Chronic Ankle Pain In a Female Athlete
How does ankle pain develop? Ankle pain is most often due to an ankle sprain, which is an injury that causes a stretch or tear of one or more ligaments in the ankle joint. Ankle ligaments are probably the most sprained ligament in the body. Close to 26,000 people sprain their ankle ligaments every day. An ankle twist is the most common sports injury leading to ankle pain.
Inversion injury: Turning the ankle inward, injuring or tearing the ligaments on the lateral side of the ankle, usually the anterior talofibular and the tibiofibular ligaments. The inside of the ankle is held together by a group of ligaments called the deltoid ligament. This ligament is injured from turning the foot outward, as can happen when falling down stairs or mis-stepping. Once an ankle is sprained, the injury may take a few weeks to many months to fully heal. The injured ankle often remains a little weaker and less stable than the uninjured one.
What are the symptoms of ankle pain? Symptoms of pain from a sprained ankle include mild aching to sudden pain, swelling, discoloration, inflammation, inability to move the ankle properly and pain even when no weight is put on the ankle. In mild cases, there may be a propensity for the ankle to continually turn inward.
Case of a woman’s ankle pain being more than “just a sprain.” Sue came in to Caring Medical to see Dr. Hauser with the complaint of severe ankle pain. She was an avid athlete in her 20’s, playing several sports, including tennis, running, and volleyball. After a thorough evaluation with our sports medicine doctor Ross Hauser, he determined that Sue was suffering from significant ligament laxity or weakness in her ankles, which was the underlying cause of her pain. She did not know how she injured herself so severely. For months she had been taping, bracing, icing, and taking anti-inflammatory medications upon the advice of her primary care physician, but nothing would correct the problem. She even tried one cortisone shot and received no improvement at all.
During her physical examination by Dr. Hauser, she also exhibited tenderness on other parts of her body in addition to her ankles. This was a clue to Dr. Hauser that this was related to underlying nutritional issues. When delving further into her history, Dr. Hauser discovered that her ankle pain started a couple of years prior to her visit in our office, just after she had started taking birth control pills because of painful, irregular menstruation. The medication she was taking contained an analogue of estradiol. In addition to this, her diet consisted of nearly 100 percent carbohydrates, very small amounts of protein, and she was averse to taking vitamins.
Systemic Connective Tissue Deficiency: Sue was very interested in receiving Prolotherapy on her ankles because she was looking for “the fix,” but not to correcting the multiple factors that were related to her systemic connective tissue deficiency problem. She had multiple signs and symptoms that confirmed this diagnosis such as her non-healing sports injury with no overt trauma causing the original pain; multiple tender points in other parts of her body especially about the knees and hips; dry skin; brittle nails and hair; menstrual problems; improper diet for her metabolism; and finally, her taking synthetic estradiol.
In order for the Prolotherapy to be maximally effective, Dr. Hauser needed to address her inability to heal and convince her that she needed to do something about this in order to make the Prolotherapy worth enduring the shots! Reasoning alone would be insufficient.
Prolotherapy for sports injuries: Prolotherapy is a treatment that causes the body to grow strong connective tissue. This connective tissue is primarily collagen, which makes up ligaments and tendons. Thus, Prolotherapy causes the growth and strengthening of ligaments and tendons. When an injury lingers beyond the usual healing time, it typically involves the ligaments and tendons. This weakening of the connective tissue can be graphically represented. Prolotherapy injections reverse this by stimulating the connective tissues to heal. As the connective tissue grows and strengthens after Prolotherapy, the athlete reaches the eventual point where the pain has ceased. For the person with a strong immune system, no more treatment or additional medical care is needed. Prolotherapy was indeed a cure. Treatments such as RICE – rest, ice, compression, elevation, along with NSAIDs and cortisone, only worsened an already bad situation.
The Female Ankle injury: We use Sue’s case as an illustration to those women with ankle injuries where there may be more to the picture than just the “sprain.” The woman with systemic connective tissue deficiency experiences no specific traumatic event to start the pain because the condition itself is weakening the connective tissues. In such an instance, all (or a majority) of the body's connective tissues are weakening. This process occurs normally with age, but with a systemic connective tissue deficiency (perhaps more appropriately called The Hauser Syndrome) a person experiences an accelerated decline in connective tissue strength. This may result in sagging of the skin, thinning of the hair, and a myriad of other symptoms, the most prominent of which is pain. The first area to become painful will typically be the one that the athlete uses the most. For the pitcher it will be the shoulder (Dead arm Syndrome), for the runner the knee, for the golfer the back, and so on. If the golfer, in such an instance, just receives Prolotherapy, the pain relief from Prolotherapy will only last a certain amount of time. Once the connective tissue strength decreases below the pain threshold point, the pain will recur. A cure will only be obtained when the athlete receives Prolotherapy along with additional treatments to correct the connective tissue deficiency problem.
What can be done for my ankle injury and connective tissue deficiency? If Sue’s case sounds like you, you need to give us a call and get some things taken care of. Unfortunately, traditional medicine does not approach injuries like this. Women, in particular, are prone to these types of problems, and should be very wary of just following “the norm” when it comes to birth control pills, diet, and injury. In our opinion, everyone needs to find out their individual Hauser Diet Type, in order to know if their diet should be protein-based, carb-based, or balanced. Not everyone, including Sue, does well on a carb-based diet – even athletes! (especially athletes). In our opinion, nobody should be taking birth control pills – as they are carcinogenic. Make an appointment to discuss these issues with Dr. Hauser. It may not only help you recover from your lingering ankle injury, but help improve your overall health! Sue, by the way, did finally come around, and agreed to make some big changes in her life. She received Diet Typing and the results revealed Otter physiology which requires much more protein and good fats than she was eating. She stopped taking the birth control pill as well. Dr. Hauser treated her with two more Prolotherapy treatments and she was back to all of her sports and was amazed at how good she felt overall! Never underestimate the power of getting back to basics!
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Click here to read Caring Medical’s research paper entitled Dextrose Prolotherapy Injections for Chronic Pain that was published in the Practical Pain Management in January 2010.
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