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I'm about to turn myself into the physical therapist. I've sprained and resprained the same ankle four times this month. My own exercise program isn't working. What will a rehab expert do that I haven't done for myself?

We can't answer this directly since we don't know from your question just what kind of program you have been following. But we can tell you the proposed factors in recurrent ankle sprain and the principles physical therapists follow when treating a patient with chronic ankle stability (CAI). First, it's likely that there is a change in neurologic function with chronic ankle injuries. Messages from the muscles around the ankle to the spinal cord (and then to the brain) are not the same for someone with CAI compared to someone who has a normal, healthy functioning ankle. A loss of neural control leads to reduced joint proprioception (sense of joint position) and kinesthesia (awareness of movement). The end result can be joint instability, loss of function, and disability. Edema or swelling in and around the ankle can also decrease sensory feedback from the joint. Messages from the joint through the nerves to the nervous system are reduced. With injury to the joint also comes arthrogenic muscle inhibition. Arthrogenic means the cause is coming from the joint. Muscle inhibition means the muscle isn't contracting as it should. This is another way that the muscles are affected after injury and don't fire normally. The person suffers from a loss of both motor control and postural control. The slightest change in surface or environment can result in another ankle sprain. The physical therapist understands all these mechanisms. The rehab program is designed to include activities to restore joint proprioception and kinesthetic awareness. Exercises to strengthen the muscles and improve sensorimotor input are carried out. Rehab programs with a neurologic component are essential when trying to prevent CAI or when treating a condition of chronic instability. Expect at least a 12-week period of time before your situation is balanced. The nervous system is plastic (modifiable or changeable) and can adapt in order to restore joint stability.

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