When the physiotherapist meets with her the day after her walk, he clarifies that she didn’t trip or roll her ankle again. He notices she is walking without limping. Her ankle movement is painful but equal to her other side. There is no change in colour, temperature or skin changes. He retests her ligaments and they are somewhat aggravated but no laxity is detected. After a thorough understanding of Sally’s activity in the last 24 hours and a normal objective exam, the physiotherapist is able to confidently reassure Sally that her increase in pain is related to increased activity and that she has not reinjured the ankle. He explains that it is normal to have soreness when resuming normal activity. The fact her pain gradually decreased in the hours following her walk and had fully resolved by the next morning speaks to pain related to increased activity beyond the tissue tolerance. Furthermore, there are no signs of damage, such loss of ROM, gross swelling, redness or increased temperature. She is also able to fully weight bear through that foot and ankle.
Fast forward to six months later, Sally decides she would like to start running. She has completed her treatment with her physiotherapist and is feeling 100%. She hasn’t had ankle pain in four months. She goes for her first run and is able to run for 15 minutes before guess what?? Her ankle starts to hurt. She asks herself, why is this happening? Should she be fearful, abandon running completely and resolve that because she sprained her ankle she will never run again? Or is this a normal physiological response to a new activity?
She decides to walk the rest of the way home. The pain subsides. She notices she is not limping and she is able to go up and downstairs without incident. She is leaning toward the conclusion that perhaps she is just not used to running and nor is her ankle. She decides to try running the day after tomorrow. She was able to run 17 minutes before that pain came on and it wasn’t as intense as Day 1. She decides to follow-up with her physiotherapist.
After thoroughly understanding Sally’s recent activity and performing a detailed physical examination including a running technique assessment, her physiotherapist concludes Sally has a good running technique and her foot and ankle exam is normal. He reassures her that she is safe to run and together they design a plan to meet her goal of a 10 km fun run to raise money for the local children’s hospital in two months. Sally is so excited she doesn’t have to abandon her bucket list goal of running a 10 k. She understands now that it can be normal to have a temporary increase in symptoms with new and/or increasing activity. She also knows what signs to look for that would indicate she needed to seek attention from her physiotherapist or physician.
~ Lisa Lepage, Physiotherapist