Chiropractor Chandler AZ
PLATELET-RICH PLASMA PROLOTHERAPY FOR ANKLE PAIN
Millions of people around the globe are affected by ankle injuries every year. It is thought to be a sports injury, but normal people are equally susceptible to an ankle injury. Even walking unevenly on a rough ground can lead to an ankle injury. Ankle injuries are independent of age and gender, but people between ages 15-24 are more susceptible than others. Half of the ankle injuries occur during sports activities. In the U.S, 25,000 people are reported to suffer from ankle sprains annually. More than one million people visit emergency rooms each year due to an ankle injury. These ankle injuries include ligament and tendon damage and bone fractures.
The ankle joint consists of three bones: the tibia, the fibula of the lower leg, and the talus of the foot. These bones are held together at the ankle joint with the help of ligaments. The joint structure is stabilized by tendons that attach the muscles to these three bones.
CAUSES OF ANKLE PAINAnkle pain is caused by injury to any tissue of the ankle joint. It occurs when the ankle joint is twisted too far out of its normal position.
FractureA fracture of one or more bones in the ankle joint causes severe pain and walking impairment. The fracture can by caused by sports activity, a direct hit to the bone, or due to falling.
SprainWhen the ligament is stretched beyond the normal range of motion, it causes a sprain. It can be multiple microscopic tears in the ligament or a complete tear of the ligament.
StrainIf a muscle or tendon is stretched too far, it can damage the muscle or tendon. It is called a strain. In the ankle, peroneal tendons are more often strained. Damaged tendons can become inflamed. This condition is called tendonitis which can be very painful.
RISK FACTORS OF ANKLE PAINThe following factors can cause ankle pain:
- Falling
- Tripping
- Improper landing after a high jump
- Walking on a rough surface
- A sudden blow, such as car crash
- Twisting the ankle
- Rolling the ankle
The symptoms of a sprain and fracture are similar. These include:
- Sudden and severe pain
- Swelling
- Bruises
- Inability to walk
- Inability to bear weight on injured ankle
- Stiffness
- Tenderness
Symptoms of tendonitis can be:
- Ankle weakness and instability
- Increased height of foot arch
- Sporadic pain on the outside of ankle
Physical examination
The doctor will examine the ankle for any swelling and bruising. He will also move the ankle to check the range of motion and severity of the pain. Physical examination can be painful since the doctor is moving the injured ankle.
X-rayX-ray is recommended if a fracture is suspected. The doctor can recommend X-rays of the leg and foot to evaluate any possible injury that may cause ankle pain.
MRIIf a stress fracture is suspected, the doctor can ask for an MRI which gives a detailed image of the damaged ankle.
TREATMENT OF ANKLE PAIN
It is important to give the ankle proper rest to avoid any further damage in case of ankle pain. Keeping the weight off the ankle is helpful in reducing pain.
ICEUsing ice slows down the process of swelling and numbs the area which reduces the sensation of pain.
COMPRESSIONWrapping the injured ankle with a compression wrap is helpful in keeping the ankle immobilized and prevents any further damage.
ElevateElevating the ankle to the level of the heart prevents ankle swelling.
Pain MedicationsIn most cases, ankle pain is relieved by using pain medications such as acetaminophen or other nonsteroidal anti-inflammatory drug such as ibuprofen.
Physical TherapyPhysical therapy is helpful in strengthening the tendons and ligaments in the ankle joint. It helps to improve the range of motion, strength, and balance.
SurgeryWhen the conventional treatment options fail to relieve the pain, surgery is inevitable. Surgery is helpful in treating damaged ligaments and tendons. In the case of a fracture, the bone is surgically secured at its place by using metal plates and screws.
Alternative TreatmentAnkle pain is caused by a damaged bone, ligament or tendon. The conventional treatment options, such as pain killers, suppress the pain signals and relieve the pain. Surgery is a helpful option, but it cannot regenerate the damaged tissue and thus it is not very useful in the case where the tissue is badly damaged. Any alternative treatment option that can regenerate the tissues will be very helpful in treating ankle injuries fast while restoring the normal structure of the ankle joint.
Platelet-rich plasma prolotherapy is an alternative treatment option that is known to treat the pain by repairing the damage. It is a next generation treatment method. It is a type of Prolotherapy that uses the platelet-rich plasma drawn from the patient's blood. The word 'Prolotherapy' is a combination of proliferation and therapy. In this technique, the healing machinery of the body is manipulated and accelerated to heal the injury.
In platelet-rich plasma prolotherapy, the platelet-rich plasma is extracted from the patient under sterile conditions in a clinical settings. This blood is then centrifuged and different components of the blood are separated into different layers. The platelet-rich plasma layer is separated and the rest of the material is discarded. The platelet-rich plasma is injected at the site of injury. When the platelet-rich plasma is injected at the site of injury, it releases alpha granules that cause the release of one's' own growth factors. Growth factors are the proteins that initiate the tissue repair by cell growth and proliferation. Platelets cause the growth factors to stimulate the epithelial growth factors (EGF) which induce the cell migration and replication at the site of damage, causing the damaged tissues to heal quickly.
The platelet-rich plasma injection is followed by three stages of healing:
- Inflammation phase that lasts for 2-3 days. In this phase, growth factors are released.
- Proliferation phase that lasts for 2-4 weeks. It is vital for musculoskeletal regeneration.
- Remodeling which lasts over a year. In this phase, collagen is matured and strengthened.
The platelet-rich plasma Prolotherapy specialist makes sure that these three phases are completed to ensure the complete recovery from the injury.
Safety IssuesThe main safety concerns when using an invasive method are:
- Immunogenic reaction
- Disease transfer
- Hyperplasia
- Cancer
- Tumour growth
Platelet-rich plasma Prolotherapy uses the blood of the patient, thus there are no chances of immunogenic reaction or blood-related disease transfer. No studies have documented that platelet-rich plasma Prolotherapy causes tumor growth or cancer.
The symptoms are temporality worse after the injection. The possible side effects of platelet-rich plasma Prolotherapy are:
- Infection
- No relief of pain
- Neurovascular injury
- Scar tissue formation
- Loss of limb or death is rare, but possible
Platelets contain PDGF (Platelet-derived Growth Factor) that promote collagen and protein synthesis and VEGF (Vascular Endothelial Growth Factor) that promote the synthesis of new blood vessels. These two growth factors are very helpful in treating tissue injuries and fractures in the ankle joint.
A study published in the American Journal of Sports Medicine evaluated the platelet-rich plasma Prolotherapy for osteochondral lesions of the talus bone of the ankle. 29 patients were given either Hyaluronic Acid (HA) injections or PRP injections. The patients who received PRP injections had significantly higher scores as compared to those who received the Hyaluronic Acid injection.
Preclinical and human cell culture studies have been conducted to evaluate the PRP prolotherapy and its effectiveness. In these studies, an increased tendon repair with no scar formation is observed after PPR injection. Another study showed 60% improvement in the patients treated with platelet-rich plasma Prolotherapy for a damaged tendon. PRP prolotherapy also seems to be effective for muscle damage repair. Although limited studies are available that show the effectiveness of this technique in muscle damage repair, experiments done in the lab on the human cells have shown the effectiveness of this technique for muscle repair and cell growth.
In the case of a fracture, the PRP prolotherapy has shown great results. It not only increases the blood vessel synthesis in the fractured bone, but also increases the synthesis of collagen. A research conducted on patients with unresolved ankle pain showed that PRP Prolotherapy was very effective in eliminating pain, stiffness, and improving the quality of life.
Platelet-rich plasma prolotherapy is the future of pain management. If the conventional treatment options fail, surgery is the only option left, but with PRP prolotherapy, injuries can be treated without surgery and it will reduce the financial burden and recovery time. Thus, it is very important to establish the effectiveness of PRP and its optimized protocols.
While PRP and stem cell treatments are enhancing the tissue repair and regeneration, conservative treatments can enhance healing, strengthen the muscles, and stabilize joint movements to maximize your recovery.
COLD LASER THERAPY TREATMENTS- Accelerated tissue repair and cell growth
- Faster wound healing
- Reduced fibrous tissue formation
- Anti-inflammation
- Pain relief
- Increased blood flow
- Increased repair and regeneration
- Nerve function and repair
- Increased energy production- ATP
Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.
Laser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.
Low-level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.
Laser therapy causes vasodilatation (increases the size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.
Cold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby eliminating your pain.
Low-level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reduces your perceived pain.
Blood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated to enhance injury repair.
Low-level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing
Nerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.
ATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have the ability to heal and repair.
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercises and flexibility programs.
Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries are common because of weakness and poor stabilization of the leg and hip muscles. The combination of muscle weakness, poor coordination, and altered gait mechanics produce excessive strain on the soft tissues.
The lower extremities work as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise balls, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments foot pain and exercises.
BIBLIOGRAPHYSampson, S., Gerhardt, M., & Mandelbaum, B. (2008). Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Current Reviews in Musculoskeletal Medicine, 165–174. Thomas, M. J., Roddy, E., Zhang, W., Menz, H. B., Hannan, M. T., & Peat, G. M. (2011 ). The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain, 2870-80.