Does a fractured ankle need physiotherapy?

If you have recently broken or fractured your ankle you may have been managed in a number of different ways. The fracture may have been simply supported in a walking boot or stuck in a plaster (a stookie if you want to know what we call it in Scotland). Generally you would be encouraged to weight bear if you have an appropriate type of fracture, this is to encourage bone healing. Sometimes if the fracture is displaced then manipulation and a brace may not be enough and an operation to pin the ankle fracture is required to allow bone healing.

But whichever of these relates to you the one thing we hear from patients, is that after the initial period of support the stookie is taken off and they are generally not offered any physiotherapy. They are encouraged to try to ‘use it as normal’ and in time it will make a good recovery. Now the research (as for many problems) shows that people mostly get back to functioning at the same level at activity whether they have physiotherapy or not, eventually. So most often at the fracture clinic you get a sheet of exercises and sent on your way.

The problem with not having physiotherapy?

Not everyone does their exercises!

Compliance with exercises is always a problem for most self management plans. Some patients simply don’t follow the sheet of exercises and the exercises are not progressed. Patients often just give it little longer and then start trying to run around as normal.

If you don’t know what it should feel like you tend to be more fearful of using it properly!

Given you have just broken your ankle and it was painful, your brain will be more protective than normal and unfortunately patients can become too fearful of using it properly for long periods. We term it fear avoidance. Knowing how much to do and what it should feel like is important (and is often not on the sheet of exercises)

What is normal?

You should have normal range of movement and strength in the ankle before starting to run and jump. But what is normal?

If I am not offered it then I don’t need it?

If the research shows that by a wait and see policy you have managed to get back to full function (even if this is without full strength or range of movement- which may lead to problems in the future) then you can understand why not all patients are offered physiotherapy. But physiotherapy can:

• restore your range of movement and strength within the correct timescale for recovery
• return you to work and hobbies quicker than a simple self management plan
• ensure you make the best recovery possible and don’t run before you can walk (literally!)
• help progress your rehabilitation from simple exercises to more advanced exercises when required
• provide support, reassurance and education to help reduce you fear and empower your recovery

What does a physiotherapist do for a fractured ankle?

Your physio may need to use hands on techniques to mobilise the joints if stiff or even massage any restricted soft tissues, but mostly it will be exercise rehabilitation to improve movement, strength and proprioception. They may be quite simple exercises but are progressed to harder more functionally loaded exercises to take you towards your normal activities. It is only appropriate to return you to running if you want to, need to and used to do it. For some people their own specific goals may simply be being able to walk on rough ground to take their dog out. Not all of our patients are athletes!

But how long will this take?

This does vary depending on the type of fracture and other variables. But within a few sessions we would expect significant improvement (in most cases) and you will be confident in your self management plan leading you to your recovery.

So if you have fractured your ankle and have never felt as though you have made a full recovery or where afraid to do normal activities again then why not give us a call on 0131 478 4646 or book an appointment online.