Knee Pain Treatments (Continued)

Understanding the difference between muscles and the rest of the structures around the knee is crucial to understanding why the R.I.C.E. treatment is totally inappropriate for healing ligaments, menisci, tendons, and articular cartilage injuries. Muscles, such as the quadriceps, occupy an entire thigh, and have the strength and power to allow some athletes, like weight lifters, to squat in excess of 800 pounds. Muscles are the structures that move the joints.

Contrast this to most ligaments, which are generally less than one inch in length, and whose width is measured in millimeters. These small structures have the job of binding the bones together. The menisci and articular likewise, have their widths measured in millimetes and have the important task of cushioning the joints, as in the knee.

Muscles have a tremendous arterial blood supply, that can increase 25-fold during strenuous exercise. Ligaments, articular cartilage, menisci, and many tendons have terrible blood supplies. The menisci and articular cartilage depend on the joint fluid for their nutrition. The ligaments normally receive blood vessels from small arterial plexuses from the joints, but they themselves have essentially no blood vessels. This implies that at least some degree of their nutrition must come from diffusion of nutrients, most likely from the joint itself. Much like the articular cartilage and menisci. The actual insertion sites of ligaments into bones, called the fibro-osseous junction, are also essentially avascular (without blood supply). It should be evident now why ligaments are so easily injured. A joint is jostled 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 body has to repair the damage, but how can it do so if no immune cells can get to the area because of the poor 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 weak link in the ligament-bone complex. This is the most common area injured in the athlete and is responsible for much of the chronic knee pain that people feel. This is the exact site where Prolotherapy is administered.

As a result of immobilization (rest), ice, compression, and elevation blood flow is decreased to the knee or joint where it is used, resulting in reduced immune cell production necessary to remove the debris from the injury site. This produces formation of weak ligament and tendon tissue. The ligament-bone interface is tremendously susceptible to the effects of immobility or disuse. For instance in one study, just nine weeks in plaster cast caused the medical collateral ligament to lose 39 percent of its strength due to bone resorption at the point where the ligament attaches to the bone. Although muscle weight returned to normal by around 12 weeks, bone remineralization was not complete at 24 weeks and ligament strength was still not normal at 30 weeks. This is another reason why you cannot treat muscle injuries the same way you treat ligament injuries. They are microscopically, anatomically, physiologically different than ligaments. Ligaments, like menisci and articular cartilage, are tremendously sensitive to the detrimental effects of rest, immobilization, ice, anti-inflammatory, and cortisone injections. For these reasons, athletes and others who want to heal must say "no" to these therapies.

Swelling after an injury is the physical manifestation of inflammation. Swelling is evidence that the body is working to heal itself. Use of ice (and the R.I.C.E. protocol) will obviously prevent the body from repairing the injury. It has been shown that as little as five minutes of icing a knee can decrease both blood flow to the soft tissues and skeletal metabolism. Icing an area for 25 minutes, which is what most people and athletic trainers do, decreases blood flow to the soft tissues and skeletal metabolism by 400 percent. Healing is thus hindered by a decrease in blood flow and metabolism to the area. Icing (and the R.I.C.E. protocol) increases the chance of incomplete healing by decreasing blood flow to the injured ligaments, tendons, menisci, and cartilage. This increases the chance of re-injury or the development of chronic pain.

Back  [ 1 | 2 ]