Ligament Injuries or Sprains

One of the most common painful foot injuries

Certain factors increase risk of sprains. Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. While scientific studies are lacking, it is often thought that not ‘warming up’ is a common cause of sprains in athletes. ‘Warming up’ is thought to loosen the joint, increasing blood flow and making the joint more flexible

Sprains are classified by grades:

STAGE 1

Grade I sprain (mild)

The fibers of the ligament are stretched but intact

STAGE 2

Grade II sprain (moderate)

Is a partial tear of a ligament

STAGE 3

Grade III sprain (severe)

Is a complete rupture of the ligament, sometimes avulsing a piece of bone

Symptoms of sprains include: pain, swelling, bruising, decreased ability to move the limb, difficulty using the affected extremity. Typically, with Grade I sprains, symptoms are short lived, lasting 1-2 weeks with recovery often being complete with limited long-term effects. Weightbearing is usually seen within days with Grade I sprains, whereas pain often limits weight bearing in grade II & III sprains.

Symptoms with Grade II & III sprains may last much longer, often several months. Patients will often report hearing or feeling a pop with grade II & III sprains and joint instability may follow due to a resulting longer ligament (i.e. the bones are not bound together as tightly). In this case, there may be greater unintended motion at the affected joint.

Initial management of a sprain may involve: Protection with a brace, Compressive wraps along with R.I.C.E. (i.e. Rest, Ice, Compression, Elevation). More recent recommendations have included mobilization within 1-3 days following injury (if possible), heat (x 10 min) followed by ice (x 5 min) and acetaminophen to minimize the effect to the inflammatory process that helps to heal the ligament.

You should see a medical professional when:

Diagonsis Ankle Taping

Diagnosis

A diagnosis of a sprain can often be made with a good degree of certainty by physical examination based on the clinical presentation and method of injury. In some cases, X-rays are obtained to ensure that there is no fracture. 

Displacement of normal joint architecture in a joint can be an initial indication that a ligament has been torn. In some cases, particularly if the injury is prolonged or does not appear to be resolving as expected, an magnetic resonance imaging (MRI) is performed to look at surrounding soft tissues and the ligament (X-Ray will not show soft tissue thus making it difficult to assess the extent of injury to a ligament). MRI may also help to rule out Osteochondritis Dessicans (i.e. cartilage injury) within the joint.

Treatment

Moving the limb soon after a sprain has been shown to promote healing by stimulating growth factors in musculoskeletal tissues linked to cellular multiplication and matrix remodeling. The components of an effective rehabilitation program for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. Usually this is best accomplished with the assistance of a physical therapist or chiropractor. Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and weakness. 

Regenerative medicine procedures such as Prolotherapy, Platelet Rich Plasma (PRP) or Stem Cells are effective in healing micro or partial tears (Grade I & II injury). The aim of using regenerative medicine is to support your body’s self-healing processes, reverse disease progression and suppress inflammatory reactions that can worsen pain, leading to symptom relief and recovery of function. We utilize regenerative medicine procedures including patients’ stem cells to repair the ligaments naturally.

Prolotherapy and PRP are instrumental in releasing growth factors that may contribute to an increase in collagen production which facilitates the healing of the damage. PRP and Prolotherapy may also help to recruit fibroblasts from tissues adjacent to the area of injury). Stem Cells, on the other hand, may differentiate into numerous cells such as fibroblasts which may also facilitate healing. We often combine PRP and Stem Cells so the growth factors released via PRP have a synergistic effect on Stem Cells to enhance the therapeutic healing process. 

Grade III sprains (or complete ligament ruptures) generally require surgery for end to end repair of the ligament and relocation of the bones of a dislocated joint. Sometimes associated fractures are repaired at the same time.

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