Hip and Knee Joints of Former Elite Marathon Runners

Researchers writing in the medical journal Der Orthopäde sought to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects’ joints differ from those of control persons.

Schmitt H, Rohs C, Schneider S, Clarius M. [Is competitive running associated with osteoarthritis of the hip or the knee?] Orthopade. 2006 Oct;35(10):1087-92.

 

BACKGROUND: The aim of the study was to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects’ joints differ from those of control persons.

METHODS: Twenty former elite German marathon runners (active careers 1972-86) underwent clinical (FFbH-OA [hip joint] and AKSS [knee joint]) and radiographic (hip and knee joints, Kellgren and Lawrence classification) examination. X-Rays of the hip joints were compared with those of controls matched for age, gender and BMI who did not engage in much sport.

RESULTS: In the group of former elite marathon runners, 3 of the 38 knee joints for which comparison with control joints was possible were found to be affected by grade 2 osteoarthritis. In the same group, severe osteoarthritis (Kellgren and Lawrence grade 3) was documented in 1 and moderate osteoarthritis (grade 2) in 6 of the 28 hips for which direct comparison against the controls was possible, as against 1 hip affected by grade 2 osteoarthritis in the entire control group. The clinical evaluation showed high scores in all athletes.

CONCLUSIONS: Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.

ACL Problems Discussion

Discussions from our Radio Show on ACL Problems:

A CALLER WITH ACL PROBLEMS

CALLER: I am a tennis pro and I have played tennis for years and I have also played soccer and I have had three surgeries and I have permanent pain in my right knee.

Dr. Darrow: The caller had a torn ACL, he had one surgery several years ago where they actually cut open (an incision), because I remember the scar on his leg, (that had) to be at least a foot long. Back then the surgery was very evasive, now they do it an arthroscope. But even then many of these ACL surgeries are unnecessary. Doctors are trained to think that the ACLs are pretty much necessary and any one who rips one can’t be an athlete. But we find that many athletes go on and compete without them. So we just stabilize the ligaments in the knee and people with deficient ACLs can still do their sport.

Dr. Gene: You are saying that if you saw this Caller a few years ago you obviously would not have suggested that surgery.

Dr. Darrow: I never suggest surgery unless it is absolutely necessary. Generally for an ACL I would like to wait a couple months and see if the injury calms down. There are many studies on the ACL, that the results are much better if the patient waits (on surgery). There are some who just jump right into the surgery and then the person has a longer rehabilitation period.

Dr. Gene: How long should someone wait, the caller is a professional tennis player, if he had to get back on the court in a hurry, how long?

Dr. Darrow: The problem is this. When someone tears an ACL or a big ligament like that. You just can’t go back and play tennis right away, the rehabilitation from ACL is long and extensive before that donor ligament is “matured” is at least nine months. Most of these people who have had them done, if they go and do any sports that have any degree of twisting of the leg before that time will rip it again. You have to be very careful.

ACL REVISION SURGERY
Researchers writing in the American Journal of Sports Medicine looked at “revision anterior cruciate ligament surgery (to) determine the association between stability and functional results”

What they found was “Revision (ACL) surgery allowed approximately 60% of patients to go back to sports, most of them at lower levels than their prerevision function,” and that “patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function.”

Battaglia MJ 2nd, Cordasco FA, Hannafin JA, Rodeo SA, O’brien SJ, Altchek DW, Cavanaugh J, Wickiewicz TL, Warren RF.Results of Revision Anterior Cruciate Ligament Surgery.Am J Sports Med. 2007 Oct 11

MRI Reliability in ACL Ruptures
Researchers writing in the Korean Journal of Radiology say that MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

Chung HW, Ahn JH, Ahn JM, Yoon YC, Hong HP, Yoo SY, Kim S. Anterior Cruciate Ligament Tear: Reliability of MR Imaging to Predict Stability after Conservative Treatment. Korean J Radiol. 2007 May-Jun;8(3):236-41.

How Do You Tell A Patient That Their Knee Brace Won’t Work For Them?

There are many ways to treat a knee injury, surgery, rehabilitation, and less evasive techniques such as acupuncture, trigger point injections, Prolotherapy, exercise and specialized training. These therapies and treatments are carried out by a wide range of medical professionals and while many rehabilitation specialists do not agree on which method is best, the one thing that most agree on is that the use of a knee brace to either prevent a knee injury or help support and provide comfort will not work for everyone.

One more thing that most clinicians agree on is that despite this, a great majority of patients want the braces regardless.

Making the Argument For and Against the Brace

It is difficult to convince a patient that a knee brace will not provide the comfort and support they anticipate in their situation when so many televised sporting events will show a superstar athlete with their knee wrapped in tape or ace bandage and in some instances wearing an obvious brace. However, it can be pointed out that if braces were very effective in prevention future injury, why wouldn’t every athlete wear them regardless of decreased mobility.

From every athlete to very few, why braces are no longer worn.

George Anderson is a legendary name among National Football League trainers. From 1960‑1994 he served as head and some times only trainer for the Oakland Raiders. During the 1970′s the Raiders were a perennial football power and Anderson was responsible for keeping some of the game’s best players on the field. This included the Raider’s quarterback Ken Stabler, a numerous time all‑star, Super Bowl Winner and one of the game’s top athletes.

When your star athlete suffers an injury, such as Stabler’s medial collateral ligament injury, a team’s medical staff will get somewhat creative to keep the player on the field. In this case, Anderson designed a special knee brace that would help prevent future injury to Stabler’s MCL. Later this brace would be commercially marketed as the Anderson Knee Stabilizer.

When Anderson published his favorable review of his knee brace (1) football trainers in the high school, collegiate, and professional ranks hailed it not only as a means to get MCL (and ACL) injured players back on the field, but that it could also be used as a prophylactic knee brace. Soon, whoever could afford to outfit their team, or their best players or themselves with the brace did.

But just as quickly as the brace was embraced, research into knee bracing effectiveness for knee injuries began to appear which not only questioned whether knee bracing was effective but also suggested that they not only did not prevent injury, they may increase risk and reduce the athlete’s motion and movement and hence performance. (2‑4)

 

Knee Braces in Brief

A great majority of medical studies on knee bracing has been done to affirm or question the use of Functional and Prophylactic knee braces in athletes because of the high visibility and money interests involved in sports. Further if the braces were so effective for athletes, one could imagine what type of knee injury support it would provide for the patient with a considerably lesser risk for future trauma and need for the maximum support it provided in contact sports.

Knee braces and their functions can be briefly described as the following:

Functional Braces
As mentioned above, functional braces are typically used by athletes who have suffered a significant knee injury and believe they will be benefited by them in controlling the rotation of the knee and stabilizing it. Medical literature questions the use of these braces in surgically repaired ACL and non‑surgically repaired ACL’s. (5‑9)

Further, despite advances in technology patients have complained that the brace can slip out of place, cause discomfort and limit mobility. Additionally cost is a concern with custom made braces costing in the $1,000 range.

Some functional braces, such as the Chondromalacia supporting type are not as restrictive since their main purpose is to keep the patella from moving out of place.

Prophylactic Braces

Prophylactic braces are used to prevent injury to the knee. The most common form of this brace has a lateral post with two straps, one going around the tibia and one going around the femur.

It is these braces that present the greatest challenge to the practitioner. Many patients report that despite any evidence that the knee brace is helping their knee function or preventing an injury, the patient think it works. It is this thinking which has led some practitioners to allow their patients to leave them on. “As long as patients understand that a brace does not substitute for vigorous rehabilitation to improve strength, flexibility, and proprioception.” (10)

A difficulty with this line of thinking is that the patient may injure themselves because they think that their knee is being protected. An athlete may play as if they had no injury, a patient may think they can quickly return to normal activities such as stair climbing or return to work sooner than they should following a surgery.(11)

Further, some studies suggest that the Prophylactic Braces may increase the incident of injury. Bracing the outside of the knee was thought to minimize tears of the MCL, but it has been suggested the braces increase stress load on the medial side of the knee and other points of the knee. (12,13)

 

Rehabilitative Braces

The use of rehabilitative braces are usually limited to the period immediately following an acute injury or surgery. These are large braces that usually extend from mid‑thigh to mid-calf with large hinges on either side of the knee and multiple straps to hold it in place. This brace is perhaps the most popular prescribed knee brace because they can offer many benefits that casting or splinting cannot including: adjustability for swelling and comfort and most importantly, to allow the knee a controlled range of motion. Increasing, rehabilitation specialists are being shown that moving an injured or surgical repaired knee as soon as possible greatly accelerates recovery time. (14)

However the American Academy of Orthopaedic Surgeons, in general, do not recommend these braces, citing that “the majority of scientific studies show no difference in final outcomes of anterior cruciate reconstructed knees, whether a brace is worn or not,” “it does not appear that a brace is needed to support or protect a reconstruction in a well done surgical procedure” (15)

 

A Brace For The Arthritic Knee The Unloader/Osteoarthritis Brace

When the symptoms of osteoarthritis affect one compartment of the knee, either the medial compartment on the inner side of the knee or the lateral compartment on the outer side of the knee, but not both, the Unloader brace has been shown to decrease arthritis pain in selected studies by helping to shift the weight (or “unload” the weight) from the damaged area of the knee to the stronger, unaffected area of the knee. (16,17)

These knee braces are often prescribed to patients who can no longer tolerate or refuse anti‑inflammatory medications, and who the clinician feels will offer the greatest compliance as complaints about these braces from patients are that they are very expensive and often very bulky. Another problem is that these braces may cause bruising to the thighs and discomfort to the knee because they do not fit correctly-a well recognized problem with non-custom made braces. Typically a patient may decide on their own that this brace is too uncomfortable for them to wear.

Summary
In practice, the clinician and the patient should meet together to discuss all the pros and cons of the brace in their unique situation. In our practice we stress the following points on the patient when they request a prescription or recommendation for a brace understanding that we very rarely recommend the use of braces.

First, that the brace must never be thought of as a replacement for a medical treatment.

Second, that the patient must not be allowed to feel a sense of security that the brace will allow them, by itself, to return to a normal active life style.

Third, that perhaps with the exception of the Unloader/Osteoarthritis Brace, and only in certain situations, should a brace ever be used for any extended length of time.

Fourth, in our opinion, rehabilitation for medically treated knees must allow for increased movement and circulation to the knee, two important factors that maybe curtailed with improperly fitted or extended wear of a brace.

1. Anderson G, Zeman SC, Rosenfeld RT: The Anderson Knee Stabler. Physician Sportsmed 1979;7(6): 125‑127

2. Zemper ED. A two year prospective study of prophylactic knee braces in a national sample of college football players. Sports Training, Medicine and Rehabilitation, 1990; 1: 287 296.

3. Rovere GD, Haupt HA, Yates CS. Prophylactic knee bracing in college football. Am J Sports Med, 1987; 15(2): 111 116.

4. Hewson GF, Mendini RA, Wang JB. Prophylactic knee bracing in college football. Am J Sports Med, 1986; 14(4): 262 2666

5.Wilson LQ, Weltman JY, Martin DE, Weltman A . The effect of functional knee brace for ACL insufficiency during treadmill running. Medicine & Science in Sports & Exercise 1998; 30 5:655 664.

6. ACL insufficiency during treadmill running. Medicine & Science in Sports & Exercise 1998; 30 5:655 664.

7. Fujimoto E, Sumen Y, Ochi M, Ikuta Y: Spontaneous healing of acute anterior curciate ligament (ACL) injuries conservative treatment using and extension block soft brace without anterior stabilization. Arch Orthop Trauma Surg 122: 212 216, 2002.

8. Birmingham TB, Kramer JF, Kirkley A, Inglis JT, Spaulding SJ, Vandervoort AA . Knee bracing after ACL reconstruction: effects on postural control and proprioception. Medicine & Science in Sports & Exercise 2001; 33 8:1253 1258.

9. Wojtys EM, Huston LJ: Custom fit vs. Off the shelf ACL functional braces. Amer J of Knee Surg 2001; 14(3): 157 162.

10. Does a knee brace decrease recurrent ACL injuries? Clinical Commentary: James L. Lord, M.D. The Journal of Family Practice October 2003

11. American Academy of Orthopaedic Surgeons. Position Statement on the use of knee braces. Document number 1124, October 1997. www.aaos.org/wordhtml/papers/position/1124.htm. Accessed: October 26, 2004

12. DeVita P, Torry M, Glover KL, Speroni DL. A functional knee brace alters joint torque and power patterns during walking and running. J Biomechanics 1996; 29 5:583 588

13. Jerosch J, Castro WHM, Hoffstetter I, Reer R . Secondary effects of knee braces on the intracompartmental pressure in the anterior tibial compartment. Acta Orthopaedica Belgica 1995; 61 1:37 42.

14. Nash CE. Mickan SM. Del Mar CB. Glasziou PP. Resting injured limbs delays recovery: A systematic review. The Journal of Family Practice September 2004:706 712.

15. American Academy of Orthopaedic Surgeons. Position Statement on the use of knee braces. Document number 1124, October 1997. www.aaos.org/wordhtml/papers/position/1124.htm. Accessed: October 26, 2004

16. Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL: Reduction of Medical Compartment Loads with Valgus Bracing of the Osteoarthritic Knee. American Journal of Sports Medicine, 30 (3): 414 421, 2002.

17. Hewett TE, Noyes FR, Barber Westin SD, Heckmann TP. Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: a prospective analysis of valgus bracing. Orthopedics 1998; 21

Collagen and Degenerative Knee Pain

When the doctor says: “I am recommending surgery, ultimately you will probably need a knee replacement due to the damage in there.” There are two choices to make when the doctor says these words to you. One, accept your destiny and continue to live with an unstable and painful knee until the surgeon calls, or find a solution to your pain now.

To someone wearing a knee brace, who regularly tapes ice on their knee and takes prescribed and over-the-counter pain medication, what else could there be but surgery? How about Prolotherapy?

Prolotherapy works on all knee problems with excellent results. Only in the case of a completely torn ligament is Prolotherapy somewhat limited. If there is a partial tear (sometimes on MRI these may look like complete tears), Prolotherapy can reconstruct the ligament and strengthen the joint.

But even with a complete tear, prolotherapy is extremely beneficial because an impact with enough force to completely rupture a ligament will also loosen the entire knee structure. Prolotherapy in this situation can strengthen the surrounding tissues giving the patient/athlete a better chance of long-term success.

It is rare that a patient who is not active in sports or a competitive athlete needs ACL surgery. Many athletes function on an ACL deficient knee.

There are certainly instances in life when surgery is called for, but not nearly as often as it is currently performed. Even so-called “minor” surgery takes a drastic toll on the human body, physically traumatizing and permanently altering its structures, often to its detriment.

Is Prolotherapy The Answer To Chronic Knee Pain?

Prolotherapy is short for “proliferation therapy,” Proliferation, of course, means “rapid production.” What Prolotherapy rapidly produces is collagen and cartilage. Collagen is a naturally occurring protein in the body that is a necessary element for the formation of new connective tissue that holds the skeletal infrastructure together. These include, tendons, ligaments, muscle fascia and joint capsular tissue.

Prolotherapy helps make collagen through a series of injections, not of collagen, but of mild chemical or natural (such as dextrose-sugar) irritants, that stimulates the immune system’s healing mechanism to produce collagen naturally. Making collagen makes for strengthened and restored joints. Restored and strengthened joints makes for permanent pain relief.

In non-injured ligaments or tendons, collagen fibers are flexible and have some elasticity. But, they are not supposed to stretch very far. Injuries can stretch these fibers beyond their designed lengths. Or, wear and tear through repetitive motion can fray or tear them. When these tissues are stretched beyond their normal limits, wear out, or tear, pain is perceived.

Inflammation produces pain, which is a sign the body’s healing process is occurring. So initially, inflammation occurs as the body tries to heal the damage. Since the tendons and ligaments have a poor and limited blood supply, it is important not to shut down the initial inflammatory response. Shutting down the inflammation is equivalent to shutting down the healing cycle and YOU prevent yourself from healing correctly. In all cases that require Prolotherapy, the ligaments and tendons, whether through the use of anti-inflammatories, or because of a weakened immune system, or because of the severity of the injury, did not heal sufficiently. Injured, loose, or stretched out ligaments are often referred to as the condition of ligament relaxation, or ligament laxity. This is what produces the pain and discomfort, especially with movement because the connection of the ligament or tendon to the bone may be inflamed and the joint may move beyond its normal range of motion.

 

Research

 
Total Knee Replacement – The Best Option For Everyone?
Researchers writing in the medical journal Knee say “there is increasing evidence, based on research using patient-based outcome measures, that a significant proportion of patients experience chronic knee pain, functional disability, a poor quality of life and dissatisfaction after TKR.”

Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: Is it really an effective procedure for all? Knee.2007 Jun 25

Chondromalacia Patella

It is easy to twist a knee, bang a knee, land the wrong way, there is a lot of reasons, arthritis comes up, those are some of the reasons. Also a lot of Chondromalacia patella, that is where the knee bone kind of cracks a little bit against the femur, the thigh bone.

Chondromalacia patella. Malacia means break down, condro means cartilage, patella means the back of the knee bone, which is call the patella, (and there) is the thickest cartilage in the body. It starts rubbing the wrong way against the tract that it slides in and with repetitive use like running or stair climbing, things of that nature, any sport really, the repetitive use just wears out the back of that knee cap and begins the arthritis process and pain. This is also one of the easiest things to heal with Prolotherapy. It is usually just a couple of injections with sugar water and it starts a little inflammatory cycle and builds up collagen there.

The patella, commonly called the kneecap, sits in a groove at the front of the knee. The most common knee problems encountered in clinical practice involve the patella, because its anatomical placement subjects it directly to a variety of bony and soft tissue disorders.

A portion of the general population is subject to these disorders, which include:

• Patellofemoral syndrome (patella mistracks in femoral groove);
• Excessive torsional deformity of the tibia;
• High or lateral position of the patella;
• Shallow femoral trochlea;
• Atrophy of vastus medialus oblique muscle;
• Increased quadriceps angle (often in those with wide hips);
• Over-development of the vastus lateralis muscles;
• Flat feet;
• Excessive pronation of the feet (feet turn up to the side).

Behind the patella is a layer of articular cartilage-the thickest layer of cartilage found in any of the joints of the body.

Until recently, we did not know that cartilage is directly treatable by trigger point injections and Prolotherapy. We knew the benefits that Prolotherapy Injections offered in adjoining soft tissue, due to the strengthening of the supporting ligaments and tendons, which keep the joints properly aligned and thereby protect the cartilage from erosion caused by friction.

A recent study, showed that Prolotherapy stimulates the growth of articulate cartilage. (Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000 Mar;6(2):68-74, 77-80. )

In this study, people who had knee arthritis, and, who suffered from knee pain for an average of eight years or more, received Prolotherapy over a six month period. Important to note is that 35% of the knees examined for the study had no cartilage remaining in one or more major compartments.

The results? Thirty-five percent (35%) reduction of pain, 45% improvement in swelling and 67% improvement in knee buckling as well as a 13 degree improvement in knee range of motion.

Prolotherapy works on most knee problems with excellent results. Only in the case of a completely torn ligament is Prolotherapy somewhat limited. If there is a partial tear (sometimes on MRI these may look like complete tears) Prolotherapy maybe able to reconstruct the ligament and strengthen the joint. But even with a complete tear, Prolotherapy is extremely beneficial because an impact with enough force to completely rupture a ligament will also loosen the entire knee structure. Prolotherapy in this situation can strengthen the surrounding tissues giving the patient a better chance of long-term success. It is rare that a patient who is not active in sports or a competitive athlete needs ACL surgery. Many athletes function on an ACL deficient knee.

Discussions from our Radio Show about Chonfromalacia Patella:

Caller: I am having some inflammation and knee pain after working out, I am 52.

Dr. Darrow: By 52 the collagen in the body has started to break down. For most collagen breakdown becomes noticeable in our 40′s as we start getting wrinkles around our eyes and on our faces.

As we see in the skin on our faces, the collagen in our knees starts to go and as we continue to work out there is obviously stress on the joint.

Most knee pain that we see is called Chondromalacia patella. Malacia means break down, condro means cartilage, patella means the back of the knee bone, which is called the patella, (and there) is the thickest cartilage in the body. It starts rubbing the wrong way against the tract that it slides in and with repetitive use like running or stair climbing, things of that nature, any sport really, the repetitive use just wears out the back of that knee cap and begins the arthritis process and pain.

It is also made worse when you are sitting in a movie theater or you are in an airplane and stuck in one place for a long period of time. Often times people can have a little meniscus tear, the meniscus is a little cushion inside the knee. Prolotherapy helps grow back all of this tissue.

Before you decide on surgery, explore Prolotherapy, because of all the things Prolotherapy works on, it works fastest in the knees.



Is Your Knee Pain Diagnosis Correct?

Diagnosis of knee injuries is, in my opinion, too dependant on many large machines and invasive techniques. Your knee hurts so you visit the orthopedist, here he uses his tools to figure out why your knee hurts. While some of these tools are very impressive indeed, are they accurate?

Once X-rays rule out problems with bones, a MRI (Magnetic Resonance Imaging) is brought in because of its ability to reveal soft tissue damage, but problems with the knee, especially the cartilage, can still be very evasive and hard to pinpoint. Studies have shown that the advanced technologies commonly used to diagnosis injuries are grievously insufficient to do the job.

In one study conducted by Dr. J.A. Lawrance of Oxford, England, MRIs had a success rate of only 11% in diagnosing partial Anterior Cruciate Ligament tears. In yet another study, focusing on the knee, doctors compared the findings of standard x-ray tests and physical examinations on 210 people—all of whom were self-described as pain free at the time of the testing. Although none of the participants exhibited any pain or other symptoms of pathology, and considered themselves completely healthy in regard to their knees, the test results yielded dramatic evidence of physical problems and abnormalities, including an incidence rate of 80% or better for arthritis, patellofemoral crepitus (grinding) in 94% of the women, high percentages of asymmetry and hypermobility, and a dozen other problems to varying degrees. As the authors of the study noted: “Because patellofemoral crepitus is so common in both symptomatic and asymptomatic volunteers, the importance of this finding must be reevaluated as a surgical indication.”

The conclusion is obvious: by offering “objective” evidence and a technology based rationale to over-eager surgeons, MRIs, X-rays and other advanced diagnostic techniques contribute greatly to promoting cases of unnecessary or even ill-advised surgery. The end result is more problems for the recipients of these surgeries.

Generally speaking, the most efficient and safe method for diagnosing a knee injury is a simple manual examination, coupled with extensive questioning of the patient to determine exactly what happened and where it hurts.

An Alternative Solution to Preventing ACL Tears

Thousands of articles have been written on the various means an athlete can take to help prevent the most devastating of knee injuries – the complete tear of the ACL Anterior Cruciate Ligament. Unfortunately very few have been written on what can be the best remedy for knees at risk – Prolotherapy.

The ACL is the most famous of knee ligaments because of the frequency of injury – over 200,000 reported annually in the US. It is also the most infamous because the severity of the injury can end or derail the hopes of many young athletes.

The ACL is a strong connective band deep in the knee that helps prevent hyperextension and provides stability. Interestingly, tears of the ACL occur more without physical contact and instead are linked to the twisting of the knee while the foot remains planted. In a healthy ligament this twisting typically requires a great deal of force to cause a tear, especially a complete tear or rupture in such a strong ligament. The problem is many times the ACL is not a strong as we think it is – it does get weak with overuse.

Prevention
The internet is filled with articles on how to prevent ACL tears. They range from strength training, aerobic training, nutrition, coordination exercises, balance and posture, knee bracing, etc. But what about the high risk knee? The knee that has already been compromised by wear and tear and previous injury. How can ACL injury be prevented?

The Ligament
If you look at a picture of the human anatomy, you will see that muscles are big and red. They are red because of the abundant blood supply that runs through them that helps them grow and repair. Ligaments on the other hand are small and white and resemble thick rubber bands. They are small and white because they do not have an abundant blood supply run through them and because of this, usually do not heal well from injury and will in the case of tears – require surgery.

Over the course of an athlete’s season ligaments become weaker, they loss elasticity, and are prone to injury. This is when pain, soreness, and loss of strength appear in the knee.

The treatment causes the injury
It is about this time that icing, anti-inflammatory medications, and knee bracing or taping will be tried to get the player through the season. We have found in our practice that these remedies actually increased the risk of ACL tear rather than prevented it. This observation is supported in many medical papers citing the pros and cons of knee bracing and taping and circulatory and healing disruption by icing. In a future article we will discuss a rotator cuff tear in great detail as there is a lot of important information that needs to be conveyed regarding a rotator cuff tear.

Further, the player will begin to over compensate for the injured knee and in doing so puts the “healthy knee” at greater risk for severe ACL damage. In addition chronic ankle sprains have been cited as a cause of higher risk to ACL tear. So not healing an injury completely puts the athlete at risk for ACL tear.

The treatment that strengthens
One thing that the treatments described above have in common is that they weaken ligaments. Icing, as stated disrupts circulation needed to bring the healing cells to damaged ligaments, anti-inflammatory medications have been shown to increase the risk of ligament damage by suppressing immune function. Knee braces – there is no conclusive evidence they work and may only trick the athlete into a comfort level that their knee is protected.

Treatment Options for ACL Damage and Pain

When faced with the ACL treatment decision, a patient will usually weigh two options, surgery or no surgery. There are a lot of opinions offered as to which path the patient should take. Every ACL injury is unique to the patient, so this question is best asked of your physician and better yet, a second opinion physician. ACL surgery is an elective surgery and many athletes have chosen not to have it.

If the no surgery alternative is chosen, then the patient will then try to determine a course of action that will allow them to continue running or participate in other sports. Generally, you will know if you can run on your damaged knee or not by the amount of knee strength you still have and the level of pain you experience. Because the ACL is mostly used in supporting the knees in movement such as those found in playing tennis and basketball, (jumping, quick stopping, fast change of directions), these activities are usually stopped for fear of further damage. For the most part, many ACL damaged individuals are able to continue running or jogging and participating in certain sport activities. Read more

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