If you ask the public what is the most popular renewable energy technology, you are likely to hear solar panels and wind turbines. These technologies probably have the highest profile within the much hyped green energy sector. Solar panels and wind turbines have good credentials and should be viewed as true alternative technologies nevertheless. Still, most people forget a much simpler and humbler technology that has been around for many centuries. Wood burning stoves are not only effective and proven, but are also categorized as green, which makes them attractive yet again.

In order to fairly evaluate biomass boilers, it is important to explain how they work. Biomass boilers burn wood, which is an organic fuel (hence the bio-fuel label), rather than fossil fuels that come from the ground (oil, gas, coal). The boilers burn untreated wood (such as logs, wood chips) and treated wood (most common being wood pallets).

Wood pallets are the most efficient of the wood fuel types. They are made from sawdust which is compressed at high pressure into small pallets (roughly the size of AAA batteries). They are made from by-products of local carpentries, joinery workshops and sawmills. The high pressure compression removes moisture and increases their output to weight ratio, meaning you need less fuel to get the same amount of heat. Another benefit is that they don’t leave as much residue on the burner due to full burning reaction.

Because the boilers burn wood they are considered to be CO2 neutral. When fossil fuels are burned to generate energy and heat, they release CO2 that was trapped under the ground. This gas is widely accepted as one of the main drivers of global warming and climate change. In contrast, when we burn wood, we only release CO2 that the plant has captured during its lifetime, thus not adding more of the harmful gas into the general equilibrium.

Before going ahead and purchasing a biomass boiler, there are several points you should consider:

* Wood supplier - it is much easier to run a biomass boiler if you have a local sawmill or carpentry workshop that can provide you with a reliable source of sawdust, wood chips or even wood pallets.

* Room for the boiler - since biomass boilers are relatively big (especially when compared to modern condensing boilers) it is important to take into account their size and the required space for fuel storage next to them.

* Chimney - biomass boilers require chimneys. And more specifically, chimneys that are lined for wood burning. However, it is a problem that can be solved by adding a lined flue within the chimney.

* Smoke implications - some areas are designated ‘Smoke Free’. If you live in such are, you need to find a unit that is exempted under the Clean Air Act.

* Other considerations - It is wise to check with your local authority’s planning department regarding fitting a flue in the property. This is very important in cases where the property is a listed building, or within a conservation area.

Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards - could the patient walk or did they go to hospital? Was there an x-ray?

The amount of pain the patient suffered after the injury is extremely important and if the level of pain is very high or if it doesn’t settle, there might be a fracture. Pain should settle with time and if not the physio will refer the patient back to the orthopaedic doctor. The areas of pain should match the mechanism of injury, indicate which structures might be injured and should be tested by the physiotherapist later.

The physio will ask about previous injury to the area and the medical history of the patient, past medical conditions and medication. The physio will ask about appetite, loss of weight, quality of sleep, bladder and bowel function and relevant family history. The objective examination starts by looking at the appearance of the part for any any discolouration, swelling, skin damage or circulatory abnormality.

Examination protocols

Movements of the ankle noted up on the bed without weight bearing are dorsiflexion (pulling the ankle up), plantarflexion (pointing the foot down), eversion (turning the foot outwards), and inversion (turning the sole of the foot inwards toward the other foot). The movements tell the therapist about the willingness of the patient to move in the presence of pain and anxiety and limited movements give important information about the joint.

Manual testing of the ankle muscle strength by the physiotherapist indicates any muscle damage around the ankle. The physio tests the patient up on a couch or gets the patient to perform exercises up on their feet. Passive movement of the joint, where the physio moves the ankle and uses gentle stretching of the joint in each direction to test the structures of the joint. Palpation of the joint structures is used to find which structure is to blame.

Treatment by a Physiotherapist

Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.

Manual therapy moves the joint surfaces, restoring the normal sliding and gliding movements which allow normal joint action. Once the pain and stiffness have been reduced the physio can start working on weight bearing exercises. Initially this consists of toe raises and walking on the heels, progressing to walking quicker and running.

In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.