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Chronic ankle sprains: How to treat and rebuild strength

Many people experience chronic ankle sprains. This condition is characterized by a recurring “giving way” of the outer side of the ankle. This type of condition usually develops after repeated ankle sprains and is commonly seen in athletes as well as non-athletes while walking or physical activities. This chronic ankle instability is often a result of an injured ankle that has not adequately healed or was not rehabilitated correctly. The repetitive “giving way” is actually an overstretching of the ligaments which never properly tighten. This leaves the ankle vulnerable and unsupported. Without the proper treatment, chronic ankle instability can be very painful and limit one’s mobility. Here are suggested ways to treat that chronic ankle sprain.


Do

Do stay as active as possible

Activity that doesn’t result in severe pain will help the healing process. When looking at experimental models of animal healing, those that aren’t allowed to move the body part don’t heal as well, those that stay off the area when it hurts and quickly return to activity heal better. So the mantra here is to listen to your body. This means that if you perform an activity that causes the ankle to swell or has you limping around for days, you went too far. On the other hand, if the activity makes the ankle ache a bit for a few hours and then it quickly recovers, you’ve got about the right workload.

Do use physical therapy to strengthen the ankle

There are muscles that live in your foot and lower leg that help to stabilize the ankle. Many rehab programs involve using an unstable platform and strengthening the foot and ankle muscles by balancing on the platform. i.e. Bosu balls, balance boards, soft disks, etc. This is a good way to strengthen the ankle as long as it doesn’t dramatically increase pain.

Do consider biologic injections to ramp up the natural healing of the ligaments

Biologic injections such as Platelet Rich Plasma (PRP) is a good example of how you can use the natural healing power of your own blood platelets to increase the healing of stretched ligaments. About 90% of chronic ankle sprains can be healed through these types of injections.

PRP is a regenerative injection solution that's been used in dentistry for about 20 years. It’be been used in sports medicine for about the last decade, with many injured professional athletes availing themselves of this healing solution. The process begins when you give a sample of blood that’s spun down and the platelets isolated and concentrated. The doctor then uses imaging guidance (in the case ultrasound to visualize the ligaments) to get the healing platelets to the bad parts of the stretched ligament. The platelets then give off healing growth factors over the first 7-10 days, which act like espresso shots for the local cells that can repair the ligament, including local stem cells.

Do substitute natural anti-inflammatories if the ankle swells

The two most common and with the most evidence are high dose fish oil and Curcumin. High dose fish oil means taking 3,000-5,000 mg of day of concentrated EPA, which is not the cheap stuff you can find at the local grocery store. Fish oil is made up of primarily EPA and DHA, so EPA is one component of the fish oil. This should be converted back to the natural triglyceride form to give the best effect, so look on the manufacturer's web-site to make sure that they take this extra step after concentrating the fish oil. Curcumin is a natural spice found in Indian food and has been shown in recent studies to be as effective as Motrin. The usual dose is 500mg twice a day with meals. Make sure that the brand has Bioperine added, which is a natural pepper extract that increases absorption


Don't

Do not get steroid shots in the general area or ankle

Steroid shots are a common treatment in many orthopedic and family practice clinics. While steroids are powerful anti-inflammatories and may make you feel better in the short term, they will inhibit healing. In addition, the steroids will actually weaken the already stretched ligaments. Steroids can also have negative impacts on your overall health like weakening bones in women and confusing your hormone levels. Ask your doctor about PRP and stem-cell injections. These are a much better option than steroids.

Do not get dependant on an ankle brace

Many patients find that they can’t work-out or be active without a brace. This is fine during the acute healing phase, but this only lasts for a few weeks. However, if you’re still dependant on an ankle brace after this period, you need to see a physician for injections that can promote healing of the damaged ligaments.

Do not rush into surgery

Avoid surgery as all such procedures for this injury involve non-physiologic reconstructions of the ankle ligaments. For example, tendons are re-routed to serve as ligaments. While this might be helpful in the most severe cases, too often ankle problems that can be fixed via a simple injection are subjected to surgery. This permanently changes the normal biomechanics of the ankle and as a result many of these patients end up with ankle arthritis.

Do not abuse NSAID drugs

NSAID means non-steroidal anti-inflammatory drug, including Motrin, Ibuprofen, Aleve, Mobic, Celebrex, or Naprosyn. These are powerful anti-inflammatories that you can buy over the counter or get through a perscription. They tend to inhibit healing and more concerning, the American heart Association has sponsored a campaign to educate physicians either no to prescribe these drugs or to use the least amount possible. Why? They can double to triple your risk of dying from a sudden death heart attack.


Summary
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Chronic ankle sprains are a very common injury. They can limit mobility and become quite painful for patients if left untreated. Since the cause is a result of over-stretched ligaments, the best course of treatment is to re-tighten those ligaments. This is best done by non-surgical methods such as physical therapy or promoting healing within your own body with non-surgical biologic injections.


More expert advice about Injuries

Photo Credits: Dirima/bigstock.com; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Dr. Christopher J. Centeno, M.D.Medical Director

Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain manag...

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