00:58:14,280 --> 00:58:17,800 exercises. Any basic kind of thoughts there 1274 00:58:18,640 --> 00:58:20,480 if? If we're thinking really about 1275 00:58:20,480 --> 00:58:24,440 ankle stability and strength here, you develop that, you 1276 00:58:24,440 --> 00:58:28,480 develop stability in particular on, on one leg, it's very two 1277 00:58:28,480 --> 00:58:31,720 leg stuff doesn't really do it because the other leg stabilizes 1278 00:58:31,720 --> 00:58:35,920 for you. So it's like a, it's perfectly 1279 00:58:35,920 --> 00:58:38,200 fine for general strength, but not so much for ankle. 1280 00:58:38,200 --> 00:58:40,920 So you need to be on one leg or at least in split stance. 1281 00:58:40,920 --> 00:58:43,720 You know, split stance can offer some good stability too. 1282 00:58:43,720 --> 00:58:48,040 So I probably start with a split stance exercise actually, and 1283 00:58:48,040 --> 00:58:52,720 then develop into a single leg. I mean the best exercise for it? 1284 00:58:52,880 --> 00:58:55,720 And what's your favorite? Like I'm going. 1285 00:58:55,720 --> 00:58:58,360 To put it out there, I don't really don't like these, but the 1286 00:58:58,360 --> 00:59:01,960 best exercise, the one I give to everyone who has ankle 1287 00:59:01,960 --> 00:59:03,720 instability is a single leg sit to stand. 1288 00:59:04,240 --> 00:59:06,520 How often, Because you can modify it to the person. 1289 00:59:06,520 --> 00:59:08,080 You can. It's always going to be a 1290 00:59:08,080 --> 00:59:11,560 stability challenge and you can modify it to the person. 1291 00:59:11,560 --> 00:59:13,640 You can make it a really high seat, you can make it a really 1292 00:59:13,640 --> 00:59:15,680 low seat. You can get them to hold the 1293 00:59:15,680 --> 00:59:16,880 weight. They can be on a slightly 1294 00:59:16,880 --> 00:59:20,080 unstable surface. It's the best exercise because I 1295 00:59:20,080 --> 00:59:23,720 can modify it to the person and to the demands of their exercise 1296 00:59:23,720 --> 00:59:26,200 goals. So single leg, sit to stand. 1297 00:59:26,200 --> 00:59:28,000 You heard it here. Now that's the best one. 1298 00:59:28,160 --> 00:59:30,120 I love it. And I feel so chuffed. 1299 00:59:30,240 --> 00:59:33,520 I call it a single leg partial death squad. 1300 00:59:34,000 --> 00:59:35,760 Your name is much better than my name. 1301 00:59:36,640 --> 00:59:37,840 But yeah, you can't hide from it. 1302 00:59:37,840 --> 00:59:40,680 All the vulnerabilities show up in regardless of what joint 1303 00:59:40,680 --> 00:59:42,480 they're in. Charlie, this has been 1304 00:59:42,480 --> 00:59:44,800 fantastic. I've kept you for so long. 1305 00:59:44,800 --> 00:59:46,600 Thank you for being on here today. 1306 00:59:47,280 --> 00:59:49,600 Is there any final tip you want to give people? 1307 00:59:49,600 --> 00:59:52,280 If you can go back in time to little Charlie with his first 1308 00:59:52,280 --> 00:59:54,160 ankle sprain. And he's been told it's just an 1309 00:59:54,160 --> 00:59:56,760 ankle sprain. What would you want to tell 1310 00:59:56,760 --> 00:59:58,000 them? Just don't tolerate. 1311 00:59:58,000 --> 01:00:00,760 It just don't. If someone tries to minimize it, 1312 01:00:01,120 --> 01:00:03,360 don't allow it and find someone who's willing to give you the 1313 01:00:03,360 --> 01:00:06,400 time of day for it. And it's up to that person that 1314 01:00:06,400 --> 01:00:08,200 you then go find to solve the problem with you. 1315 01:00:08,200 --> 01:00:11,920 But yeah, don't tolerate someone minimizing an ankle sprain 1316 01:00:11,920 --> 01:00:13,480 because it could be a serious, serious injury. 1317 01:00:14,240 --> 01:00:16,760 Thank you so much. Again, Charlie, and if you're 1318 01:00:16,760 --> 01:00:19,240 looking to find Charlie, we will put all of his details in the 1319 01:00:19,240 --> 01:00:22,400 show notes. He's here in London like me, and 1320 01:00:22,440 --> 01:00:24,640 hopefully we'll be able to have you back another time, maybe to 1321 01:00:24,640 --> 01:00:26,920 talk about chronic pain or something else, who knows. 1322 01:00:27,360 --> 01:00:28,000 You're welcome. Thanks. 1323 01:00:28,080 --> 01:00:29,400 Baby, thank you again, Charlie.