Does Resting A Joint Injury Have Side Effects?
Immobilization, also known as stress deprivation, is extremely detrimental to the joints and ligaments. Immobilization causes the following changes to occur inside joints:

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 is 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) 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.