Question
QUESTION: I damaged my ankle ligaments over ten years ago playing football and had no treatment at all. i then damaged the same ligaments about 3 years ago playing football and had a few sessions of physio which did not really help. i then damaged them again last year playing football and had more physio which did not really help again. i have now damaged them again playing football and any slight knock i get or even walk over a little stone wrongly i have extreme pain in my ankle and up my leg. my ankle is so weak that i think i may need some surgery on it. what is your point of view please as im getting tired of going to my gp and getting sent to physio and it not making any difference.

ANSWER: Simon,

First, an orthopedist or a sports chiropractor should evaluate the ankle and determine if the ligaments are loose or not.  They should be able to grade ligament laxity as grades 1, 2, or 3.  With laxity, it creates what's called "mechanical instability."  Literally, the ankle joint complex loses its ability to remain tight, or stable.  Some folks are okay with this, and some develop a weakness where the ankle is more susceptible to "giving out" or re-spraining. This situation is called "Functional Instability."   You likely have this, and whether you also have any mechanical instability needs to be determined.  You can have functional instability without any ligament laxity or mechanical instability, by the way.   As far as pain goes, the best way to deal with your ankle it is to have it adjusted by a chiropractor, usually at the joint complex where the ankle meets the leg bones, or at the talus bone of the ankle.  Research shows that often there is malfunction at this joint complex with an ankle sprain and that the malfunction likely sets up the functional instability.  After you get joint manipulation to the ankle, you should also receive soft tissue procedures at the ligament complex around the joint.  This often is targeted at the most likely affected ligament, the anterior talofibular ligament, or ATFL, located at the side of the ankle (google this).  The soft tissue therapy could consists of the doctor doing transverse frictioning massage or Graston Technique (see www.grastontechnique.com).    Then you should obtain some balance exercises using a rocker board and/or AirEx pad exercises employing weightbearing and eyes-open/eyes-closed balance challenges.  If all goes well, your ankle will feel better and become more stable.   

Good Luck!  'Hope this was helpful and understandable.  

Dr. G

www.drgillman.com


---------- FOLLOW-UP ----------

QUESTION: THANK YOU FOR YOUR REPLY TO MY QUESTION. I HAVE TRIED ALL THE BALANCING TECHNIQUES, AS I WAS TOLD LOTS OF DIFFERENT EVERCISES AND MOVEMENTS WHEN MY PHYSIO SESSIONS ENDED, BUT THEY DO NOT SEEM TO HELP AT ALL. I WAS WONDERING WETHER IT IS GOING TO NEED AN OPERATION OR SOMETHING?

Answer
Simon,

That's why I recommended getting the ankle laxity graded. Grades 1 are not surgical, grade-2's usually are not.  Grade 3 may require it for stabilization.  Also, if you are doing balance exercises, etc, but have not had joint manipulation and soft tissue procedures by a skilled provider, then you're missing out.  Go through the steps I listed: 1) evaluation and grading, then 2) joint manipulation and soft tissue procedures.

'Regards,

Dr. G