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Moving Toward Better Health

The official blog of Konicki Schumacher Chiropractic

27
Feb

Ankle Pain Lasts for Years

Posted by Dr. Tom Konicki
Dr. Tom Konicki
Dr. Thomas Konicki earned his B.S. in Biology at the University of Cincinnati and then went on to the Los Ange...
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in Orthopedic Conditions/Injuries
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Dear Dr. Konicki,

Question: I sprained my ankle two years ago and my x-rays were normal. I continue to have pain along the outside of my ankle, especially when I run. Why is that and what can be done?


Answer: When you sprain an ankle, you tear the ligament fibers. A Grade I tear is a small amount of microtears and you typically treat these on your own.


Grade II is a moderate amount of tearing, which is probably what you had. Most people seek treatment for these kinds of strains/sprains to be certain there are no fractures and that they heal correctly.

Grade III sprains are complete ruptures of the ligament. These often require surgery to stitch the ligament back together, allowing it to mend. (I personally had this injury and subsequent surgery in the past year).

Your body heals with a process called Repair of Fibrosis. There are three stages in the process: inflammation, healing and remodeling of scar tissue.

Inflammation typically lasts several days and your body is trying to clean up damaged tissue as well as lay down scar tissue. This is the time that you employee R.I.C.E. - rest, ice, compression, elevation. You want to move through this stage as quickly as possible to avoid excess scar tissue formation.

The healing stage typically lasts up to six weeks in which the scar forms. Your body repairs the torn ligament with scar tissue; it does not grow new ligament tissue for repair. Therefore, the repaired ligament is not the same as the original one. It is thought that the damaged area is 70-80% as strong as the original tissue.

The last stage in the process is called remodeling. Now the scar tissue needs to increase flexibility and strength and be able to function like the original ligament. This process can take up to 12 months or more.

It is known that scar tissue has less flexibility, less strength and more nerve fibers than a normal ligament. Therefore, mild stress and strain on the ligament will fire the nerve as an early warning sign, creating pain. It is your body telling you "I'm weak here. Be careful!"
One of the best treatments I have seen for these old injuries that continue to produce pain is a technique called Cross-Friction Massage. It is designed to break-up excess scar tissue and adhesions that limit the flexibility and strength of the scar tissue.
Ligament fibers run longitudinal which contract and relax depending on how you move your ankle. When a scar forms, it forms longitudinal fibers as well as a spider web effect of additional scar tissue. These are called cross-links and limit the contraction and relaxation, causing pain every step you take when you run.

Cross-friction massage breaks up these cross-links (spider web) and returns mobility to the ligament. Additionally, ultrasound therapy can be used to help with this process. Once improved, stretching, strengthening and proprioceptive exercises for balance and coordination can reduce your risk of another injury.



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Dr. Bethany Schumacher
Dr. Bethany Schumacher
Dr. Bethany Schumacher earned her B.S. in Human Biology and Doctor of Chiropractic at the Los Angeles College ...
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Dr. Bethany Schumacher Tuesday, March 27, 2012

This is a great article, Dr. Konicki!

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