Flabby of the UK reporting for duty!

[Naturally]

Hi guys,

I'm 100% new and don't know my way around, but somebody on my fitness pal recommended it over here and I think it seems to talk common sense. I'm here because I want to lose weight - stones of it - and to work out smarter, because in truth my knowledge extends as far as "I should do weights. But I like cardio. But my leg doesn't stand up to it. I've got no time. Bummer." ENOUGH! I saw the intoduction video and though this makes sense... I can do this sort of thing and fit it into my day - hurrah!

I joined the forums because I'm after advice about working out in spite of my ankle. Long story short I broke it - badly - about a year ago, and have to be very careful about exercising now, since a) it doesn't flex like it used to, so e.g. I couldn't do the beginners squats as per the video, I'd either have to squat more shallowly or allow my heel off the floor, and if I do much on it it swells up (lots) and I'm lame on it for a couple of days later. Too much in my case includes a 1 hour zumba class, even when I took the jumps out of it Found all this out to my detriment, as my head doesn't want to admit that I still have limitations and I jump in with things like Thai boxing and Zumba and then have to go to my GP and get told off again

...That was the short version(!) so in short, where can I get me some help and ideas from people who have been in the same boat as me, injury-wise?

[ebm1224]

first off, welcome to the community! secondly, what does your doctor say about your injury - will it eventually go back to normal movement? are there exercises/stretches you can do to help it? or is this a pretty permanent thing?

lastly, the main goal is to find things you can do an enjoy. maybe your ankle isn't ready for an hour of zumba...maybe try 15 minutes and see how you feel the next day. a friend of mine tore his acl about 18 months ago and it took about a year to rehab. you just have to adjust while you're healing. can't do a full squat? go as low as you can with heels on the ground (and good form). gradually, your flexibility will increase. biking and swimming are great for join injuries. try a spin class. also, yoga and pilates might be a good fit as well.

hope that helps - glad you're here!

[Naturally]

Thanks for the welcome!

Doctor and physio have signed me off as "back to normal" with instructions to keep on doing mobilisation and stretching work, and to gradually add a bit more at a time, which means what you're saying makes perfect sense, I just didn't think about going to a zumba class and only doing 15 minutes, but perhaps I should! Consultant did originally say it would take up to 2 years until I didn't notice it any more.

It starts off stiff and mobilises better throughout exercise, likewise through the day. Funny you should mention pilates and swimming, as I enjoy both and have found I am able to do both with no problems, I had forgotten about that so thanks, I should book back in to the pilates class and take up swimming again.

Just off to try my first set of circuit reps following the instructions from this website...

[ETFnerd]

Welcome to nerd rehab... looking fwd to seeing what happens... people like and have had success doing cardio using the rowing machine which puts less pressure on your ankles...

[Oz.]

Doing squats should help mobility?

If its swelling up from use, thats not really back to normal! It might well be worth seeing a physio.

Where abouts in the UK are you? Need more of us all up in this place!

[m00se]

Do you have metalwork in your ankle? Did you have metalwork in your ankle? Do you know precisely what you did to it? A bad bimalleolar fracture will still swell through use for a year or more. Did you complete your physio? Do you still do the exercises they gave you? You should definitely be able to get into weightlifting, if you're sensible about it. One of my patients had large amounts of metal in his ankle for two years, then had it removed and is now lifting heavy as part of his rehab.

Ankle mobilisation exercises will help with letting you get back to squatting. Dorsiflex more than you plantarflex. Get it moving again as much as you can. If you can dorsiflex to 90 degrees you can squat.

[Naturally]

Wow, you really are all so helpful and encouraging on here! If there is a facility to add friends/contacts or if any of you are on MFP I am naturallykat over there, please do add me.

I am from Cheshire, very close to Chester

The details of my fracture - I dislocated my ankle, and chipped a chunk off the end of my tibia (can't remember the anatomical term for that now) and had a right lateral malleolus fracture of the fibula. The tib was touch and go as to whether or not they wanted to pin it, but they didn't. I had ORIF to the fib with a plate and 6 screws inserted, and a symodial screw, which was removed after 3 months. The rest of the screws and plate are apparently due to stay in unless I decide I want to take up contact sports. I'm a bit worried as it is about the horse riding, one kick from a horse wearing iron shoes and that could be a very mashed up leg. Anyone who cares to advise me as to if its best to get the plate taken out I would be happy to listen to you. Also any advice about the risk of microfractures with my metalwork if doing things involving jumping around (especially while I am overweight). A little knowledge of anat and phys is a dangerous thing, and in my case my knowledge is not even about humans, its about horses!

Plantar flexion is absolutely no problem (and unfortunately not much use!) its dorsi that I struggle with. NHS Physio I found useful up to a point then as much use as a chocolate teapot. I make sure I do plenty of playing around and flexing it in all directions each day, although if I'm honest I no longer do the "force it" type ones (e.g. stand facing a wall for support, flex it against the floor, decrease the angle...

When you say 90%, isn't that a right angle? That's fine, I stand up like that all day! I can probabably dorsi flex about 10 degrees less than my good ankle (while non-weight bearing) and on a good day I can get to about 45 degrees while standing.

I wondered about employing a physio privately, but I'm honestly not too sure if they will be able to do much...?

Thanks again so much for your contributions and for making me feel very welcome already!

[m00se]

You had a bimalleolar fracture-dislocation of your ankle, fixed with a seven hole plate to the fibula (six screws because the middle one of the seven is over the fracture site) and a syndesmotic screw. I did this precise surgery yesterday (except I did put a screw in the tibia and didn't use a syndesmosis screw, but the injury is almost identical). The piece off the tibia will have been too small to screw which is why they will have left it - putting screws through very small pieces makes them shatter if you're unlucky (happened to me a couple of weeks ago ), which generally means you end up needing external fixation (read: big frame around/alongside your leg).

The fact it was small is a good thing because it probably means that your deltoid ligament will be largely intact. This generally means you will have a more stable ankle than someone who needed a screw. Hooray!

Leaving the plate on your fibula will not alter your ankle's range of movement - the only time I'd suggest you have it removed is if it was causing you pain. The thing that will limit your ankle range of movement is your healing status and most of your stiffness will be due to ligament tightness. You didn't say how long ago your injury was but im guessing about a year or so. Aggressive physio will be helpful for you. I can suggest exercises you can do if you would find it helpful (private physios cost a fortune).

If you can dorsiflex to or just past 90 you should be able to squat. Just don't lean forward, keep the weight on your heels, and start light. Don't lift your heels off the ground during the squat! Start with bodyweight until you have the range of movement sorted. Light squatting like this is actually good physio, too. Calf strengthening exercises like calf raises will also help. Just remember to start off light.

Do a lot of stretching. Anything that stretches your lower limb will benefit you but make sure your hamstrings are loosened. Good hamstring stretches will be key (I'd bet money they're tight), along with ankle stretches in all dimensions. Like I say, let me know if you need specific advice

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[Naturally]

Wow - another massively helpful post, thank you again. Yes it was just over a year ago that i did it, 29th November 2010 to be precise! So you think that my range of movement and the fact that it swells up and aches if I do too much on it is normal for this stage of healing then? That's encouraging news.

Yes please I would love some suggestions for more aggressive physio.

PS wish I could remember all the details now. I remember the consultant saying that by definition of dislocating it I would have damaged certain ligaments - which would those have been, any idea?

[m00se]

You're welcome.

The range of movement is pretty good for the injury you've had. Mind you, I'm also guessing you're young so you should have had a better starting point than someone with an old ankle joint to start with. I'm sure it can be increased with enough physio, though The swelling and the aching is also normal, yes, although it sounds like the swelling is a problem for you. Rest, Ice, Compress, Elevate. It will settle with time. Bad ankle fractures can take a couple of years to be completely better.

Your consultant was right - dislocating your ankle necessarily disrupts the ligamentous support of your ankle. To say exactly which ones would require an x-ray, but I'll take a guess. Most of the time, if you needed a seven-hole plate, you will have had a fairly high fibular fracture. This usually means that the fibular ligaments can remain intact at the ankle (posterior talofbular and calcaneofibular). Depending on how badly smashed the lower portion of your fibula was you may have disrupted these, too. Usually the talofibular ligament goes ping in fracture-dislocations. You also damaged the medial malleolus and by definition your deltoid ligament will have at least partially ruptured. This requires considerable force to do. The fact that you disrupted your syndesmosis also suggests you had a fairly nasty injury. Let me guess. Fell off a moving horse?

As for what you can practically do to improve your ankle:

1. Cycle on a stationary bike. This improves ankle range of movement like nothing else. Especially if you set the resistance to its lowest setting and put the seat slightly too low.

2. Strengthen your eversion. This will improve the stability of your ankle joint and strengthen it. It will also decrease your chances of suffering future ankle injuries. This is best done by putting the outside edge of your foot against a door or a wall and pushing against it. Hold the push for 30 seconds. Repeat. Lots. You can also use a resistance band (loop it round something heavy and the other end around your foot, and re-create the same movement).

3. Strengthen your inversion. This is also important, because you injured your medial ligaments as well as your lateral ones. Exercise is the same as for eversion, but the other way around. This can also be done with a resistance band, obviously.

4. Gastrocnemius stretch. Perhaps the single biggest limiting factor for range of movement in ankle injuries is tight gastrocnemius (biggest of the calf muscles). Stand facing a wall. Put your injured foot behind the other one. Lean forwards keeping your back leg straight until you feel the calf stretching. Hold 30 seconds. Repeat. You can also do this lying on your back. Put your bad leg in the air, loop a towel round your foot, keep your leg bent, and pull. Hold the stretch when you feel it.

5. Soleus stretch. Second limiting factor for range of movement. Setup same as gastrocnemius stretch. Bend your back leg, then lean forward and down. You'll feel the pull in your lower calf. This exercise also pushes dorsiflexion more than anything else.

6. Standing calf raise. Stand on one leg (your bad one). Raise to tip-toes. Back down and repeat. Don't forget to do the other side, or you'll have one massive calf and one normal one

7. Hamstring stretch. Hugely limiting for things like squats. Setup like the gastrocnemius stretch lying on your back. This time keep your leg straight. Stretch the back of your thigh. Grit your teeth.

8. Start squatting. This strengthens all the important muscles in your legs and will loosen them up, too. It also improves mobility in the ankle joint.

9. Keep talking. Let me know what helps and what doesn't.

10. Don't do it again!

[Naturally]

Thanks Moose, will try those this afternoon, and get Googling the different ligaments, just out of curiosity.

Yeah, everyone thinks I did it falling off a horse. I didn't. I had been for a walk around the snowy and icy forest, scrambling up and down banks to break thick thick sheet ice so that the wildlife could drink (soft arse that I am), been to the town and done my shopping... came home, it was bin day, so put my wheelie bins back, went to go in the house and splat. Found myself sitting in a most unusual position with two additional joints in my leg. So yeah, its official as far as I'm concerned: Horse riding is safer than putting the bins out!

[m00se]

Its as good an excuse as any!

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[m00se]

Its as good an excuse as any!

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