A chronic sprain can cause persistent ligament pain, swelling, instability, repeated injury, weakness, or joint pain that does not fully resolve.
Learn how Dr. Siefferman evaluates chronic sprains, identifies the underlying cause of persistent pain and instability, and develops personalized treatment plans to restore function.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. When we sprain a joint, if it doesn’t fully heal, we are left with a chronic sprain. And essentially, this means that that joint is hypermobile. And when that joint is hypermobile, it is not stable, it is not secure, it is subject to extra wobble.
Now, when we use our body, we’re placing weight on that joint. And as we place weight on that wobbly joint, it will fall into a position at the end range of that joint. And what will happen is we will repetitively wear and tear that end range of the joint rather than using the full spectrum of the joint, the full weight-bearing surface area of the joint. If this is not corrected, number one, it leads to other postural changes. So specifically, if we think of the ankle, if the forefoot pronates because of a sprain, that will cause a shift in the tibia, which translates up to the knee.
That can lead to patellofemoral knee pain. It can lead to anterior pelvic tilt. It can trickle on up the biomechanical chain. And then it also causes compensatory changes in terms of avoiding weight on that joint. So when that joint has been overused because of the suboptimal biomechanics, because of the sprain, it will start to hurt. And as it starts to hurt, we will start using that joint asymmetrically. We will shift our weight to the other side, which of course also has trickle-down effects. If there’s a joint that’s sprained and it’s persistently hypermobile, it’s not performing the way that you think it should, we talk about treatment. And treatment typically includes regenerative medicine because we need to strengthen the ligaments to heal the joint, to heal the structure. And then we use physical therapy to untrain some of those biomechanical patterns that we’ve learned and train proper biomechanics.
A chronic sprain is persistent pain, laxity, or instability after a ligament injury that has not fully resolved. A sprain occurs when ligaments are stretched or torn, but lingering symptoms may involve more than delayed healing. Persistent pain after a sprain may come from ligament laxity, joint instability, incomplete rehabilitation, impaired proprioception, tendon injury, cartilage injury, nerve irritation, hypermobility, or chronic pain sensitization.
Repeated ankle sprains can lead to chronic pain, arthritis, and instability, especially when rehabilitation or diagnosis is incomplete.
At Manhattan Pain Medicine (MPM), evaluation begins by identifying why the sprain has not fully healed or why the joint continues to feel unstable.
For patients looking for chronic sprain treatment in Manhattan, MPM evaluates ligament integrity, joint stability, movement mechanics, prior imaging, rehabilitation history, pain location, swelling, weakness, nerve symptoms, hypermobility, and EDS-related tissue concerns.
Care may include diagnostic ultrasound, ultrasound-guided injections, regenerative medicine, platelet-rich plasma, prolotherapy, rehabilitation coordination, or orthopedic referral when structural instability requires surgical evaluation.
A sprain that keeps returning is not always “bad luck.” Repeated sprains may suggest ligament laxity, impaired proprioception, incomplete rehabilitation, chronic joint instability, connective tissue laxity, or another pain generator that was not fully addressed. In the ankle, chronic instability can cause repeated rolling, giving way, swelling, pain with activity, and reduced confidence with walking, sports, or stairs.
Hypermobility and Ehlers-Danlos syndrome can make sprain patterns more complex. Joint instability can lead to subluxations, dislocations, sprains, other injuries, acute pain, and chronic pain. MPM evaluates whether symptoms are driven by the ligament itself, the joint, surrounding tendons, cartilage, nerve irritation, altered movement patterns, hypermobility, or chronic pain sensitivity before recommending treatment.
Chronic sprain fits within MPM’s Hypermobility and Musculoskeletal issues Zones of Expertise. This matters because lingering sprain pain often involves both tissue injury and movement control. A ligament may be stretched or partially injured, but symptoms may also persist because the joint no longer feels stable, the muscles are guarding, proprioception is impaired, or the patient has underlying hypermobility.
Hypermobility spectrum disorders are connective tissue disorders associated with joint hypermobility, instability, injury, and pain. MPM evaluates chronic sprains with this broader context in mind, especially when patients have repeated injuries, poor tissue tolerance, EDS, hip impingement, labral tears, or instability in more than one joint.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
A chronic sprain is persistent pain, laxity, swelling, or instability after a ligament injury that has not fully resolved. It may feel like the joint never healed, keeps rolling, gives way, swells after activity, or cannot be trusted during movement. A chronic sprain may involve stretched or partially torn ligaments, incomplete rehabilitation, altered movement mechanics, impaired proprioception, tendon involvement, cartilage injury, nerve irritation, or hypermobility. The goal of evaluation is to identify why symptoms are persisting rather than treating the injury as a routine sprain.
A sprain may still hurt months later if the ligament did not fully recover, the joint remains unstable, rehabilitation was incomplete, or another structure was injured at the same time. Pain may also come from tendons, cartilage, nerves, scar tissue, joint inflammation, or altered mechanics. In some patients, hypermobility or EDS can increase ligament stress and make recurrent injury more likely. Chronic pain sensitivity may also develop when pain has persisted for a long time. MPM evaluates these possibilities before recommending treatment.
Signs of chronic joint instability may include repeated sprains, rolling, giving way, weakness, swelling after activity, pain with uneven ground, reduced confidence, clicking, catching, or a feeling that the joint cannot support weight reliably. In the ankle, chronic instability may make stairs, sports, running, or quick direction changes difficult. Instability may come from ligament laxity, impaired proprioception, incomplete rehabilitation, hypermobility, or structural injury. Persistent instability should be evaluated because repeated sprains can contribute to longer-term joint problems.
Yes. Hypermobility and Ehlers-Danlos syndrome can increase the likelihood of repeated sprains when connective tissue laxity affects joint stability. If the bones of a joint are not held securely, the joint may be more vulnerable to rolling, giving way, subluxation, dislocation, sprain, and other injuries. This can cause acute and chronic pain and interfere with daily activity. MPM evaluates repeated sprains in the context of joint laxity, movement control, tissue sensitivity, and overall musculoskeletal function.
A chronic sprain is diagnosed through history, physical examination, instability testing, movement assessment, prior imaging review, and evaluation for related injuries. The clinician may assess ligament tenderness, joint laxity, swelling, strength, balance, proprioception, tendon involvement, cartilage symptoms, nerve irritation, and hypermobility. Diagnostic ultrasound may be used in selected cases to evaluate soft tissue and ligament integrity dynamically. MRI, X-ray, or orthopedic evaluation may be needed when structural damage, fracture, cartilage injury, or surgical instability is suspected.
Yes. Diagnostic ultrasound can help evaluate selected chronic sprains, especially when soft tissue or ligament injury is suspected. Ultrasound may allow dynamic assessment of ligament integrity and joint instability while the joint is stressed or moved. This can add useful information when symptoms persist despite prior imaging or rehabilitation. Ultrasound is not needed for every sprain, and it does not replace all imaging. MPM uses diagnostic ultrasound when it may clarify the pain generator, guide treatment planning, or improve precision for ultrasound-guided procedures.
Treatment depends on the cause of persistent symptoms. Options may include targeted rehabilitation, balance and proprioception training, stability work, bracing when appropriate, activity modification, diagnostic ultrasound, ultrasound-guided injections, PRP, prolotherapy, or regenerative medicine in selected cases. Patients with hypermobility may need a stability-focused plan rather than repeated stretching. Patients with cartilage injury, tendon damage, nerve irritation, or structural instability may need a different pathway. Treatment should be individualized and should not rely on injections alone.
Surgery may be considered when joint instability persists despite appropriate nonsurgical care, when there is major ligament damage, when structural instability is significant, or when associated injuries require repair. Surgery may also be needed when repeated sprains lead to functional limitation, mechanical instability, cartilage injury, or failure to return to daily activities or sports. MPM can help evaluate nonsurgical options and coordinate orthopedic referral when surgical assessment is appropriate. The goal is not to avoid surgery at all costs, but to match care to the diagnosis.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
MPM
A sprain occurs when a ligament is stretched or torn. Ligaments help stabilize joints by connecting bones to each other. Many sprains improve with appropriate rest, protection, rehabilitation, and gradual return to activity. A chronic sprain is different. It describes persistent pain, swelling, laxity, or instability after the expected recovery period.
Patients may feel that the joint never fully healed. The ankle may keep rolling. The wrist, knee, hip, or another joint may feel unreliable. Pain may return with exercise, stairs, uneven ground, lifting, sports, or prolonged standing. Some patients also notice weakness, swelling, reduced confidence, clicking, catching, or a sense that the joint is not moving normally.
A sprain may become chronic for several reasons. The ligament may remain lax or irritated. Rehabilitation may not have fully restored strength, balance, and proprioception. Another structure may have been injured at the same time, such as a tendon, cartilage surface, joint capsule, or nerve. Pain may also persist because of altered movement mechanics, scar tissue, inflammation, or chronic pain sensitization.
In ankle sprains, repeated injury can create a cycle of instability. Without proper treatment and rehabilitation, chronic or untreated severe sprains can weaken the ankle and make reinjury more likely. Repeated ankle sprains can lead to chronic ankle pain, arthritis, and instability. While the ankle is a common example, the same diagnosis-first principle applies to other joints.
Hypermobility can make sprain recovery more complicated. Patients with EDS or hypermobility spectrum disorder may have connective tissue differences that affect joint support. A joint may move beyond its typical range or feel unstable under load. Muscles may guard to protect the joint, which can create pain, fatigue, and altered movement patterns.
For these patients, repeated sprains may reflect a broader stability issue rather than isolated injuries. Treatment may need to focus on load management, proprioception, strength, pacing, and tissue tolerance.
MPM begins with a detailed history. This includes how the sprain occurred, how symptoms changed, what treatments were tried, and whether the joint continues to feel unstable. The evaluation also reviews prior X-rays, MRI, ultrasound, physical therapy, bracing, injections, surgery, sports activity, work demands, and any history of hypermobility or EDS.
The physical examination may assess tenderness, swelling, range of motion, ligament laxity, joint stability, strength, balance, proprioception, nerve sensitivity, tendon involvement, and functional movement. The goal is to determine whether pain is coming from the ligament, joint surface, tendon, nerve, cartilage, surrounding muscle, or another structure.
Diagnostic ultrasound may be useful in selected cases. It can help evaluate soft tissue structures and dynamically assess ligament integrity or instability.
Treatment depends on the diagnosis. Some patients need targeted rehabilitation focused on strength, balance, proprioception, and gradual return to load. Bracing or taping may be helpful in selected cases, especially during higher-risk activities. Patients with hypermobility may need stability-focused training and pacing rather than aggressive stretching.
When a specific ligament or soft tissue pain generator is identified, ultrasound-guided injections may be considered. PRP, prolotherapy, and regenerative medicine may be discussed for selected ligament or chronic musculoskeletal pain patterns after the diagnosis, anatomy, risks, goals, and evidence are reviewed. These options should not be presented as guaranteed ligament repair or as replacements for rehabilitation.
Sometimes a chronic sprain is not only a ligament problem. Ongoing symptoms may be related to tendon injury, cartilage damage, nerve irritation, joint inflammation, hip impingement, labral tear, referred spine pain, peripheral neuropathy, or chronic pain sensitization. A patient with repeated ankle sprains may also have proximal hip or pelvic control issues. A patient with hip instability may have labral pathology or hypermobility-related mechanics.
This is why MPM avoids treating chronic sprain as a simple injection decision. The care plan should match the true pain generator and instability driver.
Some chronic sprains require orthopedic evaluation. Surgery may be considered when there is significant structural instability, major ligament damage, associated cartilage injury, or repeated sprains that persist despite appropriate nonsurgical care. MPM can help evaluate nonsurgical options and coordinate surgical referral when the pattern suggests that repair or reconstruction may be needed.
Patients should seek timely evaluation when pain, swelling, instability, repeated sprains, weakness, numbness, locking, catching, or loss of function persists. Urgent evaluation is important after major trauma, inability to bear weight, visible deformity, severe swelling, fever, redness, suspected fracture, progressive weakness, numbness, loss of pulses, or rapidly worsening pain.
MPM approaches chronic sprains through a diagnosis-first, function-focused model. The evaluation considers ligament laxity, joint instability, tendon injury, cartilage injury, hypermobility, nerve irritation, altered movement patterns, and chronic pain sensitization.
For patients looking for chronic sprain treatment in Manhattan, MPM offers a careful, nonsurgical pain medicine perspective that can work alongside physical therapy, orthopedics, sports medicine, and rehabilitation. The goal is to identify why symptoms persist, support joint stability and function, and match treatment to the patient’s anatomy, movement pattern, risks, and goals.
