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Shin, Calf and Ankle Injuries
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Injuries to the ankle, shin and calf are common amongst many different sports. In this area of the body, ankle sprains , calf strains and Achilles tendonitis are particularly frequent and they consequently result in a large number of missed training sessions and games over the course of a year.
Injuries to the shin, calf and ankle fall into 3 categories depending on when they are first recognized and each stage progresses to the next level if not treated; acute, sub-acute and chronic. As a general rule, acute injuries get better quicker and are easier to treat, whereas chronic injuries are harder to recognize and often take longer to resolve. This emphasizes the importance of not ignoring injuries and carrying on playing sport because minor acute injuries in this area can easily turn into sub-acute and chronic injuries and become much harder to treat.
When Should I See a Doctor?
The majority of injuries in the lower leg can be treated at home using the P.R.I.C.E. principles and progressive return to sport +/- exercises. However, there are some occasions when you should see a doctor or specialist.
If you have any of the following symptoms you should seek further medical assistance.
Severe pain in the injured shin or ankle, especially on walking.
- Severe swelling (oedema) either in the lower leg or in surrounding joints/muscles.
- Altered sensation in the shin or foot – such as a feeling of “pins and needles” (paresthesia) or a “numbness” (anaesthesia).
- Obvious deformity in the bones around the shin or ankle indicating a break (fracture).
- Unable to complete your normal daily activities (not including sport) after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.
In the first instance, if you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Also, if your ankle gives way whilst walking or feels loose (“unstable”) then you should consult your doctor or visit A&E.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your shin/ankle, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.
Immediate First Aid for All Injuries
Most injuries can be treated in the early stages at home using the P.R.I.C.E. principles. This treatment regime should be applied at home for at least the first 2 - 3 days once an injury is sustained. P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation.
- Protection - Protect the injury from further damage. Where applicable, use of a support is recommended.
- Rest - Refrain from exercising and try to reduce the demands of your daily activities to encourage healing and a fast recovery.
- Ice - The topical application of ice or cold therapy can assist in reducing the symptoms of pain and inflammation.
- Compression - The use of applied pressure and compression bandages can help reduce swelling.
- Elevation - Keeping the injured area elevated above heart level when possible can and help reduce swelling by encouraging the fluid to drain away from the injured area and back into the centre of the body.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is using a support or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.
The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:
- Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
- Reduces pain (pain gate theory)
- Reduces muscle spasm
- Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.
Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).
See P.R.I.C.E. page