Ligament Injury
Ross Hauser, M.D.
We think
many patients and 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
medications,
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.
RICE treatment
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 because 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.
