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Saturday, December 29, 2007

Struggling with pain from an ankle injury

Hi, I am a 30 year old struggling with pain from an ankle sprain injury that has not healed. I sprained my ankle in an inversion type of injury in June 2007. There was never any swelling in the ankle at all, and I did not seek treatment. Over the coarse of the next 3 weeks, I noticed a throbbing ache in the outer aspect of my foot toward my outer heel area. I wrapped with an Ace bandage and tried to limit my walking. I also was a runner/could run 4-5 miles 3 times a week until this injury.

Eventually I saw the primary care dr. and he dx me with an ankle sprain and ordered a air cast for my foot. It seemed to help the pain at first and I increased my walking and 5 days later I could not bear weight on the foot.

I had an MRI and a CT scan which showed no torn tendons/ but small tears in my post tib tendon with an accessory navicular bone. Also a tarsal coalition that I never knew I had was dx'd at this time, however my foot looks completely normal. All of my pain is on the outside of my foot. I have done pt for 3 months with ttle improvement. I am doing accupuncture now, but still take a lot of medicine for pain. Ibuporfen/Aleve/tylenol arthritis. I can stand and walk for 1.5 hours on my foot and have a lot of muscle wasting in my calf on my left leg as I continually favor that leg.

My doctor wants me to start on a medicine called Cymbalta which is an antidepressant. Apparently this medicine is also for neuropothy. This pain is real and I can't seem to find any help for my pain. I will try to do your exercises for the calf muscles. do you have any thoughts? I also am doing accupressure massage to my peroneals. Thanks for your time! -Joi
Gary Moller responds:
Therapy to assist recovery following an injury should always focus on assisting the body with healing itself. On occasion, there can be a place for various drugs, surgery and immobilisation. But these should never be at the cost of impairing natural healing processes. Nutrition, some supplements, rest/exercise, massage and Old Man Time should be the mainstays of injury rehabilitation.

Please have a read of my other articles about ankle pain here.

From what you have written, I can see no reason for prescribing Cymbalta for your ankle pain, if that is the reason given. While the injury may be depressing and frustrating, this medication has far too many risky side effects. The best action for feeling depressed about a sore ankle is to deal as best one can with the ankle through positive action. All that anti-depressants can do is dull the brain to the reality of the situation. Avoidance by way of dulling the brain is not positive action. I might add the same cautions about adverse short and long term side effects apply as well to the various pain medications that you are presently relying on to get through the day. Having said this, please discuss your needs with your doctor, including what is advised in this article, thank you.

You should heed my advice here about ankle pain.

In addition, you need to take the accupressure massage a step further. Find a trained therapist who can deeply massage all of the knotted and painful areas of the calf and ankle. This should be done about every 4th or 5th day with rest between to allow healing. The therapist should also be mobilising and tractioning the ankle and the various other joints of the foot. Where you have painful joint margins, the therapist should massage these, applying progressive finger pressure as pain permits. This massage breaks up and softens areas of scar, swelling and toxic buildups. As the massage progresses during a session, the intensity of the pain should diminish. You may feel a little bruised for a few days after. This is to be expected and the bruised gristle will eventually be replaced by healthy, supple tissue that is pain free.

The supplements, including vitamin C referred to in the article here are important when getting this kind of massage therapy. If it is going to work, you will notice a significant improvement in the pain levels after 4-6 sessions. Each session should last about an hour. Above all else, give things time and do not be panicked into radical therapies that can not be reversed.

Please keep in touch and let me know how you get on.

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