Joint Preservation Blog

January 11, 2009

Sprained Ankle Discharge Instructions

torn ankle ligament

torn ankle ligament

As a doctor who has treated sprained ankles and had a severe sprained ankle myself, here are my sprained ankle discharge instructions for my patients:

1.  Stay away from anti-inflammatories if you can help it!  These medications, otherwise known as NSAID’s block inflammation which can make things feel better, but inflammation is the basis of all healing, so blocking it is ill advised.  Use Tylenol if need a pain reliever.

2.  To control the swelling you can use ice and elevation.  Elevation means bringing the ankle above your chest/heart.  Icing means that you keep an ice bag on the ankle until the skin goes numb and then you remove it.  Again, the swelling is there is bring healing cells, growth factors, and new blood supply, so control it when it gets uncomfortable, but realize that it is serving a purpose.

3.  Immobilization as tolerated.   This means stay off of it when it hurts, but animal studies of ligament and joint healing usually show that staying completely off the area for extended periods will reduce the quality of the repair your body is able to muster.

4.  A sprained ankle takes only 4-12 weeks to completely heal.  if you still have pain, swelling, popping, clicking or other signs of an injury that is too big for your body to heal, consider getting an MRI or other type of imaging.  If the ligaments are completely torn in half, you will likely need surgery.  If they are stretched or partially torn, consider an injection based procedure to enhance healing.  In my clinical experience, prolotherapy can usually help.  Other options include surgery (I wouldn’t recommend this for a partial tear), or having the doctor inject your own stem cells into the ankle ligaments to heal the tear.  Below are videos on the newer stem cell procedures:

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January 10, 2009

athletic ankle supports

ankle-support

As a doctor with an ankle problem, who is athletic, the best ankle brace I’ve found is the Malleoloc.  However, if you have an ankle problem like I did, why not ditch the ankle supports?  There are now new treatments where they inject your own stem cells into the ankle ligament tears to heal the damage.  This way you avoid athletic ankle supports and surgery!  This procedure should allow you to get rid of the athletic ankle supports for good.  In this minor procedure, your own adult stem cells are grown to larger numbers.  These repair cells are then injected into your torn ankle ligaments.  After this cutting edge procedure, you can wear an athletic ankle support for a few weeks, but continue working out while the ligaments mend.  You get to ditch the athletic ankle supports after just a month.  Why do these injections instead of supports?  An unstable ankle eventually damages the cartilage in the ankle and leads to early arthritis.  So what’s a little ankle pain now, will be an arthritis problem in the future, unless you heal the ankle ligaments.

Mcdavid elastic ankle braces

 

mcdavid elastic ankle brace

mcdavid elastic ankle brace

 

 

As a doctor with an ankle problem, I like most of the Mcdavid elastic ankle braces that use both a hard shell component to add stability and elastic to allow movement.  However, if you have an ankle problem like mine, why not get rid of the brace?  New non-surgical treatments where the doctor injects your own stem cells into the ankle ligament tear to heal it should allow you to get rid of the Mcdavid elastic ankle brace for good.  In this procedure, your own adult mesenchymal stem cells are isolated and then grown to bigger numbers.  They are then injected under x-ray guidance into your torn ankle ligaments.  After this break-through procedure, you can wear a brace for a few weeks, but continue playing and working out while the ligaments heal.  Maximum healing is 6-12 weeks.  You can come out of the Mcdavid elastic ankle brace after just a month.  Why go through all of this?  An unstable ankle eventually damages the cartilage in the ankle and leads to early arthritis.  So what’s a pain in the ankle now, will be severe arthritis in 20 years, unless you get the ankle ligaments fixed.  Think of these ligaments as duct tape that holds your ankle bones together.  When that duct tape is torn, it needs to be fixed, not braced.

Ankle support in london?

As a physician, you might say that I have an American MD specializing in Regenerative Medicine and a “doctorate of hard knocks” in ankle braces.  When I came across people searching for “Ankle support in london” I had to throw in my two cents.  I don’t live in London, far from it, I’m in beautiful Boulder, Colorado.  If you’re looking for an ankle support brace, I can tell you first hand that I’ve tried them all.  The winner?  The Malleoloc.  However, my quest for the perfect ankle support didn’t end there, I then tried prolotherapy which allowed me to get rid of the ankle support brace.  This technique involves injecting substances into the ankle ligaments to kick off an inflammatory healing response.  This worked pretty well, even allowed me to take a run every once in a blue moon.  What would I do today instead of the ankle support?  I’d try this cutting edge procedure where they inject your won stem cells into the ankle ligaments to heal and repair the damage.  The video below shows a patient where this was done in the U.S.:

ankle sprain with bone bruise that has taken 5 months

ankle brace

ankle brace

I recently saw the call for help, “ankle sprain with bone bruise that has taken 5 months appear on the Internet. It reminded me of my own problems some 15 years a go as a young doctor just out of residency. I was running and slipped off the concrete path and severely twisted my ankle. It was so bad that I had to limp home at 1/4 walking pace. I placed myself in an immobilizer and waited for it to heal, no healing after 1-2 months. I then began an Odyssey of ankle braces. The air cast was popular at the time, it was a joke, a great way to cut off my circulation without helping any stability. Then 2 months, then 3 months… I was onto seeing specialists. The people who worked with ankle sprains in my community at the time were all podiatrists. I went one who told me he had nothing to offer. Then 3 months became 4 months. I was still limping around the house when I did anything active. I then tried more braces. I bought the old fashioned lace up type, some stability, but getting the beast on and off was a nightmare. I was in a physical free fall of sorts, going from a very active young man to a couch potato. My weight ballooned. 4 months became 5 months. I then finally found my first savior, the Malleoloc brace. While this helped, 5 months became 6 months, 7 months, 8 months, 9 months, a year. Finally I tried prolotherapy, which wasn’t perfect, but got me to the point where I could function and even go out running every once in a great while. If I had injured this today, I would have certainly chosen injecting my own adult stem cells to fix my ankle ligaments. We’ve had great success with this new cutting edge injection treatment using the patent’s own stem cells. The video below tells more:

December 24, 2008

Sports Ankle Brace

Several years ago I injured my ankle while running. It didn’t completely heal, so as a physician, I set out to find the perfect sports ankle brace. My first stop was the then famous “air cast”. This was a great way to stop the circulation in my ankle, but did little to help the pain and swelling. The next sports ankle brace I tried was the old fashioned lace-up models. They were a nightmare to get on and off, but did supply some stability. After trying 10-12 braces, I finally settled on something that worked, the Bauerfeind Malleoloc.  This was an easy sports ankle brace to get on and off and actually provided some stability. Alas, after walking around with this thing for years, I finally decided to get the ligaments fixed using prolotherapy. This worked reasonably well and took a few injections. Today there are even newer ways to fix these ligaments with the injection of stem cells. The video below will provide more information:

December 15, 2008

achilles tendon tear bursitis

The Achilles tendon is the cord that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus).  This transmitts force to the foot for “toe off” in normal walking.  An Achilles tendon tear bursitis is when the tendon gets a partial tear (not through and through, but strecthed or torn a bit) and the bursa (lubricating sac between the tendon and the calcaneus bone) gets inflammed.  This bursitis can cause pain and is usualy from too much force on the tendon.  The cause of this problem is usually altered bio mechanics.  This means that things like excessive tightness in the claf muscle, too much weight on that side of the body, or even issues with range of motion of the hip or knee joints are overloading the achilles tendon.

The most traditional way to treat this is with a steroid injection into the busa.  While this can reduce the swelling in the bursa and some of the pain, it can also destroy the body’s ability to heal the tendon tear.  Steroids will reduce the activity of the body’s own stem cells it uses for repair.  Smarter ways to fix this problem would start with changing the biomechanics to reduce over load in this region.  Orthotics may help, as well as loosening the muscles in the calf and around the knee or hip joints.  Once that’s accomplished, newer non-surgical methods to treat this problem are now available.  These include prolotherapy injections into the tendon area.  These injections are used to cause a brief inflammatory healing reaction in the tendon.  While these may help, they can only rarely help strengthen the tendon in our experience.  The issue is that the Achilles tendon is such a big and dense tendon, getting the prolotherapy medicine into the tendon can be difficult.  In addition, accessing the exact area of the bursitis without x-ray guidance is almost impossible.  A newer alternative is the injection of the patient’s own stem cells into the bursa area under x-ray guiance.  This allows the stem cells to turn into new tendon material and strengthen the tendon and reduce the bursitis.  For information on this technique, see the link at the front of the first paragraph above.  This newer stem cell tecnique avoids surgery and allows for high activity levels after the procedure, unlike surgery which usually requires at least a walking boot for immobilization.

August 21, 2008

What is joint preservation?

Joint preservation is both an unknown and new medical science.  It literally means what it sounds like, preserving a joint via a number of tools rather than replacing all or part of that joint.  So instead of a total knee replacement, fixing as many issues as possible to make sure the joint still functions.  Why do this?  Joint replacement is big surgery with big risks, so many of us would like to avoid these risks.  In addition, from a psychological perspective, one knows they are truly “old” when a surgeon cuts out what used to a perfectly good joint and replaces that with metal and plastic.  So this blog is dedicated to my clinical experience and the tools I use to save joints, hence joint preservation.

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