Our Clinical Approach to Ankle Sprain

Our Clinical Approach to Ankle Sprain

by | Feb 6, 2026 | dr-chirag-arora, Gurgaon, Health, Orthopedics

Our Clinical Approach to Ankle Sprain

Below is a stepwise orthopedic workflow we use in our clinic.

Mechanism of injury

  • Inversion → ATFL injury (outside sprain) (most common)
  • Eversion → deltoid ligament (inside sprain)
  • External rotation → syndesmotic (high ankle sprain)

Red flags

  • Unable to bear weight immediately 
  • Severe swelling within an hour (fracture)
  • Locking/catching 
  • Medial pain (deltoid injury)

Imaging

X-ray is almost always required, unless clinical decision is otherwise:

  • bone tenderness OR
  • unable to bear weight

MRI indications (never required before 6 weeks)

  • persistent pain > 6 weeks
  • recurrent
  • elite athletes (off season)
  • suspected osteochondral defect

Grading

GRADE 

PATHOLOGY

CLINICAL

I

Stretch

mild swelling, stable

II

Partial Tear

moderate pain, laxity

III

Complete Tear

gross instability

 Management Protocol

Acute phase (0–2 weeks)

PRICE protocol

  • Protection (brace/Cast)
  • Rest 
  • Ice
  • Compression
  • Elevation

Medications

  • Anti-inflammatory medications – short course 5-7 days
  • Early weight bearing as tolerated
  • Physiotherapy (Range of motion)

Walking Cast may be required

  • Severe swelling 
  • Fracture
  • Repeated ankle sprains
  • High grade injury

Return to sport criteria

    • full ROM
    • no swelling
    • 90–95% strength
    • single leg hop pain free
    • good proprioception

       Timelines:

    • Grade I → 1–2 weeks
    • Grade II → 3–6 weeks
    • Grade III → 6–8 weeks

    Surgical indications

    • chronic instability (> 3 months)
    • Recurrent swelling episodes during sports
    • Ankle instability (Exam)
    • syndesmotic diastasis
    • associated osteochondral lesion

    Options

    • Arthroscopic surgery (Brostom-gould repair)

    Our Practical Approach template

    Grade I–II

    • No immobilization required
    • Walking allowed
    • NSAIDs 5 days
    • Supplements
    • physio referral (ROM + strengthening)
    • review 14 days

    Grade III

    • Walking cast 2 weeks
    • Medications
    • supplements
    • structured rehab
    • reassess 6 weeks
    • return to sports > 6 weeks

    IF SYMPTOMS ARE PERSISTENT BEYOND 6 WEEKS, PROGRESS TO MRI.

      Consult Dr. Chirag Arora, Best , for expert evaluation, personalized rehab, and safe return to sports.

        Common Shoulder and Knee Problems in Middle-Aged Individuals

        Common Shoulder and Knee Problems in Middle-Aged Individuals

        by | Dec 3, 2025 | Gurgaon, Health, Orthopedics

        COMMON SHOULDER AND KNEE PROBLEMS IN MIDDLE-AGED INDIVIDUALS

        As we enter our 30s, 40s, and 50s, many of us start noticing aches and pains that weren’t there before—especially around the shoulders and knees. These joints handle most of our daily movement, and even small changes in strength, flexibility, or activity levels can lead to pain.
        Here’s a clear, simple guide by Dr. Chirag Arora, best in Gurgaon, to the most common shoulder and knee problems seen in middle-aged individuals and how to recognize them.

          1. Rotator Cuff Tendinitis / Tendinopathy

          This is one of the most frequent causes of shoulder pain. It occurs due to overuse, poor posture, or degeneration of the tendons with age.
          Symptoms: Pain with overhead movements, difficulty sleeping on the affected side, and discomfort while lifting.

          Treatment options: Physiotherapy/Biologic injections (PRP)/ arthroscopic surgery 

          2. Partial/Complete Rotator Cuff Tears

          With age, the rotator cuff tendons weaken, making partial tears more common—even without a major injury. Also one may develop complete tears due to injury or progression of partial tears.
          Symptoms: Sharp pain during movement, reduced strength, and difficulty raising the arm.

          Treatment options: biologic injections/ arthroscopic surgery 

          3. Frozen Shoulder (Adhesive Capsulitis)

          Often seen between ages 40–55, frozen shoulder causes progressive stiffness and pain. It’s more common in individuals with diabetes or thyroid issues.
          Course: Painful phase → Stiffness phase → Gradual recovery (over months to years).

          Treatment options: Steroid Injection shot + PT/ arthroscopic surgery 

          4.

          As the space above the rotator cuff narrows, the tendons get pinched during movement.
          Symptoms: Pain while lifting the arm sideways or overhead, especially between 60–120 degrees of movement. Clinical diagnosis is hallmark.

          Treatment options: Steroid Injection shot + PT/ arthroscopic surgery 

          5.

          The acromioclavicular (AC) joint undergoes wear with age or previous injuries.
          Symptoms: Localized pain on the top of the shoulder and pain when bringing the arm across the body.

          6. Biceps Tendinitis

          Inflammation of the biceps tendon causes pain in the front of the shoulder. Typically symptoms associated with lifting, progression can laed to SLAP tear.
          Symptoms: Pain while lifting, carrying, or doing overhead activities.

          Common Knee Problems

          1. Ligament Injuries

          ACL,MCL and low-grade PCL may occur during twisting injuries or sports.
          Symptoms: Pain, swelling, and a feeling of instability or as an acute presentation of locking episode.

          Much more common in females engaged in contact sports.

          Treatment options: Biologic injections(PRP) + PT (Partial tears)/ arthroscopic surgery (treatment of choice.

          2.

          One of the most common conditions after 40. The joint cartilage slowly wears down, leading to pain and stiffness.
          Symptoms: Pain during walking or climbing stairs, stiffness after sitting, and creaking sensations.

          Treatment options: Biologic injections(PRP) + PT/ arthroscopic surgery / Joint preservation surgery

          3. Meniscus Tears

          These are age-related/traumatic tears that may occur even during routine activities like squatting or twisting or following a sporting injury.
          Symptoms: Sharp joint-line pain, catching or locking sensations, and swelling.

          Treatment options: Arthroscopic surgery 

          4. / (Runner’s Knee)

          Caused by improper kneecap tracking, muscle imbalance, or overuse.
          Symptoms: Pain in front of the knee while climbing stairs, sitting for long hours, or squatting. 

          This is the softening or wear of the cartilage under the kneecap.
          Symptoms: Grinding sensation, pain with knee bending, discomfort during physical activity.

          Treatment options : medications and PT

          5. Iliotibial (IT) Band Syndrome

          Common in runners or individuals with tight hip muscles.
          Symptoms: Outer knee pain, especially during running or after prolonged activity.

          6. Baker’s Cyst

          A fluid-filled swelling behind the knee, often secondary to arthritis or inflammation.
          Symptoms: Tightness or fullness at the back of the knee, pain during bending.

          Why These Problems Increase in Middle Age

          • Natural wear and tear of tendons and cartilage
          • Reduced flexibility and muscle strength
          • Sedentary work or sudden increases in activity
          • Weight gain increasing joint load
          • Hormonal changes affecting soft tissue health

          These factors make the shoulder and knee more vulnerable to strain and degeneration.

          When Should You See a specialist?

          Seek medical attention if you experience:

          • Pain lasting more than 2–3 weeks
          • Swelling post injury
          • Difficulty performing daily activities
          • Increasing stiffness or restricted range of motion
          • Night pain that disrupts sleep
          • Swelling or instability in the joint

          Early diagnosis leads to quicker recovery and prevents long-term damage.

          Majority of cases can be treated with medications and PT, while some conditions such as ligament tears are predominantly treated with arthroscopic surgery.

          Book a consultation with the best , Dr. Chirag Arora, to explore Common Shoulder and Knee Problems in Middle-Aged Individuals.

          What to Expect : 3 Months post ACL Surgery

          What to Expect : 3 Months post ACL Surgery

          by | Nov 7, 2025 | Gurgaon, Health, Orthopedics

          WHAT TO EXPECT :

          Note : this are the expectations post a specific surgical technique (All inside technique) in an isolated ACL reconstruction case with peroneus graft ( OUR USUAL TECHNIQUE)

          1. Healing & Graft Status

          • The graft is revascularizing and integrating into bone tunnels.
          • It’s not fully strong yet, so pivoting, twisting, or high-impact activity should still be avoided.
          • Internal healing continues even if you “feel normal.”
          • Graft is the weakest between 6 weeks – 4 months, avoid engaging sports.
          • You may experience swelling and pain post exertion/ stiffness at night time also.

          2. Range of Motion (ROM)

          • Goal:
            • Full extension (0°) — must be achieved.
            • Flexion: 120–135° (depending on individual progress).
          • Mild tightness at end-range flexion may persist.
          • Swelling should be minimal or only mild after exercises.
          • No restrictions in walking/limp
          • Jogging or brisk walk should not be painful
          • Stairs and car driving should be comfortable.

          3. Muscle Strength

          • Quadriceps and hamstring strength: around 60–70% of the opposite side.
          • Ongoing focus:
            • Quadriceps activation (especially VMO).
            • Hamstring co-contraction and hip strengthening.
          • Still some visible thigh muscle loss is normal.
          • Continue on return to sports training
          • Proprioceptive and balance training is mandatory

          4. Activities & Physiotherapy

          Allowed / Common at 3 months:

          • Stationary cycling (no resistance → gradual resistance).
          • Elliptical trainer, treadmill walking (no running).
          • Step-ups, closed-chain squats, lunges (under supervision).
          • Balance & proprioception training (wobble board, single-leg stands).
          • Squats even weighted squats
          • Leg press 
          • Avoid treadmill

          Still Avoid:

          • Jumping, twisting, pivoting, cutting movements.
          • Outdoor running (usually begins around 4–5 months if strength allows).
          • Sports or contact drills.

          5. Symptoms You Shouldn’t Have

          • Locking, giving way, or instability — may suggest incomplete strength or graft laxity.
          • Persistent swelling or warmth — may indicate synovitis or overuse.
          • Sharp pain with movement — could be cyclops lesion or over-aggressive rehab.

          6. Expected Functional Level (END POINTS)

            • Normal walking without limp.
            • Climbing stairs comfortably.
            • Light daily activities and desk work with ease.
            • Driving (for right knee) usually allowed if reflexes and control are adequate.

          7. Red Flags to Re-check With Surgeon

          • Recurrent swelling after exercise (moderate)
          • Loss of previously gained flexion or extension.
          • Knee “giving way” episodes.
          • Persistent anterior knee pain (possible patellar tendinitis or graft impingement).
          • Incomplete knee extension

          NOTE : THESE ARE SOME REFERENCE END POINTS FOR ISOLATED ACL TEARS, THERE MAY BE SOME VARIATION. DISCUSS WITH YOUR SPORTS SURGEON IN DETAIL.

          NOTE : MENISCUS TEARS IN ADDITION DELAY THE RECOVERY TIMELINES BY AROUND 4-6 WEEKS.

          Ready to get back to your active lifestyle? Schedule your follow-up with Dr. Chirag Arora, best in Gurgaon and ensure your ACL recovery stays on the right path.

          Injectable Treatment Options for Osteoarthritis Knee

          Injectable Treatment Options for Osteoarthritis Knee

          by | Sep 15, 2025 | Health, Gurgaon, Orthopedics

          INJECTABLE TREATMENT OPTIONS FOR OSTEOARTHRITIS KNEE

          Knee injections are commonly used in the management of osteoarthritis (OA) when oral medications and lifestyle measures are insufficient. They can provide pain relief, improve function, and delay the need for surgery. Here’s a structured overview by Dr. Chirag Arora: 

          TYPES OF INJECTIONS

            Corticosteroid Injections

            • Mechanism: Potent local anti-inflammatory effect.
            • Duration of relief: Usually 4–8 weeks, sometimes up to 3 months.
            • Indications: Acute flare of pain, significant synovitis/swelling.
            • Limitations: Repeated use (>3–4 times per year) can damage cartilage, weaken tendons/ligaments.

            (Hyaluronic Acid, HA)

            • Mechanism: Restores viscoelasticity of synovial fluid, lubricates and cushions the joint.
            • Duration of relief: 3–6 months (sometimes longer).
            • Indications: Mild to moderate OA, when NSAIDs fail or contraindicated.
            • Limitations: , expensive, not effective in advanced OA.

              Platelet-Rich Plasma (PRP) / Autologous Conditioned Plasma (ACP)

              • Mechanism: Delivers concentrated growth factors from platelets to reduce inflammation and stimulate tissue repair.
              • Duration of relief: 12–24 months in many patients.
              • Indications: Younger, active patients with early OA.
              • Advantages: Biological, regenerative potential, Out-patient procedure, single shot mostly.
              • SIDE EFFECTS: SPIKE IN PAIN DURING FIRST 3-5 DAYS

              OUR GOLD STANDARD OF PRACTICE

              Stem Cell / Bone Marrow Aspirate Concentrate (BMAC) / Adipose-derived MSCs

              • Mechanism: Provide mesenchymal stem cells that may regenerate cartilage and modulate inflammation.
              • Duration of relief: Early studies suggest 1–2 years.
              • Status: Still investigational, expensive, not universally approved.
              • Indications: Early OA, patients seeking regenerative options.

              Key Considerations

              • Patient selection: Early/moderate OA (KL GD II/III) responds better than end-stage disease.
              • Guidance: Ultrasound-guided injections improve accuracy and outcomes.
              • Adjuncts: Always combined with weight management, physiotherapy, activity modification, and oral/topical meds.

              Summary:

              • Steroids → short-term relief, good for flares.
              • HA → medium-term, especially in mild-moderate OA.
              • PRP/ACP → biologic option, promising for longer-term relief.
              • Stem cells → experimental, costly, long-term potential.

              Comparison Table

              Injection Type

              		 Relief Duration

              Best for

              Advantages

              Limitations 

              Corticosteroid

              4–8 weeks (sometimes 3 months)

              Pain flare-ups, swelling, advanced OA with synovitis

              Quick relief, low cost

              Cartilage damage 

              Hyaluronic Acid (Viscosupplementation)

              3–6 months

              Mild–moderate OA

              , safe, repeatable

              Variable response, costly,

              PRP / ACP (Platelet-Rich Plasma)

              12-24 months

              Younger, active patients, early OA

              Regenerative, longer relief, safe 

              Expensive, protocols vary,

              Stem Cells (BMAC, )

              1–2 years (experimental)

              Early OA, patients seeking regenerative therapy

              Potential ,

              Very costly, limited evidence

               

              Book a consultation with the best , Dr. Chirag Arora, to explore safe and effective injectable treatments for knee osteoarthritis.

              Treatment Options for Meniscus Tears | Dr. Chirag Arora

              Treatment Options for Meniscus Tears | Dr. Chirag Arora

              by | Aug 22, 2025 | Health, Gurgaon, Orthopedics

              TREATMENT OPTIONS FOR MENISCUS TEARS

              Non-Operative Options

              • Rest, Ice, NSAIDs → for pain and swelling.
              • Physiotherapy / Exercise-based rehab → quadriceps & , proprioception training.
              • Activity modification & bracing if needed.

              Best for degenerative tears and patients without mechanical locking/catching, with minimal symptoms.

              Surgical Options

              1.Meniscal Repair (inside-out, outside-in, all-inside techniques)

              • Suturing the tear to promote healing.
              • Indications: traumatic, peripheral (red zone), vertical/longitudinal, bucket-handle tears.
              • Pros: preserves meniscus, ↓ OA risk.
              • Cons: longer rehab (~3 months).

              Types of repair

              All inside/Inside –out/ Outside-in techniques.

              ALWAYS THE TREATMENT OF CHOICE IN OUR PRACTICE, IRRESPECTIVE OF AGE OR TYPE OF TEAR

              2.  

              • Removes unstable torn fragments, preserves as much meniscus as possible.
              • Indications: irreparable tears, chronic avascular fragments.
              • Pros: quick pain relief, fast return (~3–6 weeks).

              Cons: removes tissue → ↑ long-term risk of osteoarthritis.

              3.

              • For root tears (especially posterior medial root).
              • Untreated → behaves like total meniscectomy.
              • Very high risk of OA, if treated non-operatively 
              • Strongly recommended in all age groups.

              4. Meniscal Allograft Transplantation

              • For young patients with prior subtotal/total meniscectomy + persistent pain but minimal arthritis.
              • Restores cushioning, delays OA progression.
              • Niche indication.

              Decision-making

              • Degenerative tears (middle-aged/older): start with non-op rehab → surgery only if persistent symptoms.
              • Traumatic tears (younger/athletic): attempt repair always.
              • Mechanical locking (true block to extension): often needs early arthroscopy and removal of loose body/block (repair or resection).

              Typical Recovery Timeline ()

              0 – 2 Weeks (Protection Phase)

              • Weightbearing: Often partial or toe-touch with crutches → depending on tear type & surgeon protocol.
              • Brace: Hinged knee brace locked in extension or limited flexion (to protect repair).
              • ROM (range of motion): Gradually increased, typically 0–90° flexion by 4–6 weeks.
              • Goals: Protect the repair, control swelling, start quadriceps activation (isometrics, straight-leg raises).

                2 – 6 Weeks (Early Rehab Phase)

                • Weightbearing: Progress to full weightbearing as tolerated.
                • ROM: Usually allowed full flexion gradually.
                • Strengthening: Closed-chain exercises (mini-squats, step-ups), stationary cycling.
                • Goals: Regain normal gait, increase strength without stressing the meniscus.

                6 – 12 Weeks (Strength & Conditioning Phase)

                • Activities: Advance strengthening, balance, proprioception, elliptical, swimming.
                • Restrictions: Avoid deep squats, twisting, or pivoting sports until cleared.
                • Goals: Restore muscle strength, knee stability, endurance.

                3+ Months (Return-to-Sport Phase)

                • Sport-specific drills (running, agility, pivoting).
                • Return to sports: Usually 6–9 months post-repair (depending on tear type, healing, and sport).
                • Goal: Full functional recovery with minimized reinjury risk.

                  For personalized care and advanced treatment options, consult the best in Gurgaon, Dr. Chirag Arora, to ensure the best outcome for your recovery.