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Dr. Shawn Thistle
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I Sprained Something - How Long Should I Stay Off It?
THE GLOBE AND MAIL Globe Life | HEALTH & FITNESS | Jockology
I think I sprained something. How long should I stay off it? A broken ankle's no excuse to put your feet up!
By Alex Hutchinson
Globe and Mail
Oct. 15, 2009
The question
Ouch, I think I sprained something. How long should I stay off it?
The answer
Canadian figure skater Anabelle Langlois returned to action last month, earning a bronze medal with partner Cody Hay at a tournament in Germany one year after fracturing her fibula in a training accident. With Olympic dreams on the line, Ms. Langlois's doctors had pursued every possible avenue in her rehabilitation, including two operations.
One thing they didn't recommend, though, was a long period of complete rest for the injured leg.
In the past few decades, doctors have changed their thinking about the best treatment for sports injuries ranging from sprained ankles and pulled muscles to, in some cases, broken bones. After the initial pain and swelling begins to subside - sometimes in as little as a few days - movement and gentle loading of the injured area seems to help muscles heal better, hasten return to full strength, and reduce the risk of recurrence.
That advice remains little heeded, in part because of the very real risks of pushing too soon, and in part because of our natural caution.
"In your head, you want to protect an injury," says Ms. Langlois, who at the urging of her doctor was putting weight on her injured leg within two weeks of surgery, with a still-broken bone and an open surgical wound. "That really surprised me," she says.
The goal of "early mobilization" isn't just to return an injured athlete to competition as quickly as possible. Favouring an injury for too long causes muscles to atrophy from disuse and affects the healing process.
"If an injured muscle heals without any stress being put on it, it will generally heal in a shortened position, and the affected area will be a bit weaker and more fibrotic [from abnormal scar tissue] than the surrounding tissue," says Shawn Thistle, the clinic director of Shape Health & Wellness Centres in Toronto. "It ends up being the weak link when you return to activity."
A study published last year in Histology and Histopathology illustrates the process. Brazilian researchers compared the recovery of rats who rested with others that began moving their legs either one hour or three days after a muscle injury. Both mobilized groups had more regenerated muscle fibres than the controls, but only the early-mobilization group also had a decrease in fibrotic scar tissue.
Humans and rats recover at different rates, so it's impossible to apply these findings directly to humans (and it's equally difficult to find a group of human subjects with identical injuries to conduct a similar experiment), but the same principles apply.
While excessive scar tissue creates problems, recovery should begin with an initial period of immobilization to allow the formation of scar tissue strong enough to prevent the muscle from retearing. During this period, which for mild injuries may last three to seven days, the "RICE" protocol of rest, ice, compression and elevation hastens recovery.
Once the acute phase has passed, activity can progress in a sequence beginning with simply moving the affected muscle through its range of motion, then load-bearing exercises, and eventually functional activities, says Dr. Thistle, who is also a lecturer in the orthopedics department of the Canadian Memorial Chiropractic College.
You can think of it as "MICE" rather than "RICE," where movement replaces rest. Pain can serve as a useful guide to tell you when you're pushing further than you should.
Of course, elite athletes aside, most people won't have a team of physicians carefully monitoring their progress, which makes it risky to push the pace of rehab too much. Any injury in which the initial pain and swelling persists for more than a day or two should be evaluated by a doctor or sports therapist.
But for the milder tweaks that inevitably accompany many sports, it's worth bearing the principle of "active rehab" in mind. Re-establish the full range of motion as soon as possible, and follow up by loading the muscle. Don't push to the point of pain, but don't hobble yourself by protecting an injury long after it's healed.
I think I sprained something. How long should I stay off it? A broken ankle's no excuse to put your feet up!
By Alex Hutchinson
Globe and Mail
Oct. 15, 2009
The question
Ouch, I think I sprained something. How long should I stay off it?
The answer
Canadian figure skater Anabelle Langlois returned to action last month, earning a bronze medal with partner Cody Hay at a tournament in Germany one year after fracturing her fibula in a training accident. With Olympic dreams on the line, Ms. Langlois's doctors had pursued every possible avenue in her rehabilitation, including two operations.
One thing they didn't recommend, though, was a long period of complete rest for the injured leg.
In the past few decades, doctors have changed their thinking about the best treatment for sports injuries ranging from sprained ankles and pulled muscles to, in some cases, broken bones. After the initial pain and swelling begins to subside - sometimes in as little as a few days - movement and gentle loading of the injured area seems to help muscles heal better, hasten return to full strength, and reduce the risk of recurrence.
That advice remains little heeded, in part because of the very real risks of pushing too soon, and in part because of our natural caution.
"In your head, you want to protect an injury," says Ms. Langlois, who at the urging of her doctor was putting weight on her injured leg within two weeks of surgery, with a still-broken bone and an open surgical wound. "That really surprised me," she says.
The goal of "early mobilization" isn't just to return an injured athlete to competition as quickly as possible. Favouring an injury for too long causes muscles to atrophy from disuse and affects the healing process.
"If an injured muscle heals without any stress being put on it, it will generally heal in a shortened position, and the affected area will be a bit weaker and more fibrotic [from abnormal scar tissue] than the surrounding tissue," says Shawn Thistle, the clinic director of Shape Health & Wellness Centres in Toronto. "It ends up being the weak link when you return to activity."
A study published last year in Histology and Histopathology illustrates the process. Brazilian researchers compared the recovery of rats who rested with others that began moving their legs either one hour or three days after a muscle injury. Both mobilized groups had more regenerated muscle fibres than the controls, but only the early-mobilization group also had a decrease in fibrotic scar tissue.
Humans and rats recover at different rates, so it's impossible to apply these findings directly to humans (and it's equally difficult to find a group of human subjects with identical injuries to conduct a similar experiment), but the same principles apply.
While excessive scar tissue creates problems, recovery should begin with an initial period of immobilization to allow the formation of scar tissue strong enough to prevent the muscle from retearing. During this period, which for mild injuries may last three to seven days, the "RICE" protocol of rest, ice, compression and elevation hastens recovery.
Once the acute phase has passed, activity can progress in a sequence beginning with simply moving the affected muscle through its range of motion, then load-bearing exercises, and eventually functional activities, says Dr. Thistle, who is also a lecturer in the orthopedics department of the Canadian Memorial Chiropractic College.
You can think of it as "MICE" rather than "RICE," where movement replaces rest. Pain can serve as a useful guide to tell you when you're pushing further than you should.
Of course, elite athletes aside, most people won't have a team of physicians carefully monitoring their progress, which makes it risky to push the pace of rehab too much. Any injury in which the initial pain and swelling persists for more than a day or two should be evaluated by a doctor or sports therapist.
But for the milder tweaks that inevitably accompany many sports, it's worth bearing the principle of "active rehab" in mind. Re-establish the full range of motion as soon as possible, and follow up by loading the muscle. Don't push to the point of pain, but don't hobble yourself by protecting an injury long after it's healed.
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News & Events
Shawn Speaking @
British Chiropractic Autumn Conference
Kenilworth, England
Sept. 15-16 / 2012
'Do we really provide evidence-informed care?'
'Hip mobility to spare the spine - practical applications for older patients.'
Ontario Chiropractic Assoc.
'Pathways to Practice' Seminar'
Oct. / 2012
Topic to be Announced
BOOK Shawn For Your Event
British Chiropractic Autumn Conference
Kenilworth, England
Sept. 15-16 / 2012
'Do we really provide evidence-informed care?'
'Hip mobility to spare the spine - practical applications for older patients.'
Ontario Chiropractic Assoc.
'Pathways to Practice' Seminar'
Oct. / 2012
Topic to be Announced
BOOK Shawn For Your Event
Testimonials
"Dr. Thistle provides us with a crucial piece of the puzzle when it comes to providing effective patient care. I found his presentation to be extremely informative and immediately applicable in practice. Epicurean Scholar will play an important part in my ongoing continuing education."
Dr. Chad Conaway Hanover, Ontario
NOTE: Shawn spoke to the Grey/Bruce Chiropractic Society Apr. 26 / 2012
Dr. Chad Conaway Hanover, Ontario
NOTE: Shawn spoke to the Grey/Bruce Chiropractic Society Apr. 26 / 2012
"It was by chance I met with Dr. Thistle. I reside in Los Angeles, CA and while visiting family in Toronto, I complained of upper-back and shoulder pain which had been ongoing for three months. My father suggested I go to a chiropractor. I was not enthusiastic. Subsequently, my father took it upon himself to find a chiropractor. Luckily, his online search led to Dr. Thistle, whom I met 24 hours later. He provided immediate relief. Although you can't undo months, weeks or years of issues with one visit and a few adjustments, it is clear to me that my visit with Dr. Thistle was the springboard I needed to get on the right track. Further, I have been pain free since. Dr. Thistle also went out of his way to help find a doctor in Los Angeles. I highly recommend Dr. Thistle to anyone in need of chiropractic care.
Erik B. - Los Angeles"
Erik B. - Los Angeles"
"Through many years of sports and competitive dance, I've had numerous injuries which became chronic. For years I visited many physiotherapists, massage therapists and acupuncturists, but it wasn’t until I was treated at SHAPE that I recognized the remarkable difference. In fact, its almost unbelievable how accurately they can make a diagnosis, and then perform the right treatment for the right injury. Bottom line is they provide results quickly. I can’t tell you how thankful I am to be out of some of the pain I was experiencing for years. If there’s such a thing as a miracle worker – these guys (Shawn and Sender) are it!. The fact that they follow up the next day with a phone call or an email asking how I am doing, speaks volumes for the service!
Heather F."
Heather F."
"I felt I had conquered the world! I placed 17th in my age group out of 90 competitors at the Sarasota International Marathon 2008. A week before, I had to halt my training and was terrified I would not be able to compete. I could barely manage to walk, let alone make it through training runs because my knee pain was so excruciating! I contacted SHAPE, and Shawn came to my rescue! He was able to quickly discover the area bothering me, explain why I was feeling the pain and how to avoid it in future. Without Shawn and his outstanding ability to alleviate pain through ART®, I may not have made it through my warm up on race day! He was genuinely concerned and determined to do whatever possible to make sure I could compete. He is my new HERO!
Jess H."
Jess H."
"I have been very impressed with all of the services I have utilized at SHAPE. The focus on client experience is clearly evident and I am happy to say that I am in much better physical condition overall since starting at SHAPE – greatly reduced back and neck pain since working with Shawn and definitely increased strength and cardio fitness from working with Tuan and Eric as well!"
Matthew M.
Matthew M.
"We are tournament champs! We were ranked #1 out of 40 teams and held our ground - undefeated 7:0. Despite the rain, it was awesome. I played a fair amount of points and felt 100%! Jumping, cutting, diving, and bending low were a breeze - nothing compared to Eric and Gregg's workouts! Tonight I have a game and the legs are feeling excellent. Good job Dr. Thistle - I think I was fixed after the first week! Thanks for making me bionic again!
Mica W."
Mica W."
"I just want to thank you for the treatments I have been getting from you.. The last one has changed my life. Sounds dramatic, I know, but I have finally been able to experience pain-free living for the first time in a long time, so thank you, thank you, thank you."
Phil M.
Phil M.
"I went airborne down a flight of stairs, badly bruising my left thigh and tailbone! It was quite sore and very uncomfortable. Dr. Thistle listened attentively, assessed my injuries and helped loosen and relax my tense glute and lower back muscles. I went in feeling as though I'd been hit by an SUV and walked out feeling limber and hopeful. I seldom entrust my body to chiropractors as I'm usually cautious of having more damage done to me. This is certainly not the case with Dr. Thistle. To ensure I was feeling better after my first treatment, he sent a quick note to check up on me. Hats off to the Dr. Thistles of the world, who put their heart into their work.
Rosa L."
Rosa L."