This damages ligaments on the outside of the ankle. A partial ligament tear produces a moderate sprain and a complete tear causes a severe sprain. Pain, a popping sound, swelling, bruising, stiffness and instability are signs of torn ankle ligaments. A severe ankle sprain typically causes severe signs, which may be similar to those seen with an ankle fracture. Pain is the most common immediate sign of a partial or complete ligament tear of the ankle. The pain can be moderate or severe and is generally maximum in the area of the torn ligament.
A popping sound may be heard at the time of the injury with a complete ligament tear. A partial or complete ligament tear causes ankle swelling due to bleeding and inflammation in the area. Bruising also occurs, as blood leaks into the tissues beneath the skin. The amount of swelling and bruising generally depends on the severity of the ligament tear -- it is moderate with a partial tear and severe with a full tear.
Swelling and bruising may worsen in the first couple days after the injury. Swelling, bruising and pain typically lead to ankle stiffness after a partial or complete ligament tear. With a complete tear, the ankle will also feel unstable when the person attempts to stand on the leg. See a doctor if you have moderate or severe ankle pain, swelling or bruising, or if you are unable to put weight on your ankle. An x-ray may be necessary to determine whether you have a severe sprain or a fracture.
The fibroblasts make single long molecules which, when outside of the cell, will begin to entwine around each other, forming what we call a collagen fiber, which is a "triple helix" of these molecules.
The individual molecules are held together by strong chemical bonds, As the collagen fibers wind around each other, they begin to contract and the molecules become shorter and tighter. Water is squeezed out like squeezing a sponge , which also causes shrinkage. As the millions of collagen fibers lose water and shrink, the ends of the ligament will be slowly pulled together and the laxity will decrease.
We can see this in the healing of a skin wound as the edges of the wound pull tightly together near the end of the healing process.
During the third phase of the healing process, all of the cells originally present to "clean up" the wound are recalled by the body. All that is left at the injury site are the fibroblasts which have been "turned on" and are secreting the collagen and other substances which will be used to increase the integrity of the injury site. The third phase of inflammation lasts for a number of weeks, and the "new ligament" tissue will not reach its maximum strength for several months.
Ligament Injection Therapy Now that it is understood how inflammation works, we can really understand what we need to do to create inflammation.
Ligament injection therapy simply stimulates this healing process in a more controlled and less violent way than occurs during trauma in an automobile accident, slip or fall, twist or athletic injury. The technique of creating this inflammation and the creation of collagen is done by injecting proliferants. Proliferants are nothing more than irritants. These irritants are enough to break open the surface of the cell walls and allow the spilling out of their contents into the immediate and adjacent tissue spaces near where the fibroblasts reside at the junction of the ligament and the bone.
This then stimulates the healing cascade. A number of different proliferants may be used which are capable of causing this process. Osmotic shock agents are dehydrating agents that remove the fluids from the cells around the injection site. In the modem Orthopedic medicine practice, this osmotic shock agent is primarily a concentrated solution of glucose , glycerin, and a very small amount of phenol.
It is called "P2G". Sodium morrhuate is another frequently used proliferant. This drug is the same long fat molecule that makes up the cell wall.
When injected in dilute amounts it stimulates the production of the prostaglandins or the chemical messengers of inflammation. Sodium morrhuate is extracted from cod liver oil and has the same chemical formula as arachidonic acid. All of these proliferants are injected at the fibro-osseous junction with a large amount of local anesthetic, usually Procaine. The discomfort of prolotherapy , because it is an "artificial" injury, is an important signal that healing is under way.
The pain, swelling, heat and the redness caused by the injections are all signs that the underlying cellular and chemical processes of million years of evolution are safely underway. The body's pain signals can be listened to, and as the pain decreases the joint movement can increase. Why is this secondary treatment needed? If this process is a natural on in the body, why did it not do the job correctly the first time?
Medical physicians do not understand all the reasons. Some of the more likely causes are: initially, there was continued joint displacement following the injury and the ligament healed in the "longest possible length" position, the nutrition of the patient during healing was inadequate, the genetic tendencies to heal are not complete, or that the healing process was itself suppressed by such medications as aspirin.
Aspirin and other nonsteroidal anti-inflammatories NSAIDs can knock out or suppress the healing response by interfering with the prostaglandin growth factor pathways. These drugs are frequently prescribed because they are thought to be safe and a conservative treatment modality. However, research has shown that aspirin is not without significant side-effects concerning inflammation.
In addition to well-documented adverse effects this medication has upon healing in the stomach, they may directly inhibit the healing of injured ligaments.
Prolotherapy is not a new technique. Ligament injection therapy is 2, years old. Prolotherapy was first used by Hippocrates on Olympic javelin throwers who occasionally dislocated their shoulders. It was used to treat hernias before modern surgical techniques became available. Swelling is important in the initial stages because it helps to prevent further injury, but it needs to be managed carefully.
Instability is a common symptom of damage to the knee ligament. If the ACL is torn, for example, then there will be significant instability immediately after the injury. Once the joint begins to swell, however, then this may not be so obvious. Proper treatment is essential for a full recovery. A physiotherapist may provide a conservative treatment plan or a set or exercises to perform in the lead up to surgery.
If rehabilitation is ignored by the athlete, it can result in additional problems and may prevent a full return to competitive sports. Alex Paul.
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