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Mind/Body Healing Dr. Robert Weissfeld About NeurOntogenics

The cause of ankle instability  - the conventional view

According to the American College of  Foot and Ankle Surgeons, “Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and “retrain” the tissues within the ankle that affect balance.”

Repeated ankle sprains often cause—and perpetuate—chronic ankle instability. Having an ankle that gives way increases your chances of spraining your ankle repeatedly. Each subsequent sprain leads to further weakening (or stretching) of the ligaments—resulting in greater instability and the likelihood of developing additional problems in the ankle.”

What is Chronic Ankle Instability?

Chronic ankle instability is a condition characterized by a recurring “giving way” of the outer (lateral) side of the ankle. The ankle can give while walking, running or doing other activities,. Ankle instability can affect athletes  and non-athletes alike.

The symptoms of chronic ankle instability include:

surfaces or when participating in sports

Nurontogenic principles and ankle instability

While the conventional view (left) is not untrue, it misses what may be the major factor in the treatment of ankle instability.

Examination of an unstable ankle will always show muscle aberration - some muscles too tight, some to lose, and many with aberrant muscle tests, some inhibited, others over-facilitated, all of which indicate problems with proprioception - the sense of joint position, muscular and ligament stretch. Problems with proprioception are thought to be the primary cause of ankle instability.

Following any injury, ankle sprain/strain included, a series of adaptations occur to the injured body part.  These adaptations may do the following:

Healing of the tissues may not restore function to it’s pre-trauma state. Adaptations that remain past their time of need become a maladaptive.   The presence of muscle inhibition or over-facilitation, as determined by muscle testing, indicates the presence of maladaptation and ankle instability.

According to neurontogenic principles, maladaptation, causing altered proprioception and muscle imbalance, constitutes a major piece of the cause of ankle instability. While this does not remove damaged ligaments  as a factor, treatment using neurontogenic principles often rapidly, effectively and lastingly improve ankle instability.  

Initial treatment of ankle sprain/strain - the generally accepted view.

In addition to RICE - Rest-Ice-Compression-Elevation, the latest research has shown that functional treatment is superior to complete immobilization even for severe ankle sprains with torn ligaments.  Functional treatment includes, as tolerated, use of complete range of motion and early resistance work and weight-bearing as well. Exercise and joint motion stimulate healing and influence the strength of ligaments after injury. (1 left)

Surgery, with it’s risk of side effects, can be applied at any time after the injury if conservative measures are not sufficient.  

Neurontogenic view of early treatment of ankle sprain/strain

When treated with NeurOntogenics®,  the immediate pain and resistance to weight-bearing and movement of mild to moderate ankle sprain/strain is fairly easily treatable.  The recommendation of the use of ice following injury is a nod to the understanding of neurontogenic principles; the body is understood to overreact to trauma. Pain we find, is a part of the adaptation process along with muscle imbalance and proprioceptive changes. Adaptation begins immediately following an injury, and much of the adaptation seems to be overreaction, as inhibited muscles will strengthen, pain-free range of motion will be restored, and weight-bearing tolerated immediately following treatment of a freshly sprained ankle.

NeurOntogenics®  Neuromotor Deprograming and ankle instability

As mentioned earlier, muscle imbalance, including inhibition over-facilitation, all of which indicating altered proprioception are the main findings from a neurontogenic evaluation of an unstable ankle. As stated in neurontogenic principles such imbalances are the result of adaptation to previous stress and trauma that never reverted  to normal function thus becoming maladaptive. NeurOntogenics® Neuromotor Deprograming - treatment to eliminate residual maladaptation - is very effective at restoring stability to the unstable ankle.

Depending on the integrity of the ligaments, ruptured or severely stretched ligaments will of course compromise stability to some extent, we find stability to be significantly enhanced within four to eight visits.

As long as the basic integrity of the ankle is sufficiently intact to prevent the body from going back into adaptation, the result of neurontogenic treatment is generally lasting.  Some individuals will, if their ankle injuries were severe enough, still benefit from some kind of taping or support following treatment, but many ankles go on to lasting normal function.

Standard physical therapy treatments and ankle instability

There may still be benefits that can be gained from more standard physical therapy applications.  Once muscles are freed to return to their normal function by eliminating maladaptation, the benefits of appropriate exercises will be attained much more readily.  When adaptation is no longer confusing proprioception, practice with balance and stability should achieve faster and more lasting results.  Trying to attain peak conditioning with maladaptation in place is like replacing your auto tires that have been warned unevenly without first fixing the alignment; an imperfect solution.

Neuromotor Deprograming    -  speed recovery from pain and dysfunction

- Also the longest lasting recovery possible
-  Very possibly the best value in health care

1 The best care for severe ankle sprains/stain

“... it is not  difficult to select functional treatment as the treatment of choice for acute complete tears of the lateral ligaments of  the ankle. Functional treatment includes only a short period  of protection by tape, bandage, or a brace, and allows early  weight-bearing. Range-of-motion exercises, as well as neuromuscular training of the ankle, should begin early. This  program clearly provides the quickest recovery to a full  range of motion and return to work and physical activity.  It does not, however, compromise the bate mechanical stability  of the ankle more than the other treatments, and it  does not produce more bate symptoms (giving-way, pain,  swelling, stiffness, or muscular weakness) than operation  and immobilization in a cast or a cast alone. In addition,  functional treatment seems to be virtually free from  complications,  while after the other methods of treatment, especially by  operation, serious complications sometimes occur.”  

Kannus P, Renstrom P: Treatment for acute tears of the lateral ligaments of the ankle. Operation, Cast or early controlled mobilization. JBJS 73-A: 305, 1991