An ankle sprain can happen to anyone, all it takes is one wrong step. Ankle sprains tend to be painful and limit movement, depending on their severity. In the case of such a common and variable injury, how do we know if our ankle is actually sprained or when to see a doctor?
The Ankle Joint
Also known as the talocrural joint, the ankle joint accommodates many movements necessary for everyday activity and exercise. This includes plantar flexion (pointing toes down), dorsiflexion (pointing toes up), inversion (rolling in), and eversion (rolling out) of the foot.
This joint consists of four bones- tibia (shin), fibula, talus, and calcaneus, which are held in place by various ligaments. Ligaments are soft tissue structures that connect bones to other bones and tie them together. Ligaments provide the ankle with stability and a complex range of motion.
What is a Sprain?
Sprains occur when a ligament encounters trauma and gets overstretched or torn. A sprain can be classified as being in one of three stages- stage 1 (no tears), stage 2 (incomplete tear), or stage 3 (complete tear). Stretch injuries are typically slow healing and may never heal completely due to permanent loss in tightness and stability.
Stage 1 Sprains: These are not a major source for concern and are typically allowed to heal on their own. Avoid putting weight on the injured ankle or using it excessively. A cold pack should help with the swelling and ease the pain.
Stage 2 Sprains: These are more severe than stage 1 and may require medical attention. Stage 2 sprains involve the partial tear of a ligament and may require a cast and compression to keep the weakened ligament in place and allow it to heal.
Stage 3 Sprains: These are the most severe and involve the complete tear of a ligament. Depending on the injured ligament, this type of sprain may require surgery. As with stage 1 and 2 sprains, the healing process will benefit from an ice pack, rest, and compression.
The Right Treatment
Soft tissues, like tendons and ligaments, have poor circulation and therefore take a while to heal. If injured soft tissue doesn’t heal properly, it remains loose and will contribute to joint instability. Over time, the unstable joints and altered mechanics may progress to degenerative conditions such as osteoarthritis.
Proper treatment of an injured ligament is key to alleviating pain and restoring joint function. Unfortunately, the standard treatment of injured soft tissues often involves the use of non-steroidal anti-inflammatory drugs (NSAIDS) which is counterproductive. Why? Because NSAIDS opposes inflammation, which is the body’s natural healing pathway that repairs injuries in the first place.
Why Is Inflamation Important?
Inflammation is the collection of fluid and immune components at a specific site to repair or quarantine an injury. This is why we get bruises from physical trauma or a sore throat from respiratory infections. Inflammation is necessary to aid in recovery. Therefore, opposing inflammation by taking NSAIDS inhibits healing rather than promoting it.
Taking NSAIDS to treat pain symptoms also makes aggravating the injury more likely. The pain we get from an inflammation forces us to limit the use of an injured structure and allows it to heal. Bypassing pain symptoms by taking NSAIDS will not only interfere with inflammation (and healing) but may injure us further.
Ligament Repair
Prolotherapy is the best technique for repairing a ligament that has been torn (partially or completely). These techniques involve the injection of ‘proliferants’ at the site of injury to induce inflammation and healing. ‘Proliferants’ are substances that, when injected, trigger the inflammation-healing cascade. Common proliferant solutions include hypertonic dextrose, platelet-rich plasma (PRP), or autologous stem cells. Why are these techniques better? Unlike conventional treatment for stretch injuries such as cold packs, NSAIDS, and surgery, Prolotherapy restores the injured structure and its function without masking the symptoms or making them worse. Injections lead to tightening and growth of the injured ligament, despite the area’s poor circulation.
Interested in learning more about Prolotherapy? Visits us at Santa Cruz CORE and find our more about our regenerative services.
References:
- Burks, Robert T., and James Morgan. “Anatomy of the Lateral Ankle Ligaments.” The American Journal of Sports Medicine, vol. 22, no. 1, 1994, pp. 72–77., doi:10.1177/036354659402200113.
- Riley, Graham. “Tendon and Ligament Biochemistry and Pathology.” Oxford Medicine Online, 2013, doi:10.1093/med/9780199533909.003.0001.
- “Prolotherapy for 20 Year Old Ankle Injury.” Journal of Prolotherapy, 15 July 2016, http://journalofprolotherapy.com/prolotherapy-for-20-year-old-ankle-injury/.
- Houser, Ross A. Dextrose Prolotherapy Injections for Chronic Ankle Pain. https://www.prolotherapy.com/PPM_JanFeb10_AnkleProlo.pdf.