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Ligament Injury
We think many
athletes and people suffering from chronic pain do not heal their initial
injuries because of improper treatment. This improper treatment generally
takes the form of one or all of the following recommendations: rest, ice,
immobilization,
anti-inflammatory drugs,
cortisone shots, taping, or
bracing. The athlete and/or anyone suffering a soft injury should say: No to
rest, No to ice, No to immobilization, No to anti-inflammatories, No to
cortisone shots, No to taping, and finally, say No to bracing. If the athletes
follow these seven no's they will be much more likely to heal sports injuries.
The Example of Ankle Sprains
Let's take ankle
sprains, the most common ligamentous sports injury, for example. In one study
of 563 ankle sprains in athletes who had received traditional treatment for
their injuries: 30 percent had residual pain, 20 percent felt the ankle was
unstable, and 18 percent had crepitus (crunching) in the ankle. This means
that about one out of three simple ankle sprains leaves an athlete with
chronic pain; one out of five will feel their ankles are unsteady; and one out
of five experience chronic crunching in the joint because the injury never
healed.
RICE vs. MEAT
The R.I.C.E.
treatment is the gold standard for pain management and sports injuries today.
Just go to any emergency room or sports trainer with an acute ankle sprain or
other ligament injury, and the injured person will be given these
instructions: Rest, Ice, Compression, and Elevation. Most people would also
receive instructions to take anti-inflammatory medications. This treatment is
recommended because ligament sprains are sometimes accompanied by quite a bit
of swelling. The premise with the
RICE treatment is that the swelling and
edema is harmful to the tissue. Where did such a preposterous idea originate?
Unfortunately, sports
medicine specialists and athletic trainers fell into the trap that muscles
were like
tendons and that tendons were like ligaments. In high-energy trauma,
the RICE treatment is essential for muscle injury becuase it can contain
swelling. Swelling in the muscle causes decreased circulation which leads to
still greater swelling and more tissue damage.
RICE treatment is
very effective at eliminating edema in muscle injury. What occurred in the
early 1970s, unfortunately for the athletes of the world, is that sports
medicine doctors and trainers started treating every injury as if it were a
muscle trauma injury.
The main difference
between muscles and ligaments is that muscles are massively strong structures
with a tremendous blood supply, both outside and inside the muscle (this is
why steak is red). Ligaments, on the other hand, are small tissues that have a
poor blood supply both inside and outside of the ligament (why they appear
white). Muscles, because of their good circulation, heal quickly and rarely
cause a long-term problem, whereas ligaments, due to their poor blood supply,
often heal incompletely and are the cause of most chronic sports injuries and
pain. It is our opinion that nonhealing ligaments are the number one cause of
early retirement in athletes.
The Small, Sensitive, Yet Mighty
Ligament
Many of our muscles
are mammoth structures, like the quadriceps. Ligaments, are generally less
than one inch in length, and whose width is measured in millimeters. Yet these
small structures must be mighty because they have the job of binding the bones
together.
Ligaments have
essentially no blood vessels of their own to bring them nutrients. Their
nutrition must come from diffusion of nutrients, most likely from the joint
itself. This should make it evident to you why ligaments are so easily
injured. A joint is impacted during an athletic event. The small blood vessels
to the joint are sheared. The little blood supply that the ligaments had is
then cut off. The immune system reacting to the damaged caused to the joint
wants to repair the damage, but can not do so if no immune cells can get to
the area because of the poor or interrupted blood supply.
The blood supply to
the ligaments is the worst at the point where the ligament attaches to the
bone, called the fibro-osseous junction. This is the most common area injured
in the athlete and is responsible for most lingering sports injuries. This is
the exact site where
Prolotherapy is administered.
An interesting fact
is that the colder a ligament is, the less force that is needed to cause it to
deform. This is one of the reasons many athletic injuries occur in cold
weather. Ligaments, nonetheless, are mighty. Ligaments owe their great
strength to
collagen, one of the strongest substances in the human body.
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