Dr. B. Allyn Behling-Rosa, D.O.

Great question! The answer depends on whether the 'swelling' is due to a new 'acute' soft tissue or bone injury, or infection, or after several injuries where now the 'swelling' is considered 'chronic' (more than 3 months old).

Presuming you are also not referring to an infected joint or one that had surgery at some point, individuals that participate in high-intensity repetitive activities, or those who suffer from high uric acid/gout, autoimmune or connective tissue diseases like Rheumatoid or Psoriatic Arthritis can also have 'acute on chronic attacks' on their joints.

So, it is important that the actual cause of 'swelling' is confirmed before treatment begins.

Newer acute 'swelling' is conservatively treated with rest/activity avoidance, physical therapy, support/bracing, cool compress/ice applications, and anti-inflammatory type of medicines. An infection requires antibiotics or worse case scenario, a surgical 'washout' which flushes the infection out with antibiotic-concentrated water. If the patient is having a reaction to surgical metal and/or cement components (a rarer occurrence), this is also usually addressed via a consultation with an Orthopedic Surgeon.

More progressive options to treat acute swelling seek to improve the circulation and tissue that is suboptimal due to the injury. These may include Cold LASER (photomodulation), PEMF or ICES, steroids injections or iontophoresis (which I try to avoid if possible), injections of concentrated dextrose (sugar solution) or saline (salt solution) referred to as prolotherapy, and sometimes Platelet-Rich Plasma (PRP) injections to enhance self-healing of tissues using the patient's own blood components.

Chronic swelling is thus due to the long-term effects when acute episodes of inflammation were not well-addressed - or the immune system was 'overreactive' after each injury. Essentially what happens is that the spaces between cells and tissues is changed by the poor circulation, waste products from inflammation, and 'remodeling' due to the body's attempt to heal and stabilize those tissues - via creating scar-like material. What is left is not really normal tissue at all, but deformed and poorly supported mixture of muscle, fascia and other supportive tissue - generally referred to as myofibrosis. This myofibrosis is thicker, stiffer and holds fluid between tissues in a different way than normal tissues - which gives the impression of being 'swollen'.

Only if myofibrosis is actually composed of more scar and adhesions is it surgically treated. Otherwise, this injured tissue can be treated by tissue 'manipulations', along with adjunctive use of LASER, PEMF/ICES, prolotherapy and PRP. There has also been some limited clinical use using topical or injected hyaluronidase (which breaks down hyaluronic acid within the tissues which tends to make them stiffer and 'fuller') - which seems to be showing some promising results (but still investigational).

I personally offer most of the abovementioned treatments - except for PRP and LASER (although support both of them for smaller joints like ankles).

I hope that this answers your question!

I recommend first being evaluated by your primary care provider to get a better idea of the source of your problems. It could be several things from obstruction from an enlarged prostate or severe constipation, high blood pressure (laying down increases your blood pressure), an overactive bladder from neuropathy or spinal issues, infection in the genitourinary tract, drinking too much fluid after 6pm, high sugar levels if you have diabetes, bladder stones, etc.

There are specific tests and imaging and/or procedures that are additionally performed to rule in or out a possible causes once all the variables are known.

I hope that this helps!

Family history of autoimmune and connective tissue disease is important to consider when experiencing changes in our bodies. However, the intensity, duration, recovery period and appropriate 'style' or pattern of use of your lower extremity joints is just as important. No one's joints are the same, and not all joints will hold up to the stresses of all sports - or any for some! There is specific testing for these autoimmune conditions, but it may not show up in someone your age 'officially' until later (unless you've had these issues from youth in addition to a constellation of other symptoms).

Evaluation by at least a physical therapist to assess your running gait and perform a general intake of your hip and knee and ankle joint function and range of motion is a good first step. They usually also look at how these joints are (or are not) aligned so as to support longer distance/duration repetitive activities. Maybe is it just a question of strengthening, stretching, bracing, orthotic-type inserts or different shoe types? Maybe your swimming and running forms need to be adjusted?

However, IF you are having joint warmth, swelling, redness and/or instability, you really should see a medical provider sooner than later.

Remember that injuries from overworked muscles and joints plus inadequate support and recovery time will only reoccur and even worsen your outcomes as injuries weaken our tendons, ligaments and joints.

Try to get yourself evaluated sooner than later, as it would be a shame to self-inflict early-onset arthritis if you could just get some education and direction on better options to get fit without injuring yourself.

I hope that this helps!

Most muscle spasms can be managed - once there source or etiology is determined. So yes, there are several pharmaceutical and non-pharmacological options available. A full medical and psychosocial evaluation is necessary to make the 'right' option work for you.

I hope that this helps!

Yes - it is understood that most patients have access to physical therapy directly without the need for a prescription from a physician.

However, guidelines from both the Physical Therapy associations and the Medical associations agree that if a patient's condition does not progressively improve after an adequate trial of physical therapy, further evaluation and management by a medical specialist is warranted.

Moreover, advanced imaging may also be needed if there are 'red flags' involved affecting bowel/bladder/balance issues, groin numbness, progressively worsening muscle wasting, weakness and sensory loss.

I hope that this helps!

A physiatrist (Specialist in Physical medicine and Rehabilitation) is a physician who has been cross-trained across several specialties so that they can better assess and determine appropriate treatment options for those suffering from MANY injuries and incidents, including degenerative joint disease, autoimmune conditions, connective tissue disorders, strokes, heart attacks, spinal cord injuries, cancers, orthopedic injuries or even neurodegenerative diseases.

They are not just 'exercise doctors' or an 'advanced physical therapist'.

Physiatrists approach patients and their advocates with a 'wide-lens' regarding what body systems need to be optimized so that the patient can return to their baseline function as close as possible.

Physiatrists work closely on engaging the patient and family on education regarding their issues, as well as giving them realistic expectations for their prognosis.

Most importantly, physiatrists are 'team-players' who hope to work with other specialists and primary care providers so that they can meet all the needs of patients - whether his or her dysfunction is related to bowel, bladder, balance, swallowing, cognition, strength, sensation, sleep or mood. They also address pain issues!

In some ways, they are "PRIMARY CARE PLUS" and a great addition to any patient's medical care team when there are chronic progressively worsening and/or advanced illnesses involved.

I hope that this helps!

Technically, if the ankle is not just 'strained' (mild over-stretch injury) there are 'grades' of sprains from mild to severe, consistent with one to several supportive ligaments and/or tendons components being frayed or torn. Sometimes there can even be bony fractures involved.

MRI imaging assists with this diagnosis, but it is the patient's ankle joint stability and activity tolerance that usually directs Orthopedists and Physiatrists to offer specific therapeutic options.

Age and stage of life also is important to consider when thinking about surgery. If someone has several advanced medical conditions that makes surgery riskier and thus less than desirable - especially if one is not an athlete and can get away with conservative therapies and supportive bracing during more intensive activities - surgery can be avoided (even with a more advanced sprain per MRI imaging).

Ultimately, one needs a full and proper diagnosis WITH consideration of all medical and psychosocial variables before a decision is made to just follow the more conservative approach versus surgery.

From a patient's perspective, how does this 'sprain' affect your functional independence during walking, transferring into and out of chair or bed, standing during showers, driving, or doing exercises and your favourite activities? Is there instability, pain, compromise of circulation, recurrent wounds/blisters/calluses that appear due to a deformity, development of plantar fasciitis, etc? The physician can help you weigh the risks and benefits of your options. Ultimately, this is a shared decision between the surgeon and the patient.

I hope that this helps!

This is a difficult question because the ankle and foot are complex structures and the diagnosis of 'ankle arthritis' doesn't give enough information for one to assist. You could go to a physical therapist to trial an 'ankle arthritis' protocol. However, depending on the actual joints, ligaments and tendons affected, a plan for activity avoidance -OR - engagement should vary. Please consider seeing a Specialist who can better provide you with a more specific diagnosis and thus assist you and a physical therapist with an indivialized plan of care.

Please see my recent answer regarding having an unclear diagnosis, especially as it relates to the ankle and foot. There are many musculoskeletal or arthritic reasons for ankle pain, but one could also have circulation issues with swelling or poor blood supply, gout, pseudogout, adhesions from repeated ankle injuries, remote or new fractures, neuropathies or even poorly supportive shoes for your arch. Of course having knee, hip or pelvic misalignments will also change how you walk and thus affect your ankle. Please consider seeing a Specialist to assist you in discovering a specific diagnosis or at least help you understand the nature of your pain so that an indivialized plan of care can be developed.

Presuming your surgeon fully consented you for this surgery, when to return to 'daily activities' is a difficult question. What is a "daily activity" for you? There are some relative contraindications regarding activities in the first 3 months if not forever after ankle replacement surgery, unless you want yet another surgery sooner than anticipated. Also, depending whether there were surgical complications, or your bones or soft-tissues are not optimized for healing (especially if you smoke, have diabetes, osteopenia, autoimmune disorder, or circulation issues) there may be a period of limited weight-bearing which would delay your return to "daily activities". My recommendation is to take it one step at a time: contact your surgeon and confirm the likelihood for any weight-bearing restrictions; follow postoperative instructions to the 'T'; do your physical therapeutic restorative activities; and ask for feedback when you don't seem to be recovering as expected. Often I see postoperative joints due to persistent pain and dysfunction...but there are several steps you have to (hopefully) move through before you should need services from someone like me. However, i am always happy to help you achieve a more successful outcome! Good luck!

Presuming you are inquiring about disc herniation, i believe the more important questions are where and how much has the disc moved toward your spinal canal and/or your vertebral nerves? Discs are essentially shock absorbers and part of the spine's structural support system. When they are healthy and 'younger', they stabilize the spinal bones and protect your spinal cord from all the overstretching, vibration and twisting your spine is exposed to over the years. But like anything that suffers wear and tear, the discs and vertebral bones change their shapes becoming flatter or more distorted in shape. This is referred to as bulging. As the dics evolve, extra space often develops in and around them, allowing them to move and shift. And because they are situated between the bones, they also are less likely to keep the bones from moving. This distortion continues as the wear and tear continues. Technically, all the body's tissues (ex, disc, bone, ligament) change in response to stress, but also so as to evolve into stronger tissues to stabilize the spine. You know this as arthritis. Wear and tear activity starts an inflammatory reaction. This brings calcium and other resources to help tissues adapt to the stress. Eventually a soft and flexible disc stretches out and loses good circulation and nutrition so that its walls become thinner, stiffer and more distorted - a herniation. Depending on where and how much of this distorted disc is moving close to the spinal cord or nerves, the need for treatment differs. For many, avoiding heavy lifting or vibration, purposely losing weight so as to get lean, and improving your abdominal and back muscles (like a corset) will better support the movement of the spine and reduce the effects of any disc herniations. Slow careful stretching under the direction of someone who knows what is going on with the spine helps the tissue stiffness and circulation of resources. One may think of this as resetting the discs and bones closer to where they 'should' be. Ultimately, if a disc is too stiff or even fused to the bones next to it, it is unlikely that it will move too much further unless one suffers a traumatic event like a fall or car accident. Once the spinal bones and discs stabilize, there should be less worry...unless the disc and/or bones are already touching the spinal cord or nerves. Even then, it is only it is only whether someone is starting to have worsening numbness, muscle weakness, balance / bowel or bladder issues, or terrible pain that clinicians consider more invasive interventions like surgery. Injections, nerve blocks / ablations and manual medicine techniques can temporarily treat some symptoms but likely the arthritis will continue to evolve if nothing is done to reduce the wear and tear. This is why these treatments eventually become ineffective -at which time surgery may become the "most definitive" treatment... presuming that the arthritis is not so bad that even surgery cannot help. The point is, one should do what they can regarding weight and fitness, because not everyone is a candidate for injections, blocks or surgery.