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Please read the following information and then use the links at the bottom of the page if you are looking for further information or exercise.

Important information to read if you have any concerns about your shoulder pain

Please click below to expand relevant section; these sections outline some of the main issues that we would advise you get checked by a health professional before commencing self-management exercises. These are called Red Flags and may indicate a more serious problem that requires medical assessment.

Symptoms That Are Present After Trauma

If your symptoms are caused by a recent traumatic incident (e.g. a fall, football tackle) and you have any of the following symptoms:

  • Pain and weakness at time of injury or shortly afterwards leading to a sudden loss of shoulder movement/ arm function
  • Shoulder is significantly bruised and/ or swollen
  • Shoulder and/ or surrounding soft tissue looks abnormal/deformed
  • New lumps and bumps that appear after the trauma.

NOTE: If you have an underlying poor bone density (e.g. osteoporosis) smaller amounts of force can cause the problems listed above.

Symptoms Where No Trauma Was Involved
  • Sudden loss of active movement with or without pain
  • Pain and/ or stiffness in other joints at the same time as shoulder pain developed
  • Heat, redness and/ or swelling of joint
  • Fever and general feeling unwell at same time as shoulder pain developed
  • Experiencing chest pain and / or difficulty breathing
  • Unexplained lumps and bumps that appear or are changing/ growing
  • Constant pain which does not change with rest or activity
  • Significant worsening night pain with or without night sweats
  • Unexplained weight loss and/or previous history cancer
  • Increasing numbers of joints that are painful and/or stiff
  • Any unexplained tingling, numbness and pins and needles into shoulder and/or arm

Note: Special attention should be taken if you have a history of long-term steroid/ immunosuppressive drug use, recent joint replacement, recent steroid injection, rheumatoid arthritis or other joint disease including recent infection, Intravenous drug use or alcohol misuse.

Shoulder Pain- Information and Exercises

Please make sure you have read through the important information above about shoulder pain before proceeding.

Below are some exercises to help you get your shoulder moving better. You may need to build these exercises up gradually.

You may be uncomfortable when you start doing these exercises – make sure the level of discomfort feels acceptable to you and that it doesn’t take too long to settle once you are finished.

The exercises should get easier the more consistently you manage to practice them and this may allow you to progress to more difficult exercises.

These are self help exercises:

  • Try to enjoy the exercises and work at a pace and level that feels safe
  • Please use a common sense approach when deciding which ones to try
  • The exercises listed are not designed as an alternative to professional advice.
Information about how to select the level at which to exercise
A short video (less than 2 mins watch) about exercising with pain

Shoulder Information Leaflets

Tips to manage a painful shoulder

Beginner-to-progressive shoulder exercises- leaflets and videos

Additional exercise options

Rotator cuff (shoulder muscle group) exercise options

Please read the following information and then use the links at the bottom of the page if you are looking for further information or exercise.

Important information to read if you have any concerns about your neck pain

Please click below to expand relevant section; these sections outline some of the main issues that we would advise you get checked by a health professional before commencing self-management exercises. These are called Red Flags and may indicate a more serious problem that requires medical assessment.

Symptoms That Are Present After Trauma

If symptoms are caused by a traumatic incident to your head and/ or neck (e.g. a fall or severe whiplash) please have this checked out by a health professional before commencing with an exercise program.

Note: If you have a known diagnosis of osteoporosis (low bone density) a small amount of force may cause problems that require medical assessment.

Symptoms Where No Trauma Was Involved

If you feel any of these signs appear rapidly or over a longer period of time please have these checked out by a health professional. 

  • Severe restriction in the movement of your neck and/ or head
  • Changes in your balance and the way you are walking e.g. tripping, falling
  • Weakness and/ or altered sensation into both arms and/ or legs at the same time
  • Problems with coordination of upper and/ or lower limbs e.g. writing, getting dressed, walking
  • Electric shocks sensations into both arms and legs on forward bending of your head or looking down
  • Significant changes to bowel, bladder habits and/or sexual function required immediate medical assessment. Warning: Cauda Equina Syndrome (CES): This a rare but extremely serious spinal condition that requires immediate assessment. For further information on CES:
  • New problems with talking, dizziness, swallowing or eyesight
  • Fever or generally feeling unwell at same time as neck symptoms developed
  • Constant pain which does not change with rest or activity
  • Significant pain and/ or sweats at night
  • A previous history of cancer and/ or unexplained weight loss
  • Unexplained lumps or bumps that are changing/growing
  • Increasing number of joints that are painful and/or stiff
  • Severe headaches and/ or jaw pain.

Note: Special attention should be taken if you have a history of long-term steroid/ immunosuppressive drug use, recent joint replacement, dental surgery or steroid injection. Previous spinal surgery. Rheumatoid arthritis or other joint disease, recent infection, previous history of tuberculosis, intravenous drug use or alcohol misuse.

Resources

Neck information leaflets
Neck exercises

Please make sure you have read through the important information above about neck pain before proceeding.

Here are some specific exercises to help you get your neck moving better. You may need to build these exercises up gradually.

You may be uncomfortable when you start doing these exercises – make sure the level of discomfort feels acceptable to you and that it doesn’t take too long to settle once you are finished.

The exercises should get easier the more consistently you manage to practice them and this may allow you to progress to more difficult exercises.

These are self help exercises:

  • Try to enjoy the exercises and work at a pace and level that feels safe.
  • Please use a common sense approach when deciding which ones to try.
  • The exercises listed are not designed as an alternative to professional advice.
Information about how to select the level at which to exercise
A short video (less than 2 min watch) about exercising with pain
Neck exercise videos
Neck exercise class videos (3 parts)

Neck exercise class introduction (please watch before commencing exercise parts 1-3)

Neck exercises – part 1

Neck exercises – part 2

Neck exercises – part 3

Temporomandibular joint problems (joint between jaw-bone and skull)

If you think you may have, or have been told that you have, a temporomandibular joint problem you may find the following information documents useful:

Your general health and wellbeing are essential to enjoying life and can have a big impact on your MSK condition, on how it developed and also in helping you to manage it and prevent it from coming back. 

The NHSGGC Health Improvement site below is a good place to start if you are looking for something in particular, including advice about smoking, weight, literacy and physical activity. These resources are updated regularly.

The Health and Wellbeing directory allows you to search by topic, for example ‘alcohol’ and has a huge range of resources. For more of a national perspective, try NHS Inform. In addition, we have gathered some resources on a range of topics that may be helpful for you.

Resources

Links to Resource Libraries and Services

Meeting Your Needs- Specific Topics

Physical Activity – Want to become more active?
Work – Unemployed and looking for work?
Alcohol- Want to cut down?

Making a change booklet (printable)

Smoking – Want to stop or cut down?
Stress, Anxiety or Depression – Want some support?
Weight – Looking to lose weight?
Sleep
Finance

Other Resources

Self-help Management and Helpline Versus Arthritis

Mental Flourishing – Wellbeing, Stress, Anxiety and Depression

Being Present and Self Aware: Mindfulness

Being Kind to Yourself: Self Compassion

Volunteering

Geographical mapping of uptake rates for NHSGGC Adult Screening Programmes is available at data-zone level. Maps are available at HSCP level for AAA, Bowel, Breast, Cervical and DES screening programmes.

Data zones are groups of 2001 Census output areas and have populations of between 500 and 1,000 household residents. Where possible, they have been made to respect physical boundaries and natural communities. They have a regular shape and, as far as possible, contain households with similar social characteristics.

Abdominal Aortic Aneurysm (AAA) Screening: Uptake data at datazone level from 1st April 2023 – 31st March 2024:

https://www.nhsggc.scot/downloads/aaa-screening-uptake/

Bowel Screening: Uptake data at datazone level from 1st April 2023 – 31st March 2024:

https://www.nhsggc.scot/downloads/bowel-screening-uptake-2023-2024/

Breast Screening: Uptake data at datazone level from 1st April 2023 – 31st March 2024:

https://www.nhsggc.scot/downloads/breast-screening-uptake-2023-2024/

Cervical Screening: Uptake data at datazone level from 1st April 2023 – 31st March 2024:

https://www.nhsggc.scot/downloads/cervical-screeni…uptake-2023-2024 ‎

Diabetic Eye Screening (DES): Uptake data at datazone level from 1st April 2023 – 31st March 2024:

https://www.nhsggc.scot/downloads/des-screening-uptake-2023-2024

Screening uptake 2021-22

AAA – NHSGGC

Bowel – NHSGGC

Cervical – NHSGGC

DES –NHSGGC

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The UK guidelines suggest that the average adult should undertake 150 minutes of physical activity per week. 

More than half (54%) of all Greater Glasgow and Clyde residents are not active enough to gain these health benefits.

See Chapter 5. Section 5.3.1 of the Director of Public Health Report 2015-17 for more background information on levels of physical activity in Glasgow and Clyde.

See also the NHS Greater Glasgow and Clyde 2014/15 Health and Wellbeing Survey  (Section 3.4)

To help with this, NHS Greater Glasgow and Clyde have a Physical Activity Team who work with a range of partners to try to increase physical activity levels.  Part of our remit is to work with our six Local Authority partners and to part fund the delivery of three core physical activity programmes; Health Walks, Live Active and Vitality, which are available and promoted throughout the GGC area. 

Further information

Get Active – Information for public
Guidance for health professionals

The Public Health – Health Services is responsible for co-ordinating and monitoring screening programmes across Greater Glasgow and Clyde and Argyll & Bute (part of NHS Highland).

Screening can find conditions early, before you get any symptoms. The earlier the condition is found, the better your chance of dealing with it. If a condition is found early, it is less likely to become severe and you are less likely to need major treatment.

Contact us

Alison Potts, Consultant in Public Health

Heather Jarvie, Programme Manager (adult screening)

Leanne Carnevale, Administration Team Leader

Emma Kinghorn, Senior Support Officer

Jo Zelazny, Senior Support Officer

Jade Curtis, Senior Support Officer

Liz O’Hora, Senior Support Officer

You can contact us by emailing: ggc.phsuadmin.admin@nhs.scot  or call 0141 201 4541.

Adult Screening Programmes
Reports
Datazone Maps
Cervical Skills Training
Pregnancy and Newborn Screening
Introduction

This booklet gives you information about hip arthroscopy. It will explain what will happen when you come into hospital, what to expect before you go home and when you are at home. The success of the operation is a team effort including doctors, nurses, physiotherapists but most importantly you.

Please note that your aftercare and rehabilitation will vary depending on what you have done to your hip during the operation and also on your surgeon’s wishes.

Next: Who may be suitable for a hip arthroscopy?

What is a hip arthroscopy?

A hip arthroscopy is a surgical procedure where we look inside the hip joint using a small camera on the end of a flexible tube (an arthroscope). This allows the surgeon to see any problems in the hip joint. The surgeon can then use small instruments to treat some of these problems if appropriate. Hip arthroscopy can help with the following problems:

• Labral tears

• Hip impingement

• Damaged cartilage

• Loose bodies in the joint

Next: What to expect

What to expect

The Operation:

You will have a general anaesthetic which means you will be asleep. The operation usually takes 1 to 2 hours. We use a special table to access your hip joint. This moves the joint a little further apart and allows space to insert the arthroscope. The surgeon will make 2 to 4 small cuts around your hip area. They will insert the arthroscope and any instruments needed to treat your hip through these cuts.

The Wound:

Sometimes we stitch the cuts but not always. We will cover them with a sterile dressing. Usually the nursing staff change this dressing if you stay in overnight, however if it is dry and intact they may leave it. We will give you dressings to take home with you. The nursing staff will discuss this with you on the ward.

Pain Control:

We will inject some local anaesthetic into the joint and around your cuts to help reduce the pain when you wake up. We will also give you pain killers. It is important to let a member of staff know if you are sore so they can give you something to help.

Discharge (Going Home):

Most patients go home the day after their operation but some people go home the same day. This depends what time you are back on the ward and how you are feeling.

Next: Complications

Complications

After a hip arthroscopy it is likely that you will have some muscle bruising and swelling around the hip and thigh. As with any surgical procedure there is a small risk of other complications. These may include:

  1.  Difficulty passing urine or having a bowel movement after the operation.
  2.  Problems with the anaesthetic or development of an acute medical problem (clarify).
  3.  Wound Infections: If you notice a change in the area around your wounds and they become red, very hot and swollen, or if you develop any discharge from your wounds please see your GP as soon as possible?
  4. Blood clots in your calf are known as a DVT (deep vein thrombosis):

• You may go home on aspirin to help prevent this however the best way to reduce the risk is to do the exercises in this booklet regularly and by moving around.

• If you experience pain and tenderness in your calf and it becomes hot and swollen please see your GP.

    5. Blood clots in your lung known as a PE (pulmonary embolis):

• If you experience a sudden shortness of breath which is unusual for you please see your GP.

    6. Damage or bruising to a minor nerve leading to numbness or tingling in your thigh, groin or genitalia.

    7. Damage to the major blood vessels or nerves around the joint or the joint itself.

Next: Physiotherapy

Physiotherapy

You will normally see a physiotherapist before you go home. They will show you some exercises to help keep the muscles around your hip strong and to get the hip moving. These exercises are shown in this booklet.

We will give you elbow crutches to help you walk after the operation. You may be able to take as much weight as you feel able to through your hip (fully weight bearing) but we will often advise you to take some weight off the hip by leaning through the elbow crutches (partial weight bearing). This will depend on what treatment you have done and on your consultant’s wishes. For example if you have a simple labral tidy up you will usually be able to fully weight bear. However if you have a more extensive procedure such as microfracture on your joint surface we will normally advise you to take minimal weight through your hip for 4-6 weeks. The physiotherapist will advise you how much weight to take through your hip and how long you will need to use your elbow crutches.

We will show you how to go up and down stairs before you go home.

Your physiotherapist is likely to refer you to your local physiotherapy department for ongoing rehabilitation and in some places they may refer you for hydrotherapy (rehabilitation in water). This will depend on where you stay and on your consultant’s wishes.

Next: Exercises

Exercises

1. Ankle pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and helps prevent clots forming.

2. Static Quads: Point your toes to the ceiling. Press the back of our knee against the bed tightening up the muscle at the front of your thigh. Hold for 5 seconds then relax. Repeat 10 times.

3. Static Gluts: Squeeze your bottom muscles together. Hold for 5 seconds then relax. Repeat 10 times.

4. Static Hamstrings. Dig your heel into the bed as if trying to bend your knee. Hold for 5 seconds then relax. Repeat 10 times.

5. Hip Flexion: Bend your hip and knee up and down. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg up. Do 2 sets of 10.

Following some procedures this movement may be restricted for 4-6 weeks. Your physiotherapist will advise you if this is the case.

6. Hip Abduction: Bring your leg out to the side then back in again. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg out to the side and back in. Do 2 sets of 10.

It is important to do these exercises regularly. We advise you to try and do them 4 times a day or even a set of 10 every hour or two.

 Next: Going Up and Down Stairs

Going UP and Downs Stairs

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up the stairs as you will need it when you get to the top.

Going up stairs:

1. Place your un-operated leg up onto the step

2. Lift your operated leg onto the same step

3. Bring the crutch up onto the same step

Going down the stairs:

1. Place your crutch down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

 Next: General Advice Following your Hip Arthroscopy

General Advice Following your Hip Arthroscopy

Ice:

This may help with pain and swelling around the hip or thigh area. Wrap an ice pack or a bag of frozen peas in a towel and rest this on your hip or thigh area. Do not leave on for any longer than 20 minutes at a time.

Pain Relief:

We will usually give you a 7 day supply of pain killers to take home with you and can get more from your GP if necessary once these run out. If you experience more pain when you go home and do not feel the pain killers are helping, please see your GP.

Wound Care:

If you have stitches you will need to visit your practice nurse 10-12 days after your operation to have these removed. The nursing staff will discuss your wound care with you before going home.

Rehabilitation:

It is important to do the exercises in this booklet regularly to prevent your hip becoming stiff and weak. Most patients are referred for physiotherapy locally once they are home. The length of time you need to go to physiotherapy will depend on the treatment that you have and also on what activities you plan on getting back to. You are likely to attend physiotherapy for at least 3 months.

Next: Return to Activity

Return to Activity
  • Driving: You can begin driving when you are allowed to be fully weight bearing, walking without crutches and feel comfortable to do so. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. This will vary depending on what treatment you have and on your consultant’s wishes.
  •  Work: This will depend on your job and on what treatment you have done. People in manual jobs or jobs involving a lot of walking are likely to need longer off than those who have jobs involving mainly sitting. Please discuss this with your consultant while in the hospital or in the clinic
  •  Sport: Your physiotherapist will advise you about returning to sport. Again this will depend on what treatment you have done and on the sport you wish to return to.

Next: Routine Follow-Up

Routine Follow-Up

We will see you back at the clinic 4-6 weeks after your operation. You may then have a further appointment about 12 weeks after the operation. If you need further appointments we will arrange these.

Outpatient Musculoskeletal Physiotherapy input after leaving hospital (hospital discharge)

Your referral will be sent as an urgent request. It is extremely important you attend for Physiotherapy to maximise the benefits of your surgery.

On receiving your referral, you will be contacted by either telephone or letter. If by telephone, this will show as an 0800 number. Please answer this as they do not leave a message.

If RMC (Referral Management Centre) are unable to contact you via telephone, an opt-in letter will be sent to your address. It is important you contact the telephone / email on this letter as soon as you receive it in order to offer you an appropriate appointment.

If after 2 weeks you have not heard anything, please contact RMC on 0800 592 087.

What is an ankle fracture

A fracture is a break or crack in a bone. The ankle is formed by three bones. These bones are the tibia, fibula and talus. Treatment depends on where and which bones are affected, if the fragments are badly aligned or if it causes joint instability.

Sometimes this can be managed by putting a plaster cast or splint on.

Sometimes surgery is carried out to realign and hold the bones together to improve healing.

Sometimes this is followed by a period in a plaster cast or splint and by keeping your weight off that foot using crutches.

If my injury is being treated with surgery

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some ankle fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

If I need it, what does surgery involve?

Surgery involves the bone being held with plates and screws that sit on the bone under the skin. More than one bone may need to be fixed and this sometimes needs to be done through more than one cut (wound) in the skin. The most common wounds will be on both sides of the ankle. There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaesthetist.

What happens next?

You will usually be discharged from hospital on the same or next day after surgery. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. They may also discuss whether some of your appointments may be carried out using a videophone or telephone. You will usually have follow up at 2 weeks and 6 weeks after surgery. These appointments will should be given to you before you leave hospital.

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses or podiatrists. They will examine your wound and ankle. They will change your cast or offer you a new walking boot and remove your clips/stitches. They may then send you for an X-ray of your ankle. They will then make sure you have another appointment booked for week 6 with either the fracture clinic or podiatry clinic.

At around 6 weeks after your surgery, you will come back to hospital for an X-ray and to see a healthcare specialist. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

What Problems Should I Look Out For?

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, nerve damage, tendon irritation, complex regional pain syndrome, irritating or prominent metalwork, walking difficulties, poor balance, pain, stiffness or weakness. If you are suffering from any of the list below, it may mean you have a problem from your surgery.

Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.

Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.

Stiffness – If you are having problems with ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.

Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.

Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

If you have a problem related to your ankle fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

When Can I Walk Again?

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery. You will need to wear a walking boot while you are walking for the first 6 weeks after surgery. You can take it off when you are sitting down, sleeping or doing your exercises.

If you are wearing a cast, you will usually not be allowed to put any weight through that leg for 2 weeks. Once the cast is changed you might be allowed to put some weight through it from week 2 – 6 after surgery. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home.

When Can I Return To Work?

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking. For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending of the extent of your injury. If your job involved driving you will be off work for at least 6 weeks.

When Can I Return To Driving?

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

When Can I Return To Sport?

It is advised that you do return to sport until at least 12 weeks after your injury – please seek advice from your doctor or physiotherapist who will guide you.

Do I Need Physiotherapy?

If you carry out the exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please self refer to your local physiotherapy department or arrange this with your GP.

What Will My Recovery Be Like?

Below is a rough guide of what most patients will be able to do after ankle fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0-6

  • You will be in a cast or walking boot depending on your injury
  • Keep foot elevated when you are not walking to reduce swelling
  • If you are in a walking boot you will be allowed to weight bear as your pain allows. Move your toes often.
  • If you are in a walking boot you can remove this when you are sitting down or in bed.
  • If you are in a walking boot you can begin stage 1 exercises.

If you are in a cast you will not normally be allowed to weight bear on that leg.

Weeks 2-6

  • Continue stage 1 exercises
  • Return to desk based work if required and comfortable.

Weeks 6-12

  • The fracture is united (healed)
  • You can begin to resume normal activity but be guided by any pain you are experiencing.
  • Carry out day to day activities.
  • Carry out stage 2 exercises
  • If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
  • If you were in a cast and it has now been removed you can start stage 1 exercises followed by stage 2 as your pain allows.
  • Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12

  • Return to manual work, sport and heavy activities.
  • If you are still experiencing significant pain or swelling then please contact the Fracture Care Team for advice.
Exercises – Stage 1 (week 0-6)
  • Lying on your back or sitting. Bend and straighten your ankles. If you keep your knees straight during the exercise you will stretch your calf muscles.
  • When sitting or lying, move your ankle slowly in large circles. Repeat in opposite direction.
  • Sitting on a chair, alternatively raise your toes and your heels.

Repeat each exercise 10 times, 5 times per day.

When you are comfortable doing these exercises you can begin the gentle resistance exercises below.

  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.
  • Sit on a chair or on the floor. Put the inner borders of your big toes together. Press the inner borders of your big toes together. Hold approx. 5  secs.
  • Sit on a chair or on the floor. Cross your feet and put the outer edges of your little toes together. Press the outer edges of your little toes together. Hold approx.  5  secs. 
Exercises – Stage 2 (week 6+)
  • Sitting on a chair. Cross the ankle to be stretched over the other knee. Place your hand on top of your foot and help to point your toes. This will stretch your ankle. You should feel the stretch in the front of your shin.
  • When standing, place your foot on a chair. Line your heel up with the front edge of the chair. Hold the back of the chair for balance. Gradually move your knee towards the back of the chair keeping your whole foot in contact with the chair.This will stretch your ankle. You may feel a stretch in your calf and at the front of your ankle.
  • Note: if you walked with assistance of a walking stick or walking aid prior to ankle injury then please do not attempt this exercise.
  • Sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot.Use the band / towel to gently pull your foot up towards your body. You will feel a stretch in your calf.
  • 1. Sit with operated leg crossed over and hold foot as shown
    2. Turn foot (forefoot and heel) upward so that you feel a stretch,
    3. Hold 3 seconds
    4. Then turn foot downwards, feel the stretch and hold for 3 seconds. Hold each exercise for 10 seconds. Repeat 10 times, 5 times per day.
  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.
  • Alternatively, sit on the floor or on a chair with one leg out straight in front of you.
  • Tie a rubber exercise band to something secure and put the rubber exercise band around your foot (make sure there is some tension on the band to pull against). Pull your foot up towards your body against the resistance of the band.

Hold each exercise for 5 seconds. Repeat each exercise 10 times, 5 times per day.

  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to lift the foot that is under while preventing any movement with the foot that is on top.
  • Alternatively, sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot. Pull the band/towel towards you to provide some resistance. Point your toes towards the floor, against the resistance of the band/ towel. Slowly return to starting position.

Hold each exercise for 10 seconds. Repeat each exercise 10 times, 5 times per day.

Exercises – Stage 3

The exercises in this section are not intended for anyone who required assistance of a walking stick or walking aid prior to injury.

The exercises in this section should be completed along side on-going physiotherapy input with the aim of returning to specific hobby or sport that demands higher level rehabilitation. If you are not attending physiotherapy and wish to return to sport please request referral through fracture clinic or self- refer to your local physiotherapy department.

It is normal to feel some discomfort when starting a new exercise. If any of these exercises cause increased pain at your ankle then stop the exercise and speak with your physiotherapist. 

  • Mini Band Resisted Marching: Start by standing with a mini band around both feet and arms relaxed by your side.
    Lift one leg and bring your knee towards your chest against the resistance from the band. At the same time keep the hip of the supporting leg straight. Keep your upper body upright and let arms swing by your sides at the same tempo as your legs march.

    Repeat 10  times.
  • Stand as pictured below. 
    Start in standing with your feet hip-width apart and a mini band around both feet close to your ankles. Feel how the band pulls your feet inwards.
    Step to side keeping your toes pointing forwards. 3 steps in each direction.
    Note: Keep your toes relaxed during this exercise.

    Repeat 3-5 times in each direction.
  • Stand. Step sideways and place your foot on a balance pad/ folded pillow.
    Hold 10  seconds, increase as you are able.
    Repeat 10  times.
  • Stand on one leg holding onto support of chair. Push up on your toes.

         This can be progressed into a walking exercise. As you walk try to push up on

          to your tip toes, you should feel like your heading bobbing up and down.          Repeat times 10 times.

  • Stand on one leg on a step with your heel over the edge holding onto support. Let your heel drop downwards. Push up on your toes.
    Repeat 10  times.
  • Stand on one leg on a step facing down. Slowly lower yourself by bending your knee to 30 degrees. Return to starting position.

Repeat 10  times.

  • Stand with feet together.When you feel ready try initially to jump on the spot, as you get more confident try jumping forward and backward in a Z pattern. Reverse the Z pattern.
  • Stand on one foot.
    When you feel ready try hopping on the spot, this will be closer to the 12 weeks and may even take longer than that.
    Once hopping on the spot becomes easy try to hop forward and backward, then try side to side and finally try to hop in a Z pattern. Reverse the Z pattern.
Further Information and Contact Details

Contact Details

Queen Elizabeth University Hospital main switchboard – 0141 201 1100

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Appointments booking office – 0141 347 8347 (Monday – Friday, 08:00 – 20:00)

Physiotherapy – 0141 452 3713 (Monday – Friday 8.30- 1600)

MSK Physiotherapy Self Referral  https://www.nhsggc.org.uk/your-health/health-services/msk-physiotherapy/

Further information is available at https://www.nhs.uk/conditions/broken-ankle/

Patient Initiated Return

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your ankle fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

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Accordion item 1

What is an ACL (anterior cruciate ligament)?

The following diagram shows the main structures in a healthy (right) knee.

The ACL joins the back of the femur (thighbone) to the front of the tibia (shinbone). It helps to stabilise the knee. You can damage it by a twisting movement or a movement where your body continues to move forwards but your foot stays put e.g. dodging, pivoting or landing from a jump. The main goals of ACL surgery and rehabilitation are to restore knee stability and to allow your return to work and sport as soon as possible.

Surgery

Reconstruction of an ACL involves replacing the torn ligament usually with part of the hamstring (from behind the knee) or sometimes part of the patellar tendon (in front of the knee).

The surgeon drills tunnels through the bone. Your new ACL is brought through these tunnels, and then secured.

As healing occurs, the bone tunnels fill in to secure the tendon.

Rehabilitation

Rehabilitation starts immediately after your surgery. This is where all members of the Hospital Care Team (doctors, nurses and physiotherapists) help you to achieve your full potential following your ACL reconstruction. The rehabilitation is just as important as the surgery itself. You need commitment and effort to make the most of your rehabilitation.

To make sure your progress is quick and safe your physiotherapist(s) will follow a specially designed programme based on up to date information.

Why do I need physiotherapy after my operation?

  • To minimise swelling
  • To regain full range of movement
  • To restore normal walking
  • To strengthen muscles
  • To allow safe return to sporting activities
Your physiotherapy care

Immediately after surgery

You will return from theatre with a padded crepe bandage from your calf to thigh.

You may have had a nerve block (an injection into a nerve to reduce pain after your surgery) or local anaesthetic put into your knee. These often cause numbness and a feeling that you are unable to move your leg. This is normal and usually improves within a few hours.

The medical and nursing staff will offer painkillers and we strongly advise you to take these regularly to minimise discomfort and swelling.

The padded bandage will change to a light wound covering and tubigrip.

Going home from hospital

Getting Up and About

We will give you sticks or elbow crutches to help you walk and to get about, until you have better control of your leg muscle.

We will show you how to use them properly to walk and when on stairs.

It is really important that you take good care of your wound and pain control. It is also important to keep down any swelling.

Pain

  • Wound pain is normal, this will gradually lessen over the next few days. Use the painkillers supplied by the hospital regularly.
  • If pain or swelling increase contact, your physiotherapist, GP, orthopaedic clinic or attend your local minor injuries clinic for advice.

Wound Care

  • Change the clear wound dressing. You may see dark blood stains – don’t worry this is normal.
  • If your wound becomes hot, red and weeps fluid, contact physiotherapist, GP, orthopaedic clinic or attend your local minor injuries clinic for advice.

Swelling and Warm

  • Swelling is normal immediately after surgery. Use a cold pack if your knee is hot and swollen. You can make a cold pack by wrapping a bag of frozen peas in a damp tea towel. Remove the tubigrip and apply the cold pack to your knee for not more than 15 minutes at a time. You may reapply it once your knee has returned to its normal temperature.
  • Wear the tubigrip during the day but remove it at night to allow your circulation to flow properly.
Stairs

Going up stairs

  1. Place unoperated leg up onto step
  2. Place operated leg onto same step
  3. Finally place sticks or crutch onto step

Going down stairs

  1. Place crutches or stick down onto step
  2. Place operated leg onto same step
  3. Finally place unoperated leg onto same step

Remember “up with the good, and down with the bad”

Always use your crutches or sticks to support the operated leg. Always use the hand rail, if there is one, as well as one stick or crutch.

When can I return to normal activities?

Every individual is different and you should follow the advice of your physiotherapist(s) and consultant. The following is a rough guideline:

  • Walking without crutches as advised by your physiotherapist
  • Work at a desk approximately 2 – 4 weeks, other jobs depends on activity
  • Driving approximately 4 – 6 weeks
  • Return to sport as advised by your physiotherapist
Exercise Programme

Your exercise programme should start from day one and has been carefully designed for safe and rapid progress.

Exercise

  • Rest your knee between sessions of exercise. When resting keep your leg up on a stool or settee.
  • Walk only short distances for the first few days.
  • Continue using your crutches as shown by the physiotherapist until we tell you otherwise.
  • It is important that you can straighten your knee fully and you are walking without a limp before you stop using crutches.
  • Finally, it is important to continue with the exercises as shown by your physiotherapist.

The early phase of your rehabilitation is included in this information sheet and your

physiotherapy sessions should start a few days following surgery.

Exercises Programme – Initially your physiotherapist will assist you to move your knee.

Then they will teach you how to do exercise 1 – 5 safely (see Exercise Programme over page)

  1. Static quadriceps
  2. Knee bending.
  3. Straight Leg Raise
  4. Terminal extension
  5. Prone Stretch

Continue with exercise No.1 to 5 as shown until your first Outpatient physiotherapy appointment.

Ongoing physiotherapy

You will attend out-patient physiotherapy for at least 3 months.

Your rehabilitation usually takes at least 6 months depending on goals or sports.

Exercises Week 1-2

You will see the physiotherapist after your surgery. They will teach you the following exercises.

You may feel some discomfort with some of the exercises. If you have any concerns discuss these with your physiotherapist.

  1. Static Quadriceps (thigh muscle). Position – lying down or Sitting.

Action – tighten the thigh muscle, pull your foot towards you and push your knee down into the bed or settee.

Hold for 5 seconds then relax

Repeat 10 times every 1-2 hours

2. Knee bending Position – lying down

Action – Slowly slide your heel up towards your bottom. Stop at the point of pain and

hold for 5 seconds then straighten again.

Repeat 10 times every 1-2 hours.

3. Straight leg Raise You Must keep your knee straight and locked out. Position – lying down.

Action- Tighten the thigh muscle and keep your knee straight, slowly raise your leg off the bed. Do not lift the leg higher than 10 -15cm (4-6inches) from bed.

Hold for 5 seconds.

Repeat 10 times 3 times per day

4. Terminal Extension Position- lying down with your heel on a rolled towel. Or in a sitting position  with unsupported on a stool.

Action – tighten the thigh muscle, pull your foot towards you and press your knee down.

Hold for 5 seconds then relax

Repeat 10 times every 1-2 hours

Or Rest in this positions for 10 minutes every 1-2 hours.

5. Prone Knee Stretch Position – Lying on your front with feet over the bed edge.

Action – Place a pillow or towel under your thigh for comfort. Allow the weight of your legs to stretch the back of your knee.

Hold position for 10 minutes.

Rest in this position for 10 minutes every 1-2 hours.

6. Calf Stretch Position – lying or sitting.

Action – Use a towel or belt around your foot, to pull your foot gently towards you to stretch your calf.

Perform 3 times, holding stretch for 20-30 seconds.

Repeat every 1-2 hours

Exercises Week 3 – 6

Only start the following exercises when your physiotherapist tells  you it is OK to do so.

7. Knee Flexion and Hip Extension

Knee Flexion Position – Lie face down.

Action – Tuck your good leg bend your operated leg to help bend your knee to 90

degrees.

Hip extension

If you can bend knee freely to 90 degrees, extend your hip by lifting your thigh off the bed.

Return to starting position.

Repeat each 10 times 3 times per day.

8. Hip Abduction Position – Lie on your side with your back against a wall.

Action – Keeping the heel in contact with the wall, slowly raiseyour leg.

Return to starting point. Repeat 10 times 3 times per day.

9. Action- Move your weight from side to side over your feet.

Repeat 10 times 3 times per day.

10. Single leg balance Position – Standing on one leg.

Action – Practise standing on your operated leg. Try to increase the time to match your good leg.

Hold for 30 Seconds

Repeat 10 times 3times per day.

11. Calf stretch Position– Stand by a chair or wall for support.

Action – Step back with one leg and stretch the calf by pushing the front knee forward.

Make sure your feet are pointing forwards and your heels stay in contact with the floor.

Hold for 30 Seconds

12. Mini Squat Position – Stand by a chair for balance if needed.

Action – Bend your knees and hips as if going to sit on a chair.

Do not bend the knees more than 50 degrees (halfway down).

Return to starting position.

Repeat 10 times 3 times per daily.

13. Heel raise Position – Stand by a chair for balance if needed.

Action – Slowly raise your heel up from floor, move up onto your toes.

Repeat 10 times 3times per day.

To progress you can add a hand weight.

14. Cardiovascular exercise

Using a Static bike and cycle with low resistance.

Cycle for 10 -15 minutes – before (as a warm-up) and following your exercises.

Your physiotherapist will give you guidance on all exercises.

Outpatient Musculoskeletal Physiotherapy input after leaving hospital (hospital discharge)

Your referral will be sent as an urgent request. It is extremely important you attend for Physiotherapy to maximise the benefits of your surgery.

On receiving your referral, you will be contacted by either telephone or letter. If by telephone, this will show as an 0800 number. Please answer this as they do not leave a message.

If RMC (Referral Management Centre) are unable to contact you via telephone, an opt-in letter will be sent to your address. It is important you contact the telephone / email on this letter as soon as you receive it in order to offer you an appropriate appointment.

If after 2 weeks you have not heard anything, please contact RMC on 0800 592 087.

Contacting your care team

Please contact your Physiotherapist, G.P, orthopaedic department or attend your nearest Minor Injuries clinic if you have any issues regarding your knee.

Your Accident & Emergency (A&E) centre is for serious medical emergencies. Their staff prioritise patients on the severity of the condition.