Proprietary enzyme/ flavonoid combinations Anti-inflammatory 3-4 tablets, 3-4 times per day at least 30 minutes before meals Beware of allergies and cross reactions (e.g., bromelain and pineapple). For more details, see the CSPE protocol Trauma: Diet, Nutritional Supplements and Botanical Considerations. Supplements to Promote Healing and Tissue Repair In treating any tissue trauma, one must consider the patient’s diet and recommend appropriate nutritional and botanical supplements that may promote and/or support the healing process. The following are some options to consider. Phase of Injury Substance Therapeutic Effects Dose Rehabilitative (after inflammation has subsided) Broad-spectrum vitamin and mineral supplement Tissue-healing support At least 100% RDA or Daily Value of most ingredients Rehabilitative Vitamin C Tissue-healing support Up to 1000 mg/day Rehabilitative Zinc Tissue-healing support Up to 50 mg/day Rehabilitative Glycosaminoglycans (GAGs) Tissue-healing support Chondroitin sulfate,1200 mg/day; glucosamine sulfate, 1500 mg/day For more details, see the CSPE protocol Trauma: Diet, Nutritional Supplements and Botanical Considerations.
8 4. E NCOURAGE M OTION Promoting motion as soon as possible my help prevent stiffness and maintain greater post -injury range of motion. Ankle pumps The patient lies supine, preferably with ankles slightly elevated off the end of a bench or bed, and slowly moves them through a pain free range of dorsi and plantar flexion. Recommend 10-20 pumps per hour. (Dubin 2011) Modified activities. If the sprain is relatively mild, activities like stationary cycling can be allowed. 5. M OBILIZATION /M ANIPULATION Associated with the ligamentous injury itself, hypomobility and/or malposition of the ankle joints may also occur in both acute and chronic ankle sprains (Hubbard 2008). For example, based on radiographic measurements, it has been suggested that the distal fibula may be displaced, usually anteriorly after a lateral ankle sprain. (Mulligan 2011, Hubbard 2008) Mobilization or manipulation of the foot and ankle joints can be an effective treatment as long as it is done with proper positioning to minimize the risk of aggravating the injury and within the patient’s tolerance . After an ankle sprain, restricted posterior glide of the talus can contribute to decreased dorsiflexion. The addition of an anteroposterior joint mobilization of the talocrural joint to a standard RICE protocol has been shown to improve dorsiflexion ROM and gait as compared with a group that received RICE alone (Kaminski 2013). A 2014 systematic review found that manual foot and ankle joint mobilization/manipulation diminished pain and increased dorsiflexion range of motion in acute ankle sprains (Loudon 2014). Also, early mobilization has been shown to aid in a more rapid recovery and the prevention of late residual symptoms and instability (Eiff 1994). In the case of chronic ankle sprains, Van Ochhten 2014 reported that there is moderate evidence that