Saturday, December 6, 2008

When A Doctor Gets To Taste His Own Medicine...The Story of My Ankle Sprain

So this morning I'm running and I missed the curb I was targeting for my next step. I was at the tail end of my stride when my forefoot caught the outside of the curb and my foot and ankle inverted (rolled over) with a vengeance and the weight of my full 200-lbs coming down on it.

C-R-A-C-K from the ankle then boom as I dropped to the floor. I've never felt pain like this. It was severe, it was intense, I immediately became nauseated and light headed. The pain brought tears to my eyes. Ironically, it all happened in a handicap parking space.

It took me about 10 minutes before I was able to handle the pain and think about getting off the ground. My son's surf camp instructor had brought me an instant ice pack that I help on there while I lay on the ground. I swore I broke it. I've sprained my right ankle 6 times earlier in my life which prompted me to study and research how and why ankle sprains tend to reoccur so often. This time felt much different, much more severe. I tried getting up with the help of my son's Sufing camp instructors and walked about 8 steps when I was overwhelmed with chills and light-headedness and before I actually passed out, I sat back on the ground (this time on the grass) for another 10 minutes until I was able to get up.

Before getting up I started examining my ankle. There was light tenderness at the lateral talus, lateral calcaneus and at the distal fibula. Why was the pain so intense from the injury yet when I examined it, it was so mild? Because the inflammatory process hadn't start to really kick in yet. When I moved my ankle to test its stability, wow.. there was some pain when I inverted it. OUCH! If it was fractured, I was going to have to get to the E.R. quickly before the inflammation started to build up. Often, periosteal swelling (an onion-skin like tissue layer on bones) can block some fractures from being seen on an x-ray.

I was eventually able to drive myself to Mt. Sinai Medical Center where I was quickly brought into the emergency room. I waited maybe...maybe 5 or 6 minutes. A very nice nurse practitioner came in to check me, took a history and did a cursory exam and ordered some x-rays. I asked for a bag of ice and an ace bandage and I started to take my own medicine. I placed a paper towel on the skin, placed the bag of ice on the lateral ankle and then, with the help of a nurse, wrapped the ankle moderately tight with the Ace bandage. I elevated the ankle and waited for the radiology tech to take me for an X-ray. After X-ray, I re-wrapped it and waited for the attending physician, Richard Menendez, MD to give me the news. Dr. Menendez was very nice, very thorough and explained the injury and my options. Of course I knew all of this because this is exactly the type of injury I take care of at my office on a daily basis. I knew what I was in for.

So for me, it was mixed news. The x-ray was negative for fracture. This may seem odd that I say this. But with most simple fractures, they will most often heal faster and stronger than a bad ankle sprain. Turns out I have a "bad ankle sprain". Which means weeks and weeks of therapy and more weeks and weeks of rehab with emphasis on proprioceptive neuromuscular re-education. Yes, a mouthful I know. But, probably one of the most important aspects of getting an ankle that was badly sprained to be functional again. Especially when it's the ankle of an athlete...or me, the wanna be athlete.

So, what's my medicine???

To start with: R.I.C.E. Rest, Ice, Compression & Elevation. I happened to have a Rich-Mar Auto-Sound/Multiwaveform Combo unit at my house and a Sub-Zero freezer full of ice packs. I've been using Interferential stim with ice 30 minutes every 1-2 hours since I got home. I will continue this for the next 2-4 weeks depending on my body's response. Tomorrow I will start passive ROM within a non-painful ARC of motion. As the ankle swells up and gets purple, I'll use Graston Technique ( to increase the lymphatic drainage of the ankle and reduce the swelling. This is incredible for inflammation of most things inflamed (ankles, knees, wrists, knuckles....whatever). Then there will be light Isometric resistance and an anti-inflammatory diet (not to mention some actual anti-inflammatory meds because this sucker is really throbbing with pain). I will put a little pressure on my heel a couple times per day so the capsule / ligaments around the ankle doen't get too tight due to the lack of normal movement and weight bearing.

You see, there has to be a balance between ligamentous stability and joint/tendon/muscle flexibility. Very important and all of us sports docs and sports therapists are still working on the perfect recipe for this.

Over the next weeks I will work in increasing pain free ROM, increasing muscle strength and stability. All things we do in our office, the same stuff I do with my patients. I can't wait to see the faces of my ankle sprain patients on Monday when they see me starting the process from scratch.

Eventually my life will be filled with balance and wobble boards. Working with them "eyes open" and eventually "eyes closed" to stress and rehab the higher proprioceptive centers. Eventually introducing Most Heat rather than the ice and then finishing it off with strength training with the most wonderful ankle rehab device.... The Ankle Rehab Master (To order an Ankle Rehab Master, call 954.752.2299).

Luckily, the Ankle Rehab Master happens to be manafactured by my father (I know, lucky me). What a great tool for strengthening ankles in combined vectors of motion. For those therapists, trainers and sports chiropractors out there.... not only can it easily do plantar flexion, will allow the patient (in this case...'Mwa') to do resisted inversion and eversion. Then there the combined movements of inversion with plantar flexion, eversion with dorsiflexion and everything in-between.

I'll be ready for that in about 4 weeks.... I hope.

But Monday morning, I'll be ordering an Air-Ankle stirrup to strap on my ankle so I can walk without these crutches. A recent study shows a sprained ankle will heal quicker when you wrap the ankle with an Ace bandage and use the Ankle Stirrup together. I’ve tried it with a few patients and it seems to be a good thing.

So, I know what I'm in for and I'm willing to take my own medicine.

Now it's time for more R.I.C.E.

'nuff said


Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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