Teresa’s Case Study (1) | Why Did Persistent Ankle Swelling Improve So Much After One Treatment?

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

This patient came to see me nearly three months after a significant right ankle sprain.

On 27 June 2026, she landed awkwardly while playing basketball and badly twisted her ankle. The initial injury caused marked pain, swelling and bruising, and at first she was unable to walk normally.

Since then, she had already received around six treatments elsewhere, but her recovery had remained slow.

By the time I saw her, ordinary standing and straight-line walking were mostly manageable. However, after a busy day at work or prolonged standing, the right ankle would still swell noticeably. She works in an operating theatre and spends long periods on her feet, so this remained a significant problem.

Pain also returned when she walked quickly, turned suddenly, changed direction or increased load through the ankle. She had previously been active, but she still did not feel confident enough to run or return to badminton.

Nearly Three Months Later, Why Was the Ankle Still Swollen?

At the first assessment, visible swelling was still present around the lateral ankle.

Ankle dorsiflexion and plantarflexion were largely preserved, and normal straight-line walking was not particularly painful. She could also manage single-leg standing and weight-bearing through the toes and heels reasonably well.

The pattern changed when I tested more demanding movements.

Inversion, rotation and directional changes reproduced her pain. Loading through the outside of the foot was particularly provocative.

On palpation, there was clear tenderness around the lateral ankle, with especially marked tenderness around GB40 (Qiuxu) and the sinus tarsi region.

At that point, I felt that simply describing the problem as “a sprained ankle that was taking a long time to recover” was no longer enough.

Nearly three months had passed. She had already received multiple treatments, yet swelling and local tenderness remained around the anterolateral ankle, and rotational or lateral loading could still reliably reproduce her symptoms.

This made me look more closely at the sinus tarsi region as a possible ongoing source of irritation.

The Same Ankle Sprain Does Not Always Need the Same Treatment

There are many ways to treat an ankle sprain.

Treatment may involve local acupuncture points, distal points along a channel, or methods chosen according to the tissues and structures most involved.

But this patient had already been treated several times.

If I simply continued to treat the ankle as a general sprain and added more local points around the painful area, I felt I might still be missing the main issue that was maintaining her symptoms.

Based on the examination, I considered that the sinus tarsi region was still locally irritated following the original injury.

For this treatment, I therefore used a technique that I do not routinely use for every ankle sprain: a through-needling approach from GB40 towards BL62, directed through the relevant local region.

The technique itself is not the most important part of this case.

Knowing how to perform a technique does not mean it should be used whenever someone presents with ankle pain. Direction, depth and technique all matter, but more importantly, the clinical findings must justify why that method is being chosen.

For me, treatment should correspond to what the examination has actually found.

I did not use this method simply because I knew how to do it. I used it because this patient’s examination suggested that it was appropriate.

At the Second Visit, I Rechecked the Same Findings

When the patient returned after the first treatment, the changes were quite clear.

The persistent lateral ankle swelling had reduced by approximately 70–80%, with only mild swelling remaining.

The marked tenderness around GB40 and the sinus tarsi region was also much less.

She reported that ordinary walking and routine activities were now largely pain-free. The pain that had previously appeared with sudden turning and directional changes had reduced significantly.

At the first visit, loading through the lateral border of the foot had reproduced her pain quite easily. At the second visit, she could perform the same movement with little or no significant pain.

For me, these changes were more meaningful than simply hearing, “It feels much better.”

The same findings identified during the first assessment — swelling, focal tenderness and pain with specific loading movements — had all changed after treatment.

That made me consider that the area treated at the first session was likely one of the important factors maintaining her symptoms at that stage.

Of course, a strong response after one treatment does not mean the ankle has fully recovered.

She still needs to be reassessed under higher loads: prolonged standing, running, rapid changes of direction and eventually returning to badminton.

What This Case Made Me Think About

What makes this case worth recording is not simply that the patient improved significantly after one treatment.

She had already received several treatments before coming to me.

What stood out was the importance of asking three very basic clinical questions:

Have I identified the problem that actually needs to be treated?

Do I have an appropriate method for that problem?

Is this particular patient suitable for that method?

Having a treatment tool does not mean knowing when to use it. Knowing a technique does not mean every patient with a similar symptom should receive it.

When a patient has already had repeated treatment but continues to recover poorly, sometimes the next step should not be to keep repeating the same approach.

Sometimes the more important question is:

What have we not yet found?

A good treatment result does not come only from a good technique. It also comes from choosing the right method for the right patient.

Teresa’s Case Study(01–100) | Teresa’s clinical reflections, thinking and reasoning of the cases | Auckland Acupuncture Clinic

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If an ankle sprain continues to cause swelling, pain or difficulty with turning and higher-load activities after the initial injury has settled, reassessment may help identify what is still limiting recovery.

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Disclaimer
This case study describes one patient’s clinical presentation, assessment and response to treatment. Individual responses vary, and the outcome of a single case should not be taken as evidence that the same result will occur in every patient. Persistent ankle swelling, instability, pain or loss of function should be appropriately assessed.