Repeated ankle sprains and instability; A new study shows chiropractic manipulation + rehabilitation is superior to just rehabilitation alone.
If you have an ankle that repeatedly sprains, even if you have had rehabilitation done by a physical therapist or other practitioners, you may wish to see a chiropractor instead if you want a better result.
A recent study in the Journal of Manipulative and Physiological Therapeutics (1)1 suggests that “the patients with a recurrent ankle sprain with functional instability who received chiropractic manipulative therapy plus rehabilitation showed a significant short-term reduction in pain and the number of joint restrictions in the short-term but not disability when compared with rehabilitation alone.”
From the point of view of a chiropractic sports physician who has treated many sprains to the ankle, one of the reasons the repeated sprains occur is that not only are the joint ligaments damaged to varying degrees depending on the sprain, but the muscles and tendons around the ankle can become shortened and tightened since they are compromised as well with each sprain and scarring will over time reduce the flexibility of the area. Perhaps, this is why after a few sprains to the same ankle, patients refer to their bad ankle (s). To complicate matters more, the shortening of all the tissues surrounding the ankle reduces the ability for it to function properly, limiting joint movement and eventually putting the knee and even the hip and lower back at risk, since problems that are long term in the ankle and foot will affect the hip and knee and even the lower back through compensatory mechanisms.
In all probability, it is reasonable to deduce that repeated ankle sprains is a whole person problem rather than just an ankle problem. It is therefore clinically logical that treating the fascia-kinetic chains (series of joints that affect one another) would be even more effective at reducing ankle pain and improving long term healing and rehabilitation efforts as compared to concentrating on the ankle sprain alone as if the ankle when healed will never create other problems. Assuming that ankle sprains are always self-limiting and do not have any other sequelae is likely to result in future problems and disabilities that could have been handled before they ever created a problem in the first place.
Additional approaches used by today’s chiropractor for an ankle sprain are balance boards, proprioceptive retraining, extremity manipulation, and myofascial release or instrument-assisted soft tissue methods such as Graston to reduce chronic scarring, enhance mobility and assure a much better outcome. Foot orthotics are often recommended because certain foot styles are mechanically inefficient (they are inherited) and future injuries can be prevented by the right insert since it improves the way the ankle can ideally work and affect the rest of the leg and back
The idea of treating only one area per session as often heard by patients visiting a physical therapist is makes little sense, considering ankle function affects the entire kinetic chain says Dr. Charschan, owner of Charschan Chiropractic and Sports Injury Associates. It shows an unwillingness to fully treat evaluate or ignorance of basic body mechanics that may cause future sprains and injuries that in all probability that could have been prevented with a more comprehensive approach that adds little if any cost in the management of ankle sprains.
When you look at how the ankle works and how it affects the body from an engineering perspective (it is designed to move in a number of ways to allow proper function of the knee, hip, back and spine). This is why people who have bad ankle problems or previous fractures tend to have knee or back problems afterward; a compromised ankle will have significant effects on other parts of the kinetic chains (series of joints that affect one another, similar to the way domino’s work).
1. Manipulative therapy and rehabilitation for recurrent ankle sprain with functional instability: a short-term, assessor-blind, parallel-group randomized trial
Journal of Manipulative and Physiological Therapeutics, 11/14/2014
Lubbe D, et al. – The purpose of this study was to compare manipulative therapy (MT) plus rehabilitation to rehabilitation alone for recurrent ankle sprain with functional instability (RASFI) to determine short-term outcomes. This study showed that the patients with RASFI who received chiropractic MT plus rehabilitation showed a significant short-term reduction in pain and the number of joint restrictions in the short-term but not disability when compared with rehabilitation alone.
- This was an assessor-blind, parallel-group randomized comparative trial.
- Thirty-three eligible participants with RASFI were randomly allocated to receive rehabilitation alone or chiropractic MT plus rehabilitation.
- All participants undertook a daily rehabilitation program over the course of the 4-week treatment period.
- The participants receiving MT had 6 treatments over the same treatment period.
- The primary outcome measures were the Foot and Ankle Disability Index and the visual analog pain scale, with the secondary outcome measure being joint motion palpation.
- Data were collected at baseline and during week 5.
- Missing scores were replaced using a multiple imputation method.
- Statistical analysis of the data composed of repeated-measures analysis of variance.
- The between-group analysis demonstrated a difference in scores at the final consultation for the visual analog scale and frequency of joint motion restrictions (P ≤ .006) but not for the Foot and Ankle Disability Index (P = .26).
Dr. William Charschan is the director of Charschan Chiropractic and Sports Injury Associates with locations in North Brunswick and Scotch Plains NJ. He is often referred to as The Body Mechanic because of his engineering background and his way of using engineering principals to solve every day painful problems in the musculoskeletal system. Find out more by visiting backfixer1.com. Be sure to read his book Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com and other booksellers.