Ankle Sprains – “sprains” or ligament injuries of the ankle joint occur frequently in both sporting and non-sporting situations. The dual role of the ankle in weight-bearing and in mobility make it particularly susceptible to injury. Ligament damage can take several forms ranging from minor to major damage

• Grade 1- mild sprain with no instability.

• Grade 2 – incomplete tear with mild instability.

• Grade 3 – ligament rupture with significant instability.

Injury to ligaments will cause pain and inflammation and possibly limit future function if correct rehabilitation is not carried out.

At Cardiff Bay Physiotherapy Clinic advice will be given on the speed of progression of strength, movement control and proprioception (balance) exercises. Progression is not just about being able to do the exercise but to do it correctly, with appropriate control. Remember poor practice leads to poor performance and potential strain on your injury.

Groin Strains – As there are more than 22 muscles on each side of the pelvis along with their associated tendons, the term “groin injury” is often used as a general description of injury to one of these structures. There are overlying stomach and abdominal muscles which add further pulling forces to the pelvis.

• The most common cause of groin pain in soccer players is strain of the adductor muscles of the leg at the tendon and muscle junctions.

• Groin strains are common in soccer and in the 95/96 season sidelined more than four Premiership teams (45 players)

 Often these injuries are caused by an imbalance of muscles or lack of stability around the pelvis and unless this is addressed, further problems can be had in the future leading to more injuries and time off playing.

Hamstring Strains – The hamstring muscle group is found in the back of the thigh and consists of three muscles. They are described as two-joint muscles because their contraction results in movement at both the hip and the knee. This makes them particularly vulnerable to injury. Muscle damage can take several forms ranging from minor to major damage.

• Grade 1 - minor tear of a few fibres.

• Grade 2 – tearing of more fibres but muscle still intact.

• Grade 3 – total rupture of muscle.

Any injury to muscle will cause pain and inflammation and possibly limit future function if not rehabilitated correctly, due to formation of scar tissue and residual weakness.

You need to regain strength and flexibility in the hamstring muscles in a progressive controlled manner moving from static to dynamic strengthening before going onto sport specific drills.

Achilles Tendinosis – Achilles tendinosis is a condition that affects the lower end of your Achilles tendon (behind your ankle) which connects your calf muscle to your heel. It involves degeneration of the tendon and is common in men.

The symptoms include:

• A gradual onset of pain during and after exercise over the tendon

• Stiffness in the morning

• Pain when doing a heel raise

It is important that this injury is not allowed to become a long-term problem which may lead to permanent tendon damage.

Proprioception (joint position sense) and dynamic control of the ankle need to be improved through a progressive exercise program designed individually by the physiotherapist.

Sinus Tarsi Syndrome - This is a common problem of the ankle, particularly in runners. It results from trauma or from repeated movements that are biomechanically incorrect. The condition affects the ankle joint which is very important because it is essential in taking the weight of the body and dispersing it through the foot. It is also responsible for producing and controlling many of the movements that can occur in the foot. The joint is supported by thick ligaments between the bones that sit forming a tunnel through the joint. Sinus tarsi syndrome is chronic inflammation of these ligaments.

Shoulder Impingement syndrome - pain from the shoulder is common and the pain may either be close to the joint or may radiate down the arm. It is often caused by a pinching of soft tissue structures under the tip of the shoulder, which may become inflamed. This is called impingement. As the arm is moved into certain positions, or load is taken through the arm, the structures become more pinched and the pain is increased.

The condition can be caused by some type of injury, however, in most cases it begins slowly as a result of the way you move and the way you hold your upper body and arm. Your whole posture can affect your shoulder and treatment will need to address not just the local shoulder area but also your neck, upper back and sometimes even your lower back and legs.

Certain muscles around your shoulder may be used too much and other not enough, causing an alteration in the way the joint moves. Even seemingly minor changes in the coordination between these muscles an have a serious affects on the soft tissue within your shoulder. To recover from this problem you will have to relearn how your shoulder and shoulder blade should move to re-establish coordination between these muscles.

Knee pain – Patellofemoral pain syndrome is a condition which affects the knee cap (patella) and the structures which support it, as it passes up and down the groove in the thigh bone, during bending and straightening the knee. Pain is caused because the patella no longer tracks correctly up and down the groove, this places greater strain on the supporting structures and the joint surfaces. This mal-tracking of the patella may be caused by a number of factors such as the alignment of your lower limb during movement, weakness in the quadriceps and lack of flexibility in muscles of the leg. An exercise program can be designed at the clinic to help correct these problems.

ACL Rehabilitation – The Anterior Cruciate Ligament (ACL) is one of the most important ligaments of the knee. It plays a crucial role in the locking and unlocking of the knee and excessive movement of the tibia (shin bone) on the femur (thigh bone), both in a forwards direction and in rotation. Without the ACL stabilising knee movements and providing proprioceptive feedback, the knee can become unstable during functional or sporting activities causing further trauma to the knee.

A program to improve strength around the knee and increase proprioception (feedback from the joint) can be taught at the clinic.