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Home What We Treat Foot and ankle Pain Ankle Sprains and Ankle Instability

Chronic Ankle Instability (CAI)

Chronic ankle instability (CAI) is an ongoing ankle condition, typically persisting after an initial injury affecting the structures that support the ankle. Because the foot and ankle complex forms the foundation for most physical activities, CAI can dramatically impair athletic performance, reduce overall mobility, and increase the risk of additional injuries. Without successful rehabilitation, compensation patterns that alter biomechanics can take a toll on structures and tissues throughout the body.

“At NYDNRehab, we get results where other doctors and therapists fail.”

When faced with the challenge of restoring ankle stability, many doctors and therapists are ill-equipped to achieve optimal results due to lack of knowledge and resources. At NYDNRehab, we leverage advanced technologies, orthobiologics, and cutting-edge therapies to rehabilitate damaged ankles and restore functional stability. Our track record of CAI success, backed by 20+ years of experience, makes NYDNRehab the clinic of choice for ankle rehabilitation in NYC.

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We’re located on 25th street in Manhattan NYC.
Open Monday-Friday, 10am-8pm.

table of contents

Who are doctors Kalika and Brosgol? Why should I choose NYDNRehab for ankle instability treatment? What causes chronic ankle instability? How is ankle instability diagnosed at NYDNRehab? What structures and tissues are involved in stabilizing the ankle? Is physical therapy enough to restore ankle stability? What is the role of orthobiologics in ankle stability rehab? How can I improve my ankle stability to avoid injury? Ankle Stability FAQs

Dr. Kalika and Dr. Brosgol Team Up to Revolutionize Ankle Rehab

Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Lev Kalika, DC clinical director and founder of NYDNRehab, is an internationally recognized expert in diagnostic and musculoskeletal ultrasonography, with multiple research publications to his credit. Dr. Kalika has studied alongside some of the world’s most prestigious experts in diagnostic, fascial, and nerve ultrasonography, and has presented his research at multiple international conferences.

Dr. Kalika was among the first in his field to become certified in Dynamic Neuromuscular Stabilization (DNS), one of the most evidence-based approaches for treating chronic ankle instability. Dr. Kalika was mentored directly by the creator of DNS, Dr. Pavel Kolar.

Dr. Kalika is an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to Dynamic Functional and Fascial Ultrasonography. His expertise in human anatomy and biomechanics, coupled with his skills in interpreting high-resolution ultrasound imaging, means patients at NYDNRehab get a comprehensive and accurate diagnosis that translates to successful treatment.

Dr. Yuri Brosgol

Orthobiologic specialist

Dr. Yuri Brosgol, MD is a neurologist with 20+ years of experience in treating pediatric and adult myofascial pain. When emerging research on the critical role of fascia in human mobility captured Dr. Brosgol’s interest, he pursued additional training in orthobiologics and fascial release techniques.

Dr. Brosgol learned fascial hydro release methodology directly from Dr. Carla Stecco, the world’s leading specialist in fascial science. Dr. Brosgol has become a pioneer in the use of orthobiologic solutions, blazing the trail for transformative advancements in the treatment of musculoskeletal injuries and myofascial disorders.

Together, Dr. Kalika and Dr. Brosgol are revolutionizing the way musculoskeletal pain and injuries are diagnosed and treated. Dr. Kalika’s successful track record of diagnosing and rehabilitating musculoskeletal injuries, combined with Dr. Brosgol’s expertise in treating myofascial pain, make NYDNRehab the premiere clinic for integrative sports medicine in NYC.

Advanced Therapeutics at NYDNRehab are Game-Changers for CAI Treatment

When it comes to complex post-traumatic ankle pain and instability, most medical doctors are at a loss for how to successfully restore ankle function. Attempts at orthobiologic injections and physical therapy may be provided, based on MRI imaging, but MRI cannot capture the many nuances of ankle injuries involving multiple structures and tissues. When attempts at ankle rehab fail, patients are often referred for surgery, but surgical interventions do not guarantee satisfactory outcomes, and surgery may even worsen ankle instability.

At NYDNRehab, we use the highest-resolution diagnostic ultrasonography to dynamically visualize your ankle in real time. Ultrasound gives us insight into impaired ankle biomechanics that cannot be detected by MRI, helping us to discern which structures can benefit from orthobiologics, regenerative technologies, and targeted physical therapy.

Dynamic high-resolution ultrasound imaging has multiple advantages over MRI:

  • MRI cannot detect subtle instabilities and ligament injuries that can only be visualized with ultrasound
  • Dynamic ultrasound lets us observe deficits in ankle function, strength, balance and proprioception that cannot be identified via MRI or clinical exam
  • Ultrasound enables us to compare the injured and non-injured limb in the same session
  • Ultrasound helps us distinguish functional vs structural ankle instability

Structural instability typically features damage to ligaments, most often due to a lateral ankle sprain. By contrast, functional instability is often caused by deficits in proprioception (sense of joint position), neuromuscular control (ability of muscles to react quickly), and balance, often stemming from previous ankle sprains.

Differentiating between structural and functional instability is a critical step in developing the most effective treatment protocol – a distinction that most doctors and therapists are unequipped to make, often resulting in unnecessary surgeries that fail to restore ankle stability and function.

Prior to beginning physical therapy, we pretreat your tissues to restore their functional properties, and retrain neuromuscular pathways that have been disrupted by your injury. Even old injuries can be successfully rehabilitated, and persistent compensation patterns can be eliminated. We take into account muscles, connective tissues, fascia, nerves and blood vessels whose functional properties have been altered due to injury.

At NYDNRehab, we never rely on one-size-fits-all treatment protocols that fail to deliver results. Our CAI therapy is not isolated to your ankle – in most cases of CAI, functional biomechanics are altered along the entire lower kinetic chain, requiring corrective measures to restore optimal mobility and performance. Our personalized holistic approach to patient care means you get customized treatment based on your unique patient profile.

CAI Symptoms, Causes and Risk Factors

Due to the complex structural architecture of the foot and ankle, multiple factors can play into ankle instability, and no two injuries are exactly alike. Symptoms-based diagnosis can help identify the problem, but it cannot factor in the many individual nuances that contribute to ankle instability.

Characteristics of CAI include:
  • Persistent pain, swelling and weakness after the initial injury
  • Recurrent ankle sprains
  • Persistent feelings of instability
  • Sensations of the ankle “giving way”
  • Reduced ankle range of motion
  • Poor static and dynamic balance

CAI typically arises after an initial ankle sprain, frequently involving the lateral ligaments. If not properly rehabilitated, ankle instability can have major downstream effects that affect biomechanics throughout the body. Conventional efforts at rehabilitation often stop once ankle pain subsides, leaving the patient with ongoing issues that reduce overall mobility and performance.

Factors that contribute to post-injury CAI include:
  • Inadequate ankle rehabilitation after the initial injury
  • Weakness of the muscles that provide support and govern ankle mechanics
  • Reduced proprioception due to damaged fascia and connective tissues, impairing their ability to sense the joint’s position and make adjustments
  • Stretched or damaged ligaments that no longer provide adequate structural support

In addition to a history of recurrent ankle sprains, multiple other factors can increase the risk of developing CAI.

Common CAI risk factors include:
  • Previous lateral ankle sprain(s) – the most common risk factor
  • Inadequate post-injury rehabilitation
  • Premature return to physical activity after an ankle injury
  • Weakness in the peroneal and tibialis posterior muscles that serve to stabilize the ankle joint
  • Impaired proprioception that reduces the ability to sense the ankle’s position
  • Deficits in static and dynamic balance
  • High arches (pes cavus) or flat feet (pes planus) that alter ankle mechanics
  • Joint hypermobility or inherent ligament laxity
  • Inefficient gait mechanics
  • Female sex that amplifies injury risk due to greater joint laxity, hormonal factors, and lower muscle strength relative to body mass
  • Participation in high-risk sports that involve cutting and jumping
  • Excess body mass that increases mechanical ankle stress
  • Non-supportive footwear
  • Exercising on uneven surfaces
  • Fear of reinjury and reduced confidence in ankle stability, leading to hesitancy and suboptimal strategies during dynamic activity

State-of-the-Art Diagnostics Lead to Superior Treatment Outcomes

In general it is not difficult to identify an unstable ankle, but naming the condition is not enough to successfully treat it. In most cases, patients with CAI have suffered repeated sprains, doing damage to multiple tissues and structures that make up the ankle complex. Unless all damaged tissues are identified and healed, physical therapy alone is unlikely to restore ankle stability.

Many doctors rely on MRI to visualize injured tissues, and some may even administer advanced treatments like orthobiologics and shockwave therapy. But MRI can overlook subtle damage to ligaments that affect ankle function, and MRI cannot single out other factors like impaired proprioception, fascial dysfunction, muscle weakness, and balance issues.

Moreover, CAI often causes compensation patterns that affect alignment and function along the entire kinetic chain. Treating the ankle alone without addressing other factors is bound to deliver suboptimal results, and may even make matters worse.

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A recent review of studies found evidence that Individuals with CAI exhibit multiple motor control abnormalities, with alterations in the tibialis anterior muscle on the front of the shin, and the peroneus longus muscle that dorsiflexes and inverts the foot – muscles critical for ankle stability. The subjects also exhibited premature activation of the hip and spinal muscles before activation of the ankle muscles.

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In a recent cross-sectional study, researchers used EMG to assess muscle activation in terms of amplitude, to compare participants with unilateral CAI to an uninjured control group. Both groups walked on a split-belt treadmill, with and without random left- and right-sided perturbations. Results showed that the CAI group had altered bilateral motor control strategies, with earlier activation of the leg muscles (rectus femoris, biceps femoris, and gluteus medius), along with premature activation of the trunk muscles (bilateral rectus abdominis and non-erector spinae) compared to the control group.

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Another controlled study compared a CAI group to uninjured participants using cutting and landing tasks. The CAI group exhibited smaller dorsiflexion angles in the landing tasks, with greater foot eversion, and reduced foot stability. The researchers suggested that these factors should be considered when designing and implementing interventions to restore ankle function in CAI patients.

Attempting to treat the ankle without addressing biomechanical abnormalities is a recipe for failure. At NYDNRehab, we treat the whole patient, not just the site of injury. To get the big picture, we conduct a thorough in-office exam on your first visit, using high-resolution diagnostic ultrasound to visualize your injury in real time. Dr. Kalika’s in-depth knowledge of human anatomy and his expertise in diagnostic ultrasonography ensure that all damages from your injuries are identified and taken into account when designing your personalized treatment plan.

In addition to diagnostic ultrasound, we conduct gold-standard assessments to establish a baseline of ankle function, giving us objective metrics for measuring your progress.

Your functional ankle assessment may include a battery of some of the following:

  • 3D walking and/or running gait analysis
  • Instrumented treadmill analysis of pressure and ground reaction forces
  • Assessment of walking and running spatiotemporal parameters
  • 3D hopping and jumping analysis
  • Ankle proprioception evaluation
  • Myolux foot and ankle proprioception and eccentric muscle strength testing
  • Surface electromyography (SEMG) to identify altered muscle activation patterns
  • ForceFrame testing for whole-body muscle strength and symmetry

Once we have an overall profile of the extent of your injuries, we design a personalized treatment plan based on your results. Our holistic approach ensures that all factors contributing to your ankle instability are addressed, resulting in superior outcomes compared to conventional treatment and surgery.

Structures and Tissues that Promote Ankle Stability

The human ankle is remarkably strong, able to withstand forces 4-5 times a person’s body weight during running and jumping activities. The foot and ankle complex provides a solid base of support for the entire body, relying on proprioception to make subtle changes in position to maintain balance. Proprioceptors in the foot and ankle allow for adaptation to changes in terrain, and rapid responses to outside forces.

There are multiple structures that contribute to ankle stability, but the majority of support is provided by the lateral and medial ligaments. On the medial (inner) side, four ligaments create a fan-like pattern – the anterior tibiotalar, posterior tibiotalar, tibionavicular and tibiocalcaneal ligaments – collectively referred to as the deltoid ligament.

On the lateral (outer) side, the ankle is supported by three primary ligaments – the anterior talofibular, posterior talofibular, and calcaneofibular ligaments. The lateral ligaments are not as strong as the deltoid ligament, and are at higher risk of injury. The peroneal muscles provide additional lateral stability, helping to prevent excessive inversion of the ankle.

The critical role of fascia in ankle stability has only recently been recognised by researchers, and many conventional practitioners are not aware of its importance in ankle structural integrity. Fascia acts as a stabilizing framework throughout the body, holding muscles, connective tissues and organs in place, preventing excessive movement, and maintaining joint alignment during dynamic activities.

Fascia promotes ankle stability by providing structural support, contributing to force transmission, and delivering proprioceptive feedback. Fascial tissue has a significantly higher density of proprioceptors (sensory receptors) compared to muscle tissue, making it more sensitive to changes in pressure, stretch, and movement, and serving as a prime source of information about the position of the lower kinetic chain.

Fascia and muscles work synergistically to guide and control movement, and to mediate internal and external forces – a concept called biotensegrity. Healthy fascia is smooth, elastic and slippery, but when damaged, fascia can become dense and sticky, losing its elastic properties and suppressing proprioception. Fascial dysfunction can have a dramatic impact on ankle stability, and failure to treat fascia as part of the rehabilitation protocol can undermine the success of treatment.

A 2021 study of athletes with recurring ankle sprains found that the Stecoo method of fascial manipulation, in which Dr. Kalika is trained and certified, significantly improved ankle function and range of motion in individuals with chronic ankle instability.

Other important ankle stabilizing structures include:

  • The Achilles tendon
  • The calf muscles (gastrocnemius and soleus)
  • The peroneal muscles (peroneus longus and brevis) and their tendons
  • The anterior and posterior tibialis muscles
  • The plantar fascia
The plantar fascia supports and stabilizes the foot arch, preventing excessive pronation (inward rolling) or supination (outward rolling) of the foot. The PF helps to distribute forces evenly across the foot, reducing stress on ankle ligaments and tendons. It also stores and releases elastic energy – a phenomenon called the windlass mechanism – elevating the arch at toe-off to create a rigid lever for propulsion. At the same time, the PF absorbs and distributes ground reaction forces, diverting them from the structures that directly support the ankle. A weakened, tight or dysfunctional plantar fascia can disrupt foot mechanics, increasing stress on ankle ligaments and tendons and heightening the risk of ankle sprains and CAI. By identifying and addressing all structures and tissues that contribute to CAI, we are able to dramatically enhance the functional outcomes of treatment

Precision is Key to Plantar Fasciitis Treatment Success

At NYDNRehab, we always begin with a conservative approach to plantar fasciitis treatment, but the secret to our success is precision. We have a 100% track record of success in treating plantar fasciitis, thanks to the combination of extracorporeal shockwave therapy (ESWT) and ultrasound guided dry needling (USDN).

A recent research publication in Nature cites Dr. Kalika’s own research, highlighting USDN as a top-tier evidence-based solution for plantar fasciopathy, and ranking it alongside ESWT and PRP as a primary intervention. To quote the article:

Current therapeutic approaches for plantar fasciopathy include targeted mechanotherapy, optimized ESWT protocols, ultrasound-guided delivery of orthobiologics (e.g. leukocyte-rich PRP), and precision physical therapies. Furthermore, studies demonstrate the diagnostic and therapeutic value of ultrasound elastography and US-guided interventions for pain modulation. Ultrasound-guided dry needling of myofascial trigger points has been established as a primary intervention option for plantar fasciopathy.”

For patients, our multimodal approach to plantar fasciitis means quick pain relief, fast recovery, and longer-lasting outcomes. In our experience, combining modalities with precision guidance creates the best results.

Pretreatment is Key to Physical
Therapy Success

Conventional treatment of CAI typically involves passive interventions like taping and bracing, and active interventions such as physical therapy and balance training. But such interventions do not address myofascial dysfunction and proprioceptive deficits, and athletes are often released prematurely to sports, setting them up for more injuries.

At NYDNRehab, we pretreat damaged tissues to accelerate healing and restore biotensegrity before introducing weight-bearing activities.

Your CAI prehab may include:

  • Multimodal shockwave therapy, to reduce pain and inflammation and stimulate tissue neogenesis
  • Extracorporeal magnetic transduction therapy (EMTT), to trigger a regenerative response in damaged tissues
  • TECAR therapy, to restore the ionic charge of damaged cells, for faster injury healing
  • Ultrasound-guided dry needling, to eliminate myofascial trigger points
  • Stecco fascial manipulation, to restore the functional properties of damaged fascia
  • Orthobiologic procedures, to accelerate healing at the cellular level

We monitor your response to prehab with high-resolution ultrasound, to ensure all interventions have their intended effects. Once we are satisfied that your ankle tissues are ready to tolerate force loads, we can begin a progressive protocol of personalized, one-on-one physical therapy.

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Orthobiologics Accelerate Tissue Healing

Orthobiologic injection therapies use natural/neutral solutions, injected with precision thanks to ultrasound guidance. The injected solutions stimulate cellular repair by either nourishing or irritating the targeted cells. However, orthobiologics are not a stand-alone solution – they only address tissue biology, but cannot restore functional mechanics.

Full rehabilitation of an unstable ankle requires restoration of biotensegrity, tissue strengthening, and retraining of neuromuscular pathways to optimize muscle recruitment patterns that have been disrupted. Orthobiologic treatment results are dramatically enhanced when tissues are pre-treated with focused extracorporeal shockwave therapy (fESWT) and myofascial release techniques.

Orthobiologic procedures available at NYDNRehab include:

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active agents such as growth factors, cytokines, lysosomes and adhesion proteins. To be effective, it is critical to use the correct concentration and quality of platelets, and to and follow proper isolation techniques. When administered correctly under ultrasound guidance, PRP can help to stimulate tissue repair in chronic injuries, and accelerate healing in acute injuries.

Matrix PRP

For tendon ruptures, Matrix takes PRP therapy to the next level by creating a collagenous bridge between the walls of the tear and the rest of the tendon. Matrix is a highly concentrated PRP, diluted and mixed with fibrinogen. At the injection site, the solution becomes a gel-like collagenous substance that adheres to the walls of the tear and fills the space between them, creating a fibrin matrix that helps to stabilize growth factors and attract stem cells to the treatment site.

Platelet Releasate Therapy

Platelet releasate therapy involves injecting platelet releasate – a mixture of growth factors and biomolecules – into injured muscles and tendons to promote healing. Platelet releasate works by activating leukocytes and endothelial cells, and stimulating blood vessel growth, to increase the flow of oxygen, nutrients and growth factors to the damaged tissues.

Alpha-2-Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade joint cartilage.

Prolotherapy and Prolozone

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers. Prolotherapy is often used for slow-to-heal tendon and ligament ruptures, where low vascularity inhibits tissue healing. Prolozone takes Prolotherapy to the next level by adding a combination of procaine, anti-inflammatory medications, vitamins, and minerals, followed by a mixture of ozone/oxygen gas, injected into targeted joints or tissues. When performed under ultrasound guidance, Prolozone therapy quickly reduces pain and inflammation while jump-starting the healing process.

Hyaluronic Acid Injections

Hyaluronic acid is a natural component of joint synovial fluid and fascial tissue. Its slippery gel-like properties provide lubrication that reduces friction, enabling joints, muscles and fascia to glide freely without pain. In cases of ankle instability, damaged fascia can become dense and sticky, losing its gliding properties. When combined with myofascial release techniques, hyaluronic acid injections can help to rehydrate fascial tissue and revitalize its functional properties.

Interfascial Plane and Nerve Hydrodissection

The hydrodissection procedure injects a saline solution into densified fascial layers under ultrasound guidance, separating the layers and releasing entrapped nerves and blood vessels. Hydrodissection is often used in conjunction with manual fascial release and hyaluronic acid injections, to fully restore fascial integrity. Dr. Kalika’s expertise in diagnostic ultrasound combined with Dr. Brosgol’s skill in needling procedures ensure that your orthobiologic therapy has maximal impact on the targeted tissues. Once the treated tissues have healed enough to tolerate loads, we begin a progressive program of personalized physical therapy aimed at optimizing ankle mechanics.

Dr. Kalika’s expertise in diagnostic ultrasound combined with Dr. Brosgol’s skill in needling procedures ensure that your orthobiologic therapy has maximal impact on the targeted tissues. Once the treated tissues have healed enough to tolerate loads, we begin a progressive program of personalized physical therapy aimed at optimizing ankle mechanics.

Tips for Preventing Ankle Instability

Proper training is essential for maintaining healthy feet and ankles, especially if you play sports or do fitness activities that involve running, jumping, and rapid directional changes. Yet most of us take our feet and ankles for granted – until an injury occurs. Employ the following strategies to optimize ankle stability and function:
  • Include ankle strengthening in your exercise routine. Toe raises with bent and straight knees target key ankle stabilizer muscles, such as the peroneals and tibialis posterior.
  • Eccentric loading, where the muscle lengthening phase is emphasized, stretches the Achilles tendon and the plantar fascia, helping to improve ankle range of motion.
  • Balancing on an unstable surface like a wobble board can help to improve proprioception while engaging the ankle stabilizers.
  • Regular stretching of the calf and Achilles tendon, and the anterior tibialis (shin) especially after intense physical activity, can help to promote recovery and maintain ankle range of motion.
  • Seated ankle circles in both directions, along with plantar- and dorsi-flexion, help to promote ankle mobility.
  • Liberate your feet from shoes – frequently going barefoot increases proprioception and allows your feet and ankles to move in natural patterns.
  • Avoid standing and walking in high heels, which forces your feet and ankles into unnatural positions and shortens your Achilles tendon, reducing ankle range of motion.
  • Wear supportive athletic footwear for high-intensity sports and activities that involve running, jumping and cutting.
  • Use extreme caution when walking, running or exercising on uneven surfaces, like trails or cobblestones.
  • Maintain a healthy body weight to avoid excess stress on the ankle’s supporting structures.
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Get State-of-the-Art CAI Rehab in NYC

Ankle sprains are one of the most common athletic injuries, with estimated incidence ranging from 2 to 5 per 1000 in high intensity sports involving running, jumping and cutting. Athletes often ignore mild to moderate sprains, continuing to play once the initial pain subsides. But absence of pain does not mean your ankle is healed. Failure to completely rehabilitate a sprained ankle before returning to play can mean more injuries that undermine ankle stability and reduce athletic performance.

Conventional CAI treatment by medical doctors and orthopedists does not address the many nuances of ankle instability, and surgery has inherent risks, with no guarantee of success. If your goal is to return to play at pre-injury performance levels, you need full-spectrum ankle rehab that addresses all factors contributing to CAI.

At NYDNRehab, our integrative approach, advanced methodologies, and years of experience ensure that your ankle is strong, stable and mobile, so you can return to play with confidence. NYDNRehab is your one-stop-shop for advanced diagnostics, orthobiologics and regenerative therapies, for the best functional ankle rehabilitation in NYC.

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Clinical Case Studies
NYDNRehab

Case Study: Demystifying Persistent Ankle Pain

Our Patient Our patient is a 44 year-old female complaining of ankle pain. She had sprained the ankle two years prior and had been successfully treated with physical therapy. The Challenge Eight months after her initial treatment, the patient’s ankle pain returned, somewhat distal to the original site of trauma. She reported worse pain and […]

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Chronic Ankle Instability FAQs

What causes chronic ankle instability?
CAI is typically caused by an initial ankle sprain that has not been properly rehabilitated, followed by subsequent sprains or microtraumas to the ankle’s supporting structures. Damaged ligaments are especially slow to heal, and their capacity for proprioception can be severely impaired. Regenerative therapies and orthobiologics help to stimulate healing in avascular tissues like ligaments and tendons. Early treatment and full rehabilitation after an ankle sprain is the best way to avoid CAI.
Who is at risk for chronic ankle instability?
Athletes in high-intensity cutting, running and jumping sports are at high risk for CAI, especially if they’ve had a previous ankle sprain that was inadequately rehabilitated. Non-athletes with weak ankles and excess body mass may also be at risk. Individuals with joint hypermobility syndrome (JHS) or hypermobile Ehlers-Danlos (hEDS) syndrome are also at high risk of ankle sprains and CAI.
When should I see a doctor for CAI?
The best time to see a doctor is immediately after your first ankle sprain. However, it is never too late to rehabilitate your ankle, even after multiple sprains or traumas. If your goal is to return to your favorite sport or activity at per-injury performance levels, look for a holistic sports medicine practitioner with a track record of successfully treating CAI. Definitely consult a doctor if you’re experiencing:
  • Repeated ankle sprains or ankle giving way
  • Persistent pain, swelling, or instability
  • Difficulty walking or performing daily activities
  • Symptoms that don’t improve with rest or basic first aid
What are the treatment options for CAI?
Conventional doctors and therapists use strategies like taping and bracing, custom orthotics, and physical therapy exercises to improve strength, balance and proprioception. But those interventions do not help to heal damaged tissues and structures or restore their functional properties. Surgeries for ligament reconstruction or tendon transfer to improve structural support may be recommended, but they should be a last resort – there is no guarantee that surgery will fully restore ankle stability and function, and it could make things worse. Holistic interventions such as regenerative technologies, myofascial release techniques, orthobiologics and personalized physical therapy offer the most promise for restoring functional ankle mobility and stability..
Can I continue to play sports with chronic ankle instability?
While many athletes continue to play, using taping and bracing for extra ankle support, doing so is not advised. Continuing to load damaged tissues will result in further damage that affects athletic performance. Your best bet for a long athletic career is to rehabilitate sports injuries immediately after they occur.

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    Latest Research & Evidence

    Article

    2021

    The influence of fascial manipulation on function, ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability.

    • Kamani
    • Neha C.
    • Shruti Poojari
    • Raja G. Prabu
    Learn More

    Article

    2021

    Muscle activations during functional tasks in individuals with chronic ankle instability: a systematic review of electromyographical studies

    • Labanca
    • Luciana
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    Article

    2021

    The effect of chronic ankle instability on muscle activations in lower extremities.

    • Lin
    • Chiao-I.
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    Article

    2017

    Assessment of evertor weakness in patients with chronic ankle instability: Functional versus isokinetic testing.

    • Terrier
    • Romain
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    Article

    2024

    Differences in intra-foot movement strategies during locomotive tasks among chronic ankle instability, copers and healthy individuals.

    • Yu
    • Peimin
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    footer6
    Physical therapy and rehab can be time consuming,
    and a faulty diagnosis can make treatment a total waste of time.

    Failure to accurately diagnose a condition in its early stages can lead to chronic
    problems and sometimes devastating results

    Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

    footer4

    Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

    Learn more »
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    Accurate Diagnosis Is the ONLY way to
    Successful Treatment
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    A bad physical therapy experience is one of the primary causes of unnecessary surgery

    At NYDNR, we believe in
    medical innovation

    We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.

    • С.A.R.E.N.
    • Kineo
    • Proteus shoulder arm recovery
    • Zebris
    • Manuthera 242
    • ESWT
    • Vertimax
    • Ankle Stabilizing Device
    • Blood Flow Restriction
    С.A.R.E.N. С.A.R.E.N. Kineo Kineo
    Proteus shoulder atm recovery Proteus shoulder atm recovery Zebris Zebris
    Manuthera 242 Manuthera 242 ESWT ESWT
    Vertimax Vertimax Ankle Stabilizing Device Ankle Stabilizing Device Blood Flow Restriction Blood Flow Restriction Training
    • Aplio i800
    • Vibration Platform
    • Sensa mat
    • Force Plate
    • Fascial Gun
    • ShooTools Slider
    • Redcord
    • Cryo Therapy
    • Skier's Edge
    Aplio i800 Aplio i800 Vibration Platform Vibration Platform Sensa mat Sensa mat
    Force Plate Force Plate Fascial Gun Fascial Gun ShooTools Slider ShooTools Slider
    Redcord Redcord Cryo Therapy Cryo Therapy Skier's Edge Skier's Edge

    Most importantly,

    we are the only facility in the US

    where structural medical diagnosis is reflected in functional treatment, and vice versa.

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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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