Twisted Ankle and Prolotherapy
In this article, Ross Hauser, M.D., a chronic pain specialist and Prolotherapy physician, explains a case history of a women with chronic ankle sprains and how Prolotherapy worked for her.



Nothing was better than a hike in the fall for Louise. Louise felt like she was in heaven when she was able to hike in the Great Smoky Mountains. She always carried her hiking stick and was careful where she placed her feet. On this beautiful fall morning, however, a distant sight captivated her and, as her feet touched the slippery rock, she suddenly lost her balance. Her left ankle was suddenly in excruciating pain. Her husband helped her back to the car and they visited the local emergency room. The emergency room physician examined her and x-rayed her ankle, giving the reassuring news that her ankle was not broken. She was told that she had suffered a sprain in her ankle and that all would be well in about a month. All she had to do was put ice on it, keep it elevated to reduce the swelling, and just rest. In case you do not know, this is the infamous RICE treatment. Relieved, Louise and her husband left for home with a prescription for pain medication (anti-inflammatory, of course) and elastic bandages (the compression part of RICE). Louise used the elastic bandages, the pain pills, and put the ice on her ankle. She was saddened that she was unable to hike, but she knew that the season was early and that by next month she would be back on the trails again.
 

The next month came and left, and Louise was still unable to walk without excruciating pain in her left ankle. Just the act of putting on shoes and going to church was more than she could tolerate. The ankle would swell, and by the end of the day it was twice the size of the right ankle. When she saw her doctor again, he explained that sometimes it takes longer for a ligament to heal than it does for the bone, since the blood supply is not quite as good. He told her to be patient and that things would get better. To help the swelling decrease, he suggested she increase her anti-inflammatory medication. She gladly complied.
 

By springtime her left ankle was no better. Because she was taking the increased dose of her anti-inflammatory medications every day, she developed stomach pain, and her family doctor gave her ulcer medication. Prior to this, Louise had never had to take any medication and now she was putting pills in her mouth three times a day. Hiking was not even an option. Merely going to the grocery store left her feeling worse than she had ever felt on even the longest hike. By nighttime, the ankle would be throbbing and pulsating, and her sleep was restless and fitful. She did not know what to do, except lie in misery day and night! This is in a formerly active woman. Unfortunately, it is a sad story that is seen far too often in my office and around the country.
 

Then one Saturday while she was on the Internet on her computer, she had begun to browse sites related to pain. Accidentally, she stumbled on something called Prolotherapy. Her curiosity was peaked, and she decided to attain more information. When she received information from one of the web sites two weeks later, she was ready and eager to make an appointment with a doctor who was knowledgeable in Prolotherapy.
 

She made an appointment with me and I concurred that she was suffering from a sprain to one of the outside ankle ligaments. I obtained an ankle MRI to confirm the initial suspicions. It showed a partial tear of two of the ankle ligaments. I then decided that it would be quite useful for Louise to undergo a series of Prolotherapy treatment. Louise needed no sedation for these injections, and the needle that was used was quite small. Her ankle felt somewhat stiff for seven days after the treatments, but with each treatment, her ankle began to feel stronger and stronger. By the third series, I felt she needed to begin working with a local Physical Therapist who was trained in ankle rehabilitation. He told her it was very important for her to begin to undergo balance training, and that she would need to do her home exercises religiously. Louise was anxious to get started on this. She was happier than she had been in a long time, since she was beginning to regain her ability to walk. By the fifth Prolotherapy session, her ankle pain was gone. For one more month, she continued to work with her physical therapist, and by that fall she was back doing short hikes on her beloved trails.

Acute ankle sprains are typically treated by immobilization, presumably to help the injured ligaments heal. Nothing could be further from the truth. Immobilization is the quickest way to cause a dramatic decline in ligament function and strength. Anti-inflammatory medications are often given after an acute injury, but should definitely be avoided during this time. Anti-inflammatory medication may actually prevent the body's own healing process from occurring. 

Do you have ligament irritation of the ankles?
To test for ligament irritation in the area of the right ankle, cross your right ankle over the left knee. Your right hand should be placed over the right ankle. The left hand then pulls on the toes of the right foot, inverting the ankle. If pain is felt in the right ankle with this maneuver, most likely injury to the ligaments on the outer part of the ankle has occurred. The same maneuver can be used for testing the left ankle.
 

An inner ankle sprain usually involves the deltoid ligaments. The test for this ankle sprain involves eversion of your foot (the opposite direction from inversion) by turning your foot out. If this causes increased pain on the inner part of your ankle, then there is a high likelihood of ligament injury to the deltoid ligaments. Unfortunately, many times the stability tests are negative, in that they do not reproduce pain. A better measure of ligament injury is by direct palpation. Often, when the stability test is negative (no pain), direct palpation over the injured ligament will be very painful. This is where the Prolotherapy is given.