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Q: I’m training for a triathlon and have chronic pain in my ankle. I’m also trying to conceive my second child and don’t want to do anything that might interfere with fertility or harm the baby. Any suggestions? -Denise J., Haleiwa, Hawaii
A: Ankle pain can be caused by various factors. In an athlete, repetitive stress can lead to tendon strains, ligament sprains, or small hairline fractures in one of the bones of the leg. Ultimately, the cause of ankle pain cannot be determined without a thorough physical examination. However, some factors for healing are important despite the cause of pain. You can maintain your cardiovascular and muscular fitness in other ways until you diagnose and treat the ankle pain. Try swimming, push-ups, and maybe Spinning. Completely avoid pounding the pavement.
In terms of diagnosing your problem, a musculoskeletal ultrasound is sensitive, inexpensive, and can be done in an office without radiation exposure. If the suspected problem is deep within one of the many joints in the ankle, an MRI may be necessary. Finally, an X-ray, bone scan, or CT scan could be used if hairline fractures are suspected; however, I would recommend these as a last resort due to the radiation. Please be sure you are not in early pregnancy before taking this test. A plain X-ray would be safe, and would confirm or refute the hairline fracture possibility.
If it is an unhealed fracture, take homeopathic symphytum (comfrey) 12C, three pellets twice daily for six weeks. Also, apply contrast hydrotherapy to the ankle at least once daily during this same period. This means placing your foot in hot water to cover the ankle for 30 seconds, then quickly switching to very cold water for 10 seconds, and then alternating the hot and cold dips several times in a row. Repeat at least three times per session and always end with the cold dip. Two buckets or tubs large enough to accommodate your foot, ice, and hot water are all you need for this highly effective, low-tech, therapy. Tendon and ligament injuries can respond well to a technique called prolotherapy, where the tendon or ligament is stimulated to regrow. (Visit getprolo.com to find a doctor who practices prolotherapy.) A complete tendon or ligament rupture is a surgical indication, however.
Bursitis of the Hip
Q: I’ve been diagnosed with bursitis of the hip, which is painful. Now I’m also getting knee and shin pain. Help! -Angela G., Chicago
A: Bursitis develops from both inflammatory and noninflammatory causes. For inflammatory bursitis, protein-digesting enzymes are my favorite natural anti-inflammatory therapy. These include papain, Serratia peptidase, and bromelain. The latter, derived from the core of the pineapple stem, appears to be the strongest and most effective of the bunch. Try taking about 500 to 1,000 mg two to three times daily on an empty stomach (e.g., 30 minutes before meals or roughly two hours after meals). Bromelain works best in combination with inflammation-reducing bioflavonoids, such as curcumin (from turmeric), quercetin, boswellia, and resveratrol.
Large clinical trials have established that the omega-3 fatty acids in fish oil are potent mediators in reducing inflammation. Take 1,000 to 2,000 mg daily of mixed EPA and DHA. Also, avoid animal products-especially red meat, but ideally also dairy products such as milk and cheese-for six weeks as part of your healing strategy. Omega-3 fatty acids are better for chronic bursitis or prevention of recurrent bursitis, as they may take six to eight weeks for beneficial results.
For bursitis specifically, a tight iliotibial (IT) band is often part of the problem, and this is a difficult part of the body to stretch. Consider seeing a physical therapist, osteopath, or naturopathic physician for this problem. If your knee and shin pain are on the same side of your body, you may be walking, standing, and/or sleeping in order to minimize hip irritation; however, this may be putting extra pressure on the joints farther down your leg.
If your lower leg pain is on the opposite side, you are probably favoring the hurt hip and overusing the opposite leg. Clearing up the original problem will also resolve the lower leg pain.
Q: Is apple cider vinegar good for osteoarthritis? What do you recommend for “noisy” joints? -Karen G., Sarasota, Fla.
A: Osteoarthritis, or DJD (degenerative joint disease), is a slow destruction of the cartilage padding around joints that mostly affects knees, hips, thumbs, and the spine. Many folks with osteoarthritis will notice that the nightshade plants (e.g., tomato, potato, eggplant, peppers, tobacco) worsen joint pain. Tomato and potato in high doses are the most likely culprits, so start by eliminating those two foods first. Improving digestion is also important. Why? Undigested food particles can get into your circulation, stimulating an unnecessary immune response and irritating joints. This is where apple cider vinegar may be helpful.
Apple cider vinegar helps properly acidify the stomach and enhance protein digestion. Furthermore, acidic stomach contents help trigger the release of bile (from the liver) and pancreatic enzymes, which are key for breaking food down into micromolecules and establishing proper absorption of nutrients. If you have a sensitive digestive system, or have type A blood, 1 teaspoon of vinegar at mealtimes will enhance your digestion. Incidentally, vinegar also helps reduce blood sugar spikes after eating.
For “noisy” joints that pop and creak: glucosamine alone, 1,500 mg daily, is very helpful long term. Keep in mind that glucosamine is not a quick fix. My experience-backed by recent clinical trials-suggests that the addition of chondroitin only adds expense.