It is estimated that 40% of all people who suffer an ankle sprain will suffer chronic pain and weakness in that ankle long-term. The reason is because your ankle never healed properly. Our ankles are held together by ligaments and tendons, strong bands of connective tissue. Ligaments hold the ankle bones together while tendons attach the muscles to the bones.
When ankle sprains occur, the ligaments of the ankle are stretched and torn. Most commonly, ankle sprains occur when an athlete lands unevenly from a leap or jump, or has someone fall on their ankle during contact sports. Sprains can also occur when stepping into a hole or divot on a playing field or golf course. The severest of ankle sprains are the extreme or violent twist or “roll-over” of the ankle causing a hyperextended turning in or turning out of the foot. The turning out injury causes a sprain of the anterior talofibular ligament, and this is the most commonly injured part of the ankle.
When ankle sprain is suspected, the severity of the injury is then graded and a treatment suggested.
GRADING THE SPRAIN
GRADE 1 SPRAIN
A grade 1 sprain is the least severe of ankle sprains. The ligaments are slightly stretched with a minimum of tearing to the ligament fibers. More of a discomfort than pain is felt as the athlete can usually “walk it off.”
GRADE 2 SPRAIN
There is stretching of the ligaments and partial tearing causing an unstable or loose joint. The condition is also referred to as ligament laxity, as the ligament, now stretched beyond its normal range has become weakened or lax, as an overstretched rubber band. There is noticeable swelling and tenderness and depending on extent of injury, instability when walking.
GRADE 3 SPRAIN
A complete tear of the ligament causing extreme instability, swelling, and pain.
Grade 3 sprains are not the most common forms of ankle sprains and while surgery may be prescribed, it is rarely necessary since the ligament usually scars over during healing.
TREATMENT OF ANKLE PAIN
The “gold” standard of treatment in Grade 1 and Grade 2 sprains is RICE. Rest, ice, compression, and elevation. However, this therapy does not fully allow the ligaments to heal because it reduces and impedes inflammation that is needed to stimulate new tissue regeneration and there is a high incidence of chronic or recurrent ankle sprains.
HEALING THE ANKLE SPRAIN
The body’s natural healing response is inflammation. Inflammation is the trigger for the immune system to begin the cascade of events in injury repair. When ligaments do not heal completely, they weaken and put the patient at risk for chronic ankle sprain.
When there is not enough inflammation to heal a ligament, we will induce an inflammation by injury doing prolotherapy. Prolotherapy works by introducing a mild irritant through injections to the exact spot of the ligament damage. This irritant is usually something as benign as dextrose and anesthetics. What the dextrose does is create a small, controlled inflammation at the spot of injury accelerating healing and returning strength and resiliency to the ligament and thus stability to the ankle. In remittent cases, PRP (Platelet Rich Plasma) is used as a stronger proliferant to obtain the desired result.
Prolotherapy is minimally invasive, does not require long periods of inactivity and in fact, Dr Mahl will usually recommend supervised activity or a training plan to get the athlete back on the field as fast as possible.
One to six treatment sessions is typical for the competitive athlete and general patient who is suffering, spaced at weekly intervals or even every three weeks depending on their specific needs and desires and our goal.