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What
Do You Do When Braces and Taping
No Longer Hold Your Ankles and Knees Together?
It is a familiar locker
room ritual. The taping of ankles and knees to provide support and limit
movement of an existing injury. Despite numerous medical studies confirming the
ineffectiveness of taping, and in some cases, actually contributing to further
injury, most continue to do it.
Why? Because nearly every televised sporting
event will show an athlete wearing a brace or being taped.
In a classic study, researchers at
the University of Wisconsin studied the four most common ankle taping methods,
namely: the basket weave, the basket weave and stirrup, the basket weave and
heel lock, and the basket weave with combination stirrup and heel lock. After
the test subjects exercised for a period of ten minutes, the study's authors
noted,"...While some support is given to the ankle joint by current methods
of taping, it is doubtful that the protection is as great as many
believe..."
Other studies showed that more
injuries occur to taped than to non-taped ankles, further, athletes with
histories of ankle sprains were twice as likely to sustain further sprains
regardless of shoe or external supports (taping).
A good summary statement concerning
the use of tape was put forth by NIKE Sport Research Review. The use of tape to
support the ankle is currently the most common method of prevention, despite
potentially negative side effects."
The Knee
The knee is a remarkable joint in
the fact that it has a design flaw, it is wobbly. While held together by massive
thigh muscles and strong
ligaments, the knee, even in its healthiest state,
cannot avoid being unstable. Knee injury is the most frequent cause of
disability related to sports activity. It does not require participation in team
or contact sports to occur. Devastating knee injury can occur in aerobic
workout, treadmill walking or running, step machines, or even in walking by
simply turning the "wrong" way.
The Knee Brace
In 1978 Oakland Raider's head
trainer George Anderson developed the "Anderson Knee," a brace
designed to extend the playing career of quarterback Ken Stabler and his
chronically injured knees. Immediately other trainers began using the knee brace
on their "injury prone" athletes.
Despite any proof that these braces
prevented injury to already damaged knees, medical personnel of several National
Football League teams thought to use the brace on healthy knees as an injury
deterrent. Suddenly a frenzy hit the sports injury field as at least eight
different manufacturers entered the market within five years. Six years after
the introduction the of Anderson Knee, the American Orthopaedic Society of
Sports Medicine (AOSSM) called for research into the effectiveness of using knee
braces on healthy knees to prevent injury.
The end result of this was that the
American Academy of Orthopaedic Surgeons issued a position statement, cautioning
clinicians regarding recommending the use of knee braces because the studies
showed that braces did not prevent injury and some studies were showing that
braces actually increased knee injury rates. The American Orthopedic Society for
Sports Medicine and the Journal of Bone and Joint Surgery took the same stand.
Two other studies were called for
by AOSSM. The first was conducted at the University of North Carolina at Chapel
Hill. Researchers charted all the knee injuries to the school's football players
five years before and two years after knee braces were introduced. The knee
braces did not show that they prevented injury. The last study involved two
years of bracing compared with two years of non-bracing at Wake Forest
University in Winston-Salem, North Carolina. This study should have caused the
abandonment of bracing football players because it showed an increase in the
number of serious knee injuries when athletes braced their knees. There were
three times the number of severe grade-3 anterior cruciate ligament injuries in
those using braces.
There was an overall increase in
knee injuries of 20 percent. The number of surgical procedures on knees
increased by almost 50 percent during the bracing years.
Regardless of all the data,
regardless of the discomfort of using a knee brace people still use them. Why?
Because they give a false sense of security.
The Internal Braces -- Ligaments and
tendons -- How Do they Get Damaged?
Tape and braces are used because
they are thought to provide artificial strength to the
connective tissue that
hold joints in place--the ligaments and tendons. It is damage to these
structures, that cause
chronic pain and injury.
A year ago a young man in his early
thirties limped into our clinic reporting that he had "blown" out his
knee a couple of times. To keep as active as he could he had been wearing a
massive knee brace for the last four or five years. He had received a lot of
rehabilitation, but his prognosis was that the chronic knee damage was beyond
surgical repair.
On physical examination, he
exhibited laxity and weakness in his anterior cruciate and
medial collateral ligament. At this point the patient requested
Prolotherapy be performed. After
one treatment, natural repair of the knee began, within two month the brace was
gone. Three months later, a second treatment. The knee, without surgery or
drugs, had been repaired.
What is Prolotherapy?
Despite its usual tags of
"revolutionary" or "controversial", Prolotherapy is a very
simple procedure. It is a series of injections, consisting mostly of naturally
derived substances such as corn extract, given in the knee, ankle, or at the
site of chronic pain in joints, where the ligaments and tendons attach to the
bone. These injections are designed to stimulate the immune system by tricking
the body into thinking a new injury has occurred.
The injected substances mimic
injury by causing irritation and mild swelling in the painful area. The immune
system responds to this "injury" by sending macrophages, cells that
remove debris and irritants from the body. After the macrophages carry off the
irritants for elimination, the immune system sends in
fibroblasts, cells that
rebuild connective tissue (the term Prolotherapy is derived from proliferate
meaning to grow),where damage has occurred. This rebuilding process results in
new ligament growth which can be 40% stronger than the original ligament.
Consequently, the physical
structure supported by this connective tissue becomes stronger and more stable,
thereby eliminating or greatly diminishing the pain triggered by the
corresponding nerves and muscles and quickly returning people to active sport
participation.
While generally Prolotherapy
treatments are given once a month to allow time for the growth of the new
connective tissue and patients normally require four to six treatments for
complete recovery, injured athletes will want to return to their golf or tennis
game or other activities as quickly as possible. In this case
Prolotherapy injections are sometimes given on a weekly basis, or a stronger solution is used
to speed the healing process. This is not the ideal situation however. The
preferred regime is for the patient to receive Prolotherapy treatments in the
off-season to allow complete strengthening to take place.
RELATED
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Prolotheray and Knee
Pain Part 1
Prolotherapy
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Prolotherapy and Knee
Replacement
Knee
Cap - Patella Disorders and Prolotherapy
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