1. Proliferation of fatty tissue within
the joint
2.
Cartilage damage and necrosis
3. Scar tissue formation and
articular cartilage tears
4. Increased randomness of the
collagen
fibers within the ligaments and
connective tissues
5. Ligament weakening with a decreased
resistance to stretch
Both intra-articular
and extra-articular (inside and outside, respectively) ligaments and
periarticular (joint soft tissue) connective tissue are brutalized by
immobility. Gross inspection of the ligaments after stress deprivation shows
them to be less glistening and more "woody" on palpation. Under a
microscope the collagen of the ligament is very random. Chemically, the
ligaments lose water and glycosaminoglycans (which help maintain structure) so
there is a net loss of mass in the ligaments. There is also more degradation
of the collagen with stress deprivation. These changes translate to a much
weaker structure.
In one study,
knee ligaments immobilized for even a few weeks showed that the ultimate load,
linear stiffness, and energy-absorbing capacity of a bone-medial
collateral ligament-bone preparation is reduced to about one third of normal. In addition
to weakening of the ligaments themselves, immobilization decreases the
strength of the fibro-osseous junction where the ligament attaches to the
bone. In one study, after eight weeks of immobilization a 39 percent decrease
in the strength of the anterior cruciate ligament was exhibited. A weakening
of the bone where the ligament attaches was also found.
In contrast to the
rapid weakening of the ligaments with stress deprivation, rehabilitation of
the ligament is a much slower process. Most would estimate that for every day
a ligament is not moved or put under some stress, it takes at least two days
of stress or mobility to rehabilitate it. Often the rehabilitation or
strengthening process is incomplete. Most studies note that even after months
of exercise, the detrimental effects of immobility are evident in ligaments,
even if the immobilization lasted a short time. The insertion site of
ligaments (fibro-osseous junction) heals even slower.
These are also
reasons why chronic
ligament injury is the cause
of most non-healing sports injuries and chronic pain. Since the fibro-osseous junction heals more slowly,
it is the least likely to heal. This is another reason that
Prolotherapy treatments
are
directed at the fibro-osseous junction—to cure sports injuries.
It turns out that
immobilization and rest further decrease the metabolic rate in
tendons and
ligaments. In one study looking at the regeneration of tendons, William
Lindsay, M.D., wrote, "the relatively inert metabolic state of tendons
was accentuated by immobilization." Immobilization has numerous
detrimental effects on all connective tissues.
If rest and
immobilization hinders ligament and tendon healing, then studies should show
that early mobilization and exercise helps soft tissue healing. This is
exactly what has been shown. For this reason a much better approach to healing
sports injuries is the MEAT regime.
The MEAT Regime: The Future to
Healing Sports Injuries
Treatments that
promote soft tissue healing will be the future of sports medicine. The old
edict of "anti-inflame the area" will be replaced by "stimulate
the area to heal with
inflammation." The new acronym that will be
declared across the nation and in all of the locker rooms, will be M.E.A.T.
Movement, Exercise, Analgesics, and Treatments specific to encouraging healing
(like
Prolotherapy
injections) will be prescribed.
RICE and MEAT are
physiologically at the extreme opposites of each other. RICE suppresses blood
flow and immune function thus delaying recovery and hindering collagen
formation after a sports injury. The possibility of healing a sports injury
with RICE is much decreased. MEAT, on the other hand, stimulates blood flow
and immune function to the injury site encouraging collagen formation. The
speed of recovery from the sports injury is shortened and the likelihood of
complete healing after a tendon and ligament injury is enhanced.
Movement and
exercise, the first two recommendations of MEAT, have been shown to be very
effective at enhancing ligament and tendon healing. Exercise can increase the
strength in an injured ligament by 50 percent compared to a non-exercised
group.
Perhaps the most
important ligaments for the athlete are those in the knee. Numerous studies
have shown that exercise increases the strength of the knee ligaments when
they are injured. In one study, the anterior cruciate ligament was
strengthened by a statistically significant amount with exercise. Exercising
the knee six days per week, instead of three days per week also produced the
most improvement in ligament strength. The medial collateral ligament (MCL) of
the knee has also been shown to heal better with early motion and exercise in
athletes.
It is clear that exercise and mobility are significantly better for healing than immobility and
rest for ligaments. Do not get too excited, however. As previously stated, the
repair and regeneration begins within the first few days and occurs for the
next six weeks. From week six until 12 months, the injured ligament undergoing
repair remodels, contracts, and gains some tensile strength. Even though
ligaments heal for a full year after the injury, after 12 months the strength
of the ligament is generally only 50 to 70 percent of the original ligament
strength. Imagine the status of the ligament strength at day four or two weeks
after the injury? This fact is an example of why ice,
cortisone shots, anti-inflammatories,
braces, and taping are so dangerous. They cover up the fact that the athlete
has an injury. The athlete goes out and plays even though his ligament is only
25 percent of the strength of his original, uninjured, ligament. Sports
medicine specialists are wondering why the athlete does not heal. Get a clue.
It is their treatments that are preventing the healing. The best treatment for
the athlete is to heal the injured ligament back to 100 percent as quickly as
possible. There is only one treatment that can do this. That treatment is
Prolotherapy
