Back Clinic Sports Injuries Chiropractic and Physical Therapy Team. Athletes from all sports can benefit from chiropractic treatment. Adjustments can help treat injuries from high-impact sports i.e. wrestling, football, and hockey. Athletes that get routine adjustments may notice improved athletic performance, improved range of motion along with flexibility, and increased blood flow. Because spinal adjustments will reduce the irritation of the nerve roots between the vertebrae, the healing time from minor injuries can be shortened, which improves performance. Both high-impact and low-impact athletes can benefit from routine spinal adjustments.
For high-impact athletes, it increases performance and flexibility and lowers the risk for injury for low-impact athletes i.e. tennis players, bowlers, and golfers. Chiropractic is a natural way to treat and prevent different injuries and conditions that impact athletes. According to Dr. Jimenez, excessive training or improper gear, among other factors, are common causes of injury. Dr. Jimenez summarizes the various causes and effects of sports injuries on the athlete as well as explaining the types of treatments and rehabilitation methods that can help improve an athlete’s condition. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Blood flow restriction (BFR) training is a training strategy which involves the use of cuffs or pliers placed proximally around a limb, with the intent of maintaining arterial inflow while occluding lymph flow through exercise (According to Scott et al. 2015).
BFR, or blood flow restriction training, has been utilized throughout a range of exercise modes. These include cycling, walking and strength training. When doing resistance training with blood flow restriction therapy, tight cuffs or pliers are commonly utilized. Virtually, blood flow restriction training is most frequently employed when utilizing resistance training with low loads of around 20 to 30 percent of 1RM and with wraps that are wrapped at a perceived tightness of 7 out of 10.
When compression of the vasculature proximal to the muscles is achieved via other means, the expression blood flow restriction training is more commonly used. An alternative way of employing this pressure is through the usage of knee bends. This sort of blood flow restriction therapy can be termed blood flow restriction training that was sensible to distinguish it from the method in which inflated cuffs are utilized to produce a strain.
Blood Flow Restriction Therapy Findings
Blood flow restricted (BFR) training is a safe and effective method of improving power and strength in healthy, active people. A relatively unexplored possibility of this modality lies in treating patients with musculoskeletal injury and hamstring weakness despite improvement during postoperative strengthening, and conventional therapy.
This case series describes patients with chronic quadriceps and hamstring weakness who received an intervention of BFR at low loads, 20 percent of 1 repetition max (1RM), to restore strength. There was a case series conducted of seven patients, all situated with traumatic injuries. The seven patients were treated in the same center and using the BFR protocol. All seven patients had dynamometer testing that demonstrated thigh muscle weakness despite 35 to 75 percent torque deficit in flexion or knee extension and rehab with therapy in comparison with the lower extremity. Patients underwent two weeks of BFR training therapy using a pneumatic tourniquet set at 110 mm Hg while performing leg extensions, leg presses, and leg presses.
All affected extremities were retested after two weeks (six therapy sessions). Dynamometer measurements were done with flexion and extension. The data recorded included peak torque normalized for moderate power, body weight, and work.
All seven patients showed improvements in peak torque, moderate power, and overall work for both knee flexion and extension, with power being the most improved overall. Peak torque improved an average of 13 to 37 percent, based on speed and contraction direction. Average electricity improved a mean of 42 to 81 percent, and workforce improved a mean of 35 to 55 percent.
Conclusion
Blood flow restriction (BFR) treatment at low loads can impact development in muscular strength in patients who are unable to perform high-resistance exercise or individuals who have persistent extremity weakness despite conventional treatment. Blood circulation limitation training seems to be effective and safe. But, specific caution ought to be expressed regarding its usage under particular conditions, and for prolonged amounts of time.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sports Care
Athletes engage in a series of stretches and exercises on a daily basis in order to prevent damage or injury from their specific sports or physical activities as well as to promote and maintain strength, mobility and flexibility. However, when injuries or conditions occur as a result of an accident or due to repetitive degeneration, getting the proper care and treatment can change an athlete’s ability to return to play as soon as possible and restore their original health.
The tensor fascia latae (TFL) is a problematic muscle for many individuals. Oftentimes, it contributes to tightness related to the IT band and is dominant within the gluteus medius. Its function are hip flexion and abduction, and it has a tendency to be tight in many runners and athletes. Performing soft tissue mobilization will help resolve tightness in addition to promote regeneration and recruitment of the gluteus medius.
A lot of men and women argue the effectiveness of foam rolling up the IT band itself. While many healthcare professionals are not inclined to ignore this fact altogether, it is believed that polyurethane rolling likely has a much greater impact on the length/tension of the soft tissue beneath and associated with the IT band (e.g. glutes, quads, hamstrings and TFL). The TFL is frequently full of trigger points.
You will find a variety of foam roller exercises that you can do, and choosing the stretch or exercise is dependent on the muscle group that you want to massage, in this case, the tensor fascia latae.
Tensor Fascia Latae (TFL)
The tensor fasciae latae (TFL) muscles are at the front sides of your buttocks. Foam rolling these muscles provides a deep and effective sports massage, improving functionality and alleviating soreness. It may be one of the stranger looking moves onto a foam roller coaster, but you’ll enjoy the relief that you are given by this stretch! To massage the TFL, start by laying face-down, with your foam roller just underneath the front of one hip. Your other leg should be cocked slightly to the side, similar to a spiderman pushup. Your leg should be cocked slightly to the side, very similar to a spiderman pushup. You need to use your forearms to help maintain your core tight, and bear some of the weight. Next, roll along the front and outside portion of your upper torso, right. That is it! Before repeating on the opposite side Roll slowly, and hold for 20-30 moment.
The Foam Roller TFL Exercise is an excellent self-massage exercise which will offer your tensor fasciae latae (TFL) muscles ( front sides of your hips) a deep and effective sports massage, consequently improving the health and quality of your muscle tissue and helping you to perform much better. It will also alleviate soreness and make your muscles feel better.
The foam roller overloads the muscle tissues through compression, causing your nerves to relax, signalling muscle spasms to close off, pumping blood and also causing your lymphatic system to start flowing, in order to assist muscle regeneration and recovery. You will work out those knots (muscular adhesions) in your muscles caused either by childbirth, by the repetitive strain of the golf swing, or by walking a challenging golf program. This will allow you to extend the muscles back out which makes them functional and more more pliable.
The Foam Roller TFL Exercise can be performed both before and after practicing on any sport of physical activity, or the scope. It’s also excellent after sitting in exactly the same position for a little while, and may be enjoyed anywhere and anytime you feel tight and needing a massage or prior to bedtime.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sports Care
Many athletes engage in frequent warm-up stretches and exercises before participating in their specific sport of physical activity, in order to avoid experiencing sports injuries. Although these can help prevent a variety of sports injuries, athletes may still suffer an injury as a result of an accident. From chiropractic care to surgery, in severe cases, sports care is important for athletes to continue participating in their specific sport of physical activity.
Self-myofascial release, also known as “foam rolling,” has changed from a once mysterious technique used solely by professional athletes, athletes, and therapists to a familiar everyday method for people at all levels of fitness.
Products, technology, and data have introduced an increasing array of training and recovery methods to the individual.
Self-myofascial release is a fancy word for self-massage, utilized to release muscle stiffness or trigger points. This technique can be performed using a foam roller, lacrosse ball, Theracane, or your own hands. By applying pressure to these painful areas, you are able to assist in the recovery of muscles and helping to restore them. Proper function means your muscles are healthy, elastic, and ready to perform at a moment’s notice.
Determining Tight Muscles & Trigger Points
Trigger points are referred to as “knots” which form in muscles. They’re unique and may be identified once they begin to refer pain. Pain referral, for our purposes, may be described as the pain felt when pressure is applied to a single area of their body, but the pain is felt or radiated in a different area.
A common case of a trigger point is felt while foam rolling your iliotibial (IT) band as it causes pain to radiate up to the hip or all the way down the leg to the ankle. When rolling on tight/sore muscles you may experience pain or discomfort. It should be uncomfortable, but not unbearable, and it must relieve the symptoms, when you are done.
For many, deep tissue massage is simple to understand. Somebody is able to exercise the knots in your muscles, and it is commonly known that this process may be uncomfortable and occasionally painful. Because only you can feel what is happening, self-myofascial discharge provides the consumer the capability to control the recovery and healing procedure by applying pressure in precise places.
It is always suggested to consult with your physician or physical therapist to get therapeutic/sharp pain and receive approval prior to beginning self-myofascial release. You will be cleared immediately and your doctor will encourage the practice. Releasing trigger points helps reestablish appropriate movement patterns and pain free movement, and finally, to boost functionality. Utilizing stretching alone isn’t always enough to discharge muscles. Imagine a bungee cord with a knot tied into it and then envision stretching the cord. This creates tension, stretching the part of the muscle and the attachment points. The knot, however, has remained unaltered.
Foam rolling can assist in dividing these muscle knots, resuming normal blood flow and function. The aim to any recovery or corrective technique is to get you back to normal functioning’s point, as if nothing was ever wrong.
Causes of Trigger Points & Tight Muscles
Both have exactly the same contributing factors such as training, flexibility, movement patterns, posture, nutrition, hydration, rest, anxiety, and other lifestyle factors. Our bodies learn to compensate for what we throw at them daily, but we can transcend our ability to recover via intense workouts, bad posture, and other lifestyle factors.
Deep compression can help to break up or relax tight muscles and adhesions formed between muscular layers and their environment. Imagine you are currently tenderizing your muscles. They should be soft and supple as a baby’s muscles. If our muscles are not taken care of properly we can experience loss of motion that is debilitating.
The deep compression of self-myofascial release enables normal blood flow to return and the recovery of healthy tissue. The body wants to be healthy and strong, but an extra boost is required to attain optimum tissue and muscle health.
How Do I Know What to Foam Roll and How to Do It?
Areas to concentrate on can be identified in two different ways. The first is through screenings. When you have followed the two posts – screening and stylish hinge screening – and also have had struggles with either movement, foam rolling should be included by you into retrieval program and your workout. You may target you are currently focusing on.
If after using the foam roller your motion enhances, you’ve got a more specific plan to follow. Second, muscles and trigger points are discovered utilizing techniques’ listing below and researching every one.
To foam roll correctly, apply moderate pressure to a particular muscle or muscle group using the roller and your own leg. You should roll slowly, no longer than one inch. Pause for several moments when you find areas that are painful or tight and relax as far as you can. You should begin to feel that the muscle releasing, and pain or the distress should reduce.
If a place is too painful to use direct pressure, then change the roller and then apply pressure on the surrounding area and gradually work to loosen the entire area. The purpose is to restore muscles – it isn’t a pain tolerance evaluation. You could also use different objects to operate on muscles such as lacrosse ball, a tennis ball, Theracane, or Trigger Point Therapy Kit.
Never roll a joint or bone. Avoid your back. To target these muscles I advise using lacrosse or tennis balls. If you’re experiencing difficulties with your neck, refer these problems to an appropriate medical practitioner and need attention that is advanced.
What Happens After Foam Rolling?
You might be sore the next day. It should feel like your muscles are worked/released, but you shouldn’t push yourself to the purpose of excessive soreness. Drink lots of water, get enough sleep , and eat clean. Fuel your muscles and this can help flush your system. Before focusing on precisely the same place give it 24-48 hours.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Additional Topics: Sports Care
Many athletes engage in frequent warm-up stretches and exercises before participating in their specific sport of physical activity, in order to avoid experiencing sports injuries. Although these can help prevent a variety of sports injuries, athletes may still suffer an injury as a result of an accident. From chiropractic care to surgery, in severe cases, sports care is important for athletes to continue participating in their specific sport of physical activity.
Concussion, also known as mild traumatic brain injury (MTBI), has been a poorly understood condition known to the majority of healthcare providers as difficult to objectify and manage.
Historically, there has been no testing available to conclude an accurate diagnosis. In the absence of objective imaging findings of bleeding in the brain, a diagnosis of “mild traumatic brain injury” has been affixed to the condition, whereas if there’s evidence of traumatic bleeding then the diagnosis “traumatic brain injury” is applied.
Although Hartvigsen, Boyle, Cassidy and Carroll (2014) reported that 600 out of 100,000 Americans are affected every year by concussion, Jeter et al, (2012) reported that close to 40 percent of people experiencing a mild brain injury do not report it to their doctor, making accurate statistics very tricky to conclude. Despite potential under reporting in the people, we realize concussion is an issue that has consequences that are important from the perspective of a clinical result and we cannot afford to ignore this condition.
Mechanism of Injury: Mild Traumatic Brain Injury
Mild traumatic brain injury or concussion results from transfer of mechanical energy from the outside environment to the brain due to traumatic events where there’s a sudden acceleration and then a sudden deceleration of the mind and brain, such as in a Coup/Contrecoup injury during a whiplash scenario. As the brain is freely moving to a degree because it’s only surrounded by cerebral spinal fluid, it continues moving in the original direction and as the head “whips” rapidly in the opposite direction, the brain bounces off parts of the inner skull, which in turn rebounds shortly after the head changes direction. This is one easily defined mechanism of MTBI that doesn’t cause gross bleeding, yet leaves the brain injured through direct compression or overstretching (axonal shearing) of central nervous system components.
Although this has been examined extensively in the military, it’s been recently investigated in professional sports, where after several lawsuits and lives at risk, there are now definitive “concussion protocols” in place. Part of the protocols as reported from the British Journal of Sports Medicine (2016) is the Sports Concussion Assessment Tool 2 or SCAT2 that’s been adopted by numerous professional sports leagues. However, the majority of concussion victims are not active participants in the military or a professional sports team and many find their way into chiropractic practices as a consequence of sports injuries, car accidents, slip and falls and every other sort of head trauma etiology. Even though the mechanisms might vary, the induced end results are the same.
For generalized patient intake protocols, according to both Medicare and academia standards, a questionnaire outlining a summary of body systems is mandated, and part of those questions center on brain function. As reported by Jeter et al behavioral and cognitive symptoms, signs and symptoms are reported on standard patient intake questionnaires and require consideration of a diagnosis of concussion.
Prominent symptoms of concussion include: balance issues, vomiting, nausea, headache, drowsiness, dizziness, fatigue, vision, light or noise sensitivity and sleep disturbances. Cognitive symptoms include deficits in attention, concentration, memory, mental processing speed, and working memory or decision making. Behavioral symptoms include anxiety, depression, irritability, depression and aggression. The researchers went on to report that approximately 25 percent of the cases can have these symptoms persist.
Diagnosis and Treatment for MTBI
As a profession, chiropractic is a important part of the rehabilitation for the concussion population as the post-traumatic patient typically presents to the average chiropractic practice. As chiropractors (along with all healthcare providers), even if you mix the history with the above symptoms inclusive of neurological, behavioral and cognitive traits, you then have the direction or “triage road map” of the way to conclusively differentially diagnose your individual, including what tests to consider conducting in order to do so. The first line of testing is to consider imaging to rule out bleeding and ensure the patient does not require an immediate consultation. Treating blindly can place your patient in risk that is possible.
Imaging of the brain requires either MRI or CAT scans, MRI being the more sensitive, and in the absence of bleeding, the diagnosis is limited to MTBI or concussion (used interchangeably). More recently, diffusion tensor imaging (DTI) has been a tool available to picture mTBI victims that uses tissue water diffusion speeds to determine bleeding at a very small level giving demonstrable evidence to brain injury. As reported by Soares, Marques, Alves, and Sousa, (2013), DTI has several issues to overcome to certify accuracy including, but not limited to, tissue type, integrity, barriers and quantitative diffusion rates that are required to infer molecular diffusion prices. DTI is a model based upon assumption with a outlook as a tool.
Historically, MTBI was exclusively diagnosed by an omission of advanced imaging findings and the presence and persistence of the neurology, cognitive and behavioral signs and symptoms. Today, brain-derived neurotrophic factors (BDNF) offer responses about carpal brain pathology that is both conclusive and reproducible. Based on Korley et al. (2015), brain-derived neurotrophic factors is a secreted autocrine (compound hormone or messenger in blood) which promotes the development, maintenance, survival, differentiation and regeneration of neurons. BDNF also is important for synaptic plasticity (strengthening of synapses over time) and memory processing. Germane to MTBI and concussion, BDNF has been implicated in decreasing brain injury, with elevations and restoring traumatic brain injury.
Korley went on to report that BDNF levels were the highest in the normal group with lower values in mTBI and even lower in traumatic brain injury (TBI) subjects. In addition BDNF values were associated with incomplete recovery of patients that were MTBI compared to moderate or severe TBI patients. Because of this, it has been ascertained that BDNF has for identifying associated sequelae at 6 23, a prognostic value.
Korley stated that BDNF is the most abundantly secreted brain neurotrophin and as a secreted protein and can be readily measured using well-established immune-assay methods, identifying it as a non-necrosis brain injury biomarker. This distinguishes BDNF from other biomarkers which are components of neurons and myelin based proteins among other structures. In order for structural fibers to be found in high abundance in circulation, adequate cellular necrosis and damage to the blood barrier membrane must be observed, however BDNF does not require cellular damage or necrosis to be observed in circulation enabling DDNF to be more plentiful in flow than structural proteins.
Following a traumatic brain event, BDNF supports synaptic reorganization and recovery during the brain circuitry “reconnection” phase. Therefore, a better prognosis is indicated by lowered values. In patients with a co-morbidity of BDNF of anxiety, depressive disorders and schizophrenia BDNF values on the day of injury predispose this population to incomplete recovery as a risk element. Korley et al.. Concluded that serum BDNF discriminates between MTBI and TBI cases. Also, diminished BDNF values are associated with recovery in identifying and useful symptoms 6-months post-trauma.
Conclusion
Simply put, a blood test could assist providers in concluding the existence and/or severity of traumatic brain injury or mild traumatic brain injury. An early diagnosis is afforded by the results so you can devise a treatment plan inclusive of changing activities of everyday living to prevent additional damage and optimize the repair procedure with minimizing further chemical, physical or emotional stressors.
Based upon interviews with leading neurologists and neurosurgeons who understand and have first-hand expertise of both receiving chiropractic care and handling and treating MTBI patients, it is strongly recommended that until the signs and symptoms of the neurologic, cognitive and behavioral abate that high-velocity rotational cervical adjustments be avoided to enable the brain to “repair and rewire” the connections without additional possibilities of and Coup/ Contrecoup energy to the mind. This is a recommendation which we agree while recognizing that chiropractic care should not be avoided adapted to allow the brain to heal.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
References:
1. Hartvigsen, J., Boyle, E., Cassidy, J. D., & Carroll, L. J. (2014). Mild traumatic brain injury after motor vehicle collision: What are the symptoms and who treats them? A population-based 1-year inception cohort study. Archives of Physical Medicine and Rehabilitation, 95(Suppl. 3), S286-S294.
2. Jeter, C. B., Hergenroeder, G. W., Hylin, M. J., Redell, J. B., Moore, A. N., & Dash, P. K. (2013). Biomarkers for the diagnosis and prognosis of mild traumatic brain injury/concussion. Journal of Neurotrauma, 30(8), 657-670.
3. British Journal of Sports Medicine. (2016). Sport concussion assessment tool 2. Retrieved from bjsm.bmj.com/content/43/Suppl_1/i85.full.pdf
4. Soares, J. M., Marques, P., Alves, V., & Sousa, N. (2013). A hitchhiker�s guide to diffusion tensor imaging. Frontiers in Neuroscience, 7(31), 1-14.
5. Korley, F. K., Diaz-Arrastia, R., Wu, A. H. B., Yue, J. K., Manley, G. T., Sair, H. I., Van Eyk, J., Everett, A. D., Okonkwo, D. O., Valadka, A. B., Gordon, W. A., Maas, A. I., Mukherjee, P., Yuh, E. L., Lingsma, H. F., Puccio, A. M., & Schnyer, D. M., (2015). Circulating brain-derived neurotrophic factor has diagnostic and prognostic value in traumatic brain injury. Journal of Neurotrauma, 32, 1-11.
Additional Topics: Weakened Ligaments After Whiplash
Whiplash is a commonly reported injury after an individual has been involved in an automobile accident. During an auto accident, the sheer force of the impact often causes the head and neck of the victim to jerk abruptly, back-and-forth, causing damage to the complex structures surrounding the cervical spine. Chiropractic care is a safe and effective, alternative treatment option utilized to help decrease the symptoms of whiplash.
According to the American Academy of Orthopedic Surgery �The most common soft tissues injured are muscles, tendons, and ligaments.
Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples of an acute injury include sprains, strains, and contusions.�� (orthoinfo.aaos.org/topic.cfm?topic=A00111) We must also not forget that there are other soft tissues that can get injured and the true definition of soft tissue, which is anything not bone is soft tissue.
This includes the brain, lungs, heart and any other organ in the body. However, in medicine soft tissue injuries are commonly known to be limited to the muscles, ligaments and tendons.
Soft Tissue Injury Classification
When we look at the type of structures that muscles, tendons and ligament are composed of, we will realize that they are connective tissue. According to the National Institute of Health �Connective tissue is the material inside your body that supports many of its parts. It is the “cellular glue” that gives your tissues their shape and helps keep them strong. It also helps some of your tissues do their work (www.nlm.nih.gov/medlineplus/connectivetissuedisorders.html). Unlike fracture repair where the bone is replaced and usually heals properly if aligned and rested, connective tissue disorders undergo a different type of wound repair that has aberrant tissue replacement as sequella to bodily injury and has subsequent abnormal permanent function.
If we focus on sprains or ligamentous injuries, according to the American Academy of Orthopedic Surgery there are three types of sprains:
Sprains are classified by severity:1
Grade 1 sprain (mild):�Slight stretching and some damage to the fibers (fibrils) of the ligament.
Grade 2 sprain (moderate):�Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
Grade 3 sprain (severe):�Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.
Regardless of the severity of the sprain, there is tissue damage or bodily injury and the next step is to determine if there is healing or wound repair. According to Woo, Hildebrand, Watanabe, Fenwick, Papageorgiou and Wang (1999) ��as a result the combination of cell therapy with growth factor therapy may offer new avenues to improve the healing of ligament and tendon. Of course, specific recommendations regarding growth factor selection, and timing and method of application cannot be made at this time.
Previous attempts at determining optimal doses of growth factors have provided contradictory results. Although growth factor treatment has been shown to improve the properties of healing ligaments and tendons, these properties do not reach the level of the uninjured tissue.� (p. s320)
�No treatment currently exists to restore an injured tendon or ligament to its normal condition.�, stated Dozer and Dupree (2005). (pg. 231).
Soft Tissue Recovery Process
According to Hauser, Dolan, Phillips, Newlin, Moore and Woldin (2013) �injured ligament structure is replaced with tissue that is grossly, histologically, biochemically and biomechanically similar to scar tissue. Fully remodeled scar tissue remains grossly, microscopically and functionally different from normal tissues� (p. 6) �the persisting abnormalities present in the remodeled ligament matrix can have profound implications on joint biomechanics, depending on the functional demands placed on the tissue.
Since remodel ligament tissue is morphologically and mechanically inferior to normal ligament tissue, ligament laxity results, causing functional disability of the affected joints and predisposing other soft tissues in and around the joints further damage.� (p.7) �studies of healing ligaments have consistently shown that certain ligaments do not heal independently following rupture, and those that didn�t feel, do so characteristically inferior compositional properties compared with normal tissue. It is not uncommon for more than one ligament undergo injury during a single traumatic event.� (p.8) �osteoarthritis for joint degeneration is one of the most common consequences of ligament laxity.
Traditionally, the pathophysiology of osteoarthritis was thought to be due of aging and wear and tear on the joint, but more recent studies have shown that ligaments play a critical role in the development of osteoarthritis. Osteoarthritis begins when one or more of ligaments become unstable or lax, and the bones began to track improperly and put pressure on different areas, resulting in the rubbing the bone on cartilage. This causes breakdown of cartilage and ultimately leads to deterioration, whereby the joint is reduced to bone on bone, a mechanical problem of the joint that leads to abnormality of the joints mechanics. Hypomobility and ligament laxity have become clear risk factors for the prevalence of osteoarthritis.� (p.9)
Looking globally at the research over the last 16 years, in 1999 it was concluded that the most current treatments to repair or heal the injured ligament do not reach the level of the uninjured tissue. In in 2005 it was concluded that no treatment currently exists to restore an injured tendons or ligaments to its normal condition. In addition the current standard of ligament research in 2013 concluded that that ligaments do not feel independently, but damage ligaments are a direct cause of osteoarthritis and biomechanical dysfunction (abnormality of joint mechanics). The latest research has also concluded that ligament damage or sprains is the key element in osteoarthritis and not simply aging or wear and tear on the joint.
As a result it is now clear based upon the scientific evidence that a soft tissue injury is a connective tissue disorder that has permanent negative sequela and is the cause of future arthritis. This is no longer a debatable issue and those in the medical legal forum who are still arguing �transient soft tissue injuries� are simply rendering rhetoric out of ignorance and a possible ulterior motive because the facts clearly delineate the negative sequella based upon decades of multiple scientific conclusions.
The caveat to this argument is that although there is irrefutable bodily injury with clear permanent sequella, does it also cause permanent functional loss in every scenario? Those are two separate issues and as a result of the function of ligaments, which is to connect bones to bones the arbiter for normal vs. abnormal function is ranges of motion of the joint. That can be accomplished by either a two-piece inclinometer for the spine, which according to the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (p. 400) is the standard (and is still the medical standard as the 6th Edition refers to the 5th for Ranges of motion).
The other diagnostic demonstrable evidence to conclude aberrant function is to conclude laxity of ligaments through x-ray digitizing. Both diagnostic tools confirm demonstrably loss of function of the spinal joints. ��
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Woo S, Hildebrand K., Watanabe N., Fenwick J., Papageorgiou C., Wang J. (1999) Tissue Engineering of Ligament and Tendon Healing, Clinical Orthopedics and Related Research 367S pgs. S312-S323
Tozer S., Duprez D. (2005) Tendon and Ligament: Development, Repair and Disease, Birth Defects Research (part C) 75:226-236
Hauser R., Dolan E., Phillips H., Newlin A., Moore R. and B. Woldin (2013) �Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics, The Open Rehabilitation Journal (6) 1-20
Cocchiarella L., Anderson G., (2001) Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, AMA Press
Additional Topics: Preventing Spinal Degeneration
Spinal degeneration can occur naturally over time as a result of age and the constant wear-and-tear of the vertebrae and other complex structures of the spine, generally developing in people over the ages of 40. On occasion, spinal degeneration can also occur due to spinal damage or injury, which may result in further complications if left untreated. Chiropractic care can help strengthen the structures of the spine, helping to prevent spinal degeneration.
According to the National Institute of Health�s, National Institute of Arthritis and Musculoskeletal and Skin Disorders:
A sprain is an injury to a ligament (tissue that connects two or more bones at a joint). In a sprain, one or more ligaments is stretched or torn. A strain is an injury to a muscle or a tendon (tissue that connects muscle to bone). In a strain, a muscle or tendon is stretched or torn.
Historically, doctors of all disciplines in the clinical setting and lawyers in the medical-legal arena have erroneously attempted to separate them into 2 distinct injuries allowing a false conclusion to be derived in either prognosis or legal arguments when considering connective tissue pathology as sequella to trauma.
Anatomy of Sprains and Strains
Solomonow (2009) wrote:
There are several ligaments in every joint in the human skeleton and they are considered as the primary restraints of the bones constituting the joint. Ligaments are also sensory organs and have significant input to sensation and reflexive/synergistic activation of muscles. The muscles associated with any given joint, therefore, also have a significant role as restraints. In some joints, such as the intervertebral joints of the spine, the role of the muscles as restraints is amplified. The role of ligaments as joint restraints is rather complex when considering the multitude of physical activities performed by individuals in routine daily functions, work and sports, the complexity of the anatomy of the different joints and the wide range of magnitude and velocity of the external loads. As joints go through their range of motion, with or without external load, the ligaments ensure that the bones associated with the joint travel in their prescribed anatomical tracks, keep full and even contact pressure of the articular surfaces, prevent separation of the bones from each other by increasing their tension, as may be necessary, and ensuring stable motion. Joint stability, therefore, is the general role of ligaments without which the joint may subluxate, cause damage to the capsule, cartilage, tendons, nearby nerves and blood vessels, discs (if considering spinal joints) and to the ligaments themselves. Such injury may debilitate the individual by preventing or limiting his/her use of the joint and the loss of function. Pgs. 136-137
While ligaments are primarily known as mechanical or supportive structures responsible for joint stability, they have equally important neurological functions. Anatomical studies have shown that ligaments in the extremities and the spine are endowed with nerves called mechanoreceptors. The presence of such that sense and send neurological information to the spine and brain in the ligaments confirms that they contribute to proprioception (feeling and analyzes one�s physical positon in space and time) and kinesthesia (similar to proprioception but can maintain feeling in these nerves even with aberrant neurological imput elsewhere) and also has a distinct role in reflex activation or inhibition of muscular activities.
Simply put, the nerves in ligaments attempts to alter muscle activity to prevent further biomechanical failure and pathology (bodily injury), which effects one�s ability to move in a balanced homeostatic manner leading to further functional loss in a short amount of time. The presence of such nerves in the ligaments confirms that they contribute to proprioception and kinesthesia and have a distinct role in reflex activation or inhibition of muscular activities. Therefore, the muscles and tendons (which are inherent in muscular activity), are responsive and dependent upon ligament activity in function with both normal and pathological (inclusive of trauma) activities.
Solomonow (2009) also reported that as far back as the turn of the last century, that a reflex may exist from sensory receptors in the ligaments to muscles that may directly or indirectly modify the load imposed on the ligament. A clear demonstration of a reflex activation of muscles finally provided in 1987 and reconfirmed several times since then. It was further shown that such a ligamento-muscular reflex exists in most extremity joints and in the spine.
Mechanism of Injury
A Single trauma according to Panjabi (2006) can cause either a tear in the ligament called laxity or a subfailure injury of the spinal ligaments and injury to the mechanoreceptors embedded in the ligaments and the following cascade of events occur: pgs. 669-670
NOTE: The subfailure injury of the spinal ligament is defined as an injury caused by stretching of the tissue beyond its physiological limit, but less than its failure point.
When the injured spine performs a task or it is challenged by an external load, the transducer signals generated by the mechanoreceptors are corrupted.
Neuromuscular control unit has difficulty in interpreting the corrupted transducer signals because there is spatial and temporal mismatch between the normally expected and the corrupted signals received.
The muscle response pattern generated by the neuromuscular control unit is corrupted, affecting the spatial and temporal coordination and activation of each spinal muscle.
The corrupted muscle response pattern leads to corrupted feedback to the control unit via tendon organs of muscles and injured mechanoreceptors, further corrupting the muscle response pattern.
The corrupted muscle response pattern produces high stresses and strains in spinal components leading to further subfailure injury of the spinal ligaments, mechanoreceptors and muscles, and overload of facet joints.
The abnormal stresses and strains produce inflammation of spinal tissues, which have abundant supply of nociceptive sensors and neural structures.
Consequently, over time, chronic biomechanical failure develops leading to premature degeneration and long-term pain.
Simply explained, when there is a ligament injury or sprain, the nerves in the ligament fire signals that go to the central nervous system and causes the muscles to react as compensation to bodily injury to stabilize the structure. That in turn sets up another cascade of problems if not compensated for or repaired as the muscle spasticity cannot maintain itself for long periods of time and goes into a posture of tetanus, or perpetual spasm until the lactic acid builds. This is followed by the muscle failing and putting the entire structure in a chronic biomechanically unstable position and causing the bone to remodel or become arthritic.
According to Hauser ET. Al (2013) ligament instability in either subfailures or laxity are a clear cause of osteoarthritis. This is not speculative as the inured will develop arthritis in 100% of the time and is consistent with Wolff�s Law that has been, and continues to be accepted since the late 18th century.
Therefore, as per the above scenario, strain-sprain is an intertwined syndrome that cannot either mechanically or neurologically be separated and will cause arthritis in 100% of the post-trauma instance. How much arthritis and how quickly it will develop is dependent upon how much ligamentous damage there is.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
Solomonow, M. (2009). Ligaments: a source of musculoskeletal disorders.Journal of Bodywork and Movement Therapies,13(2), 136-154.
Panjabi, M. M. (2006). A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction.European Spine Journal,15(5), 668-676.
Hauser R., Dolan E., Phillips H., Newlin A., Moore R., Woldin B., Ligament & Healing Injuries: A Review of Current Clinical Diagnostics and Therapeutics, The Open Rehabilitation Journal, 2013, 6, 1-20
Additional Topics: Preventing Spinal Degeneration
Spinal degeneration can occur naturally over time as a result of age and the constant wear-and-tear of the vertebrae and other complex structures of the spine, generally developing in people over the ages of 40. On occasion, spinal degeneration can also occur due to spinal damage or injury, which may result in further complications if left untreated. Chiropractic care can help strengthen the structures of the spine, helping to prevent spinal degeneration.
If you have a child who plays sports, then you share my excitement for them when they play the game. You probably also share my apprehension about injuries. I recently witnessed one of my daughter�s teammates tear her ACL in a volleyball match�in a non-contact play. The same thing happened to my son and it was heart wrenching. In fact, this caused me to look at the latest research for ways to prevent this from happening to my child and to other children in our community. It is more important than ever before to have parents understand the importance of injury awareness. �This has never been more true today as we become a highly competitive�community.
The Research Is Revealing
My son and daughter�s teammate are not alone. There are nearly 150,000 ACL injuries in the U.S. each year (American Orthopaedic Society for Sports Medicine). 70% of those are non-contact injuries involving landing or cutting. Females are 2-8 times more likely to suffer an ACL injury than males. Worse still: 1 in 4 go on to have another knee injury later.
One study (American Journal of Sports Medicine, 2014) looked at re-injury rates in 750 people after 5 years and found that of the 561 people who finished the study, 4.5% had their graft repairs tear and 7.5% tore the ACL in the other knee. What I found most disturbing is that the highest incidence of further injury occurred in the people who had their first surgery before 20 years of age!
I looked at several studies going back 15 years. They all conclude about the same things when it comes to injury prevention: a program of education, strength, flexibility, sport specific agility drills and plyometrics [aka: jump training] help to prevent injuries.
You might well ask: If we know that is the case, then why haven�t we taken the recommended actions to reduce the number of injuries �the rate of which are basically unchanged in the past 10 years? There are a number of reasons, and perhaps one of them is because we parents assume this is part of the coach�s job.
Truth be told, though, we really expect coaches to focus on technical training �that will help our children gain proficiency and expertise. Sure, they want to reduce injuries, too, but they can�t do it all and most don�t have degrees in injury prevention. So, if the coach can�t do it, who can? Well, if you are lucky enough to have a certified athletic trainer at your school, that helps. But for me, the �aha!� from the research is that injury prevention falls first and foremost on my shoulders as a parent.
What a Parent Can Do �And Should Not Try Do
A�childs athlete�s best training tool is BODY AWARENESS. Learning how to decelerate and land from a jump are just some of the important skills to learn that can help with performance and safety”.
The research backs this up.
There are various screening tools to assess an athlete�s ability to hop from a box, jump and land. Athletes who have poor control or have asymmetries right to left were correlated with greater injury risk. (Chorbe et al N AmJ Sorts Phys Ther 2010; Padue et al AJSM 2009).
The�PUSHasRx’s�and other local pre-season programs are progressive student education programs�starting with teaching body control in static positions, progressing to linear jumping drills and plyometrics. Then, the young athletes are taught to apply the learned techniques to deceleration activities in their sport, while all along maximizing strength and joint range of motion. This type of program needs to be ongoing to be effective (Padue et al AJSM 2012) and typically works best if done 2-3 times per week pre- season and 1 time per week in season.
Mind and Body Make the Winning Combination
So why can�t we just give our children a packet of drills to do on their own or take them to the gym ourselves? After all, I was a pretty good athlete in my day� Well, one reason is psychological. They need to understand the serious purpose of the activities and be 100% committed to what they are learning and doing. One way to do that is to work with a professional. �Sometimes kids need to hear it from someone not in a parent position to understand. �We just will have to do what it takes to get our kids to understand.
The second reason is about what is known as �motor memory�. Form is everything and it takes a trained eye to recognize and teach form, such as good landing mechanics and deceleration skills so that they become a part of motor memory. The bottom line is: If your child practices good jump-landing techniques s/he may have better form and motor memory to handle knee joint loading forces (Meyer et al. Am J Sports Med 2013).
As we head into summer�sports, let�s give our kids the best opportunity for an injury free season. I urge you to do what I�m doing: seek out a body awareness/training professional who can teach them to stay in the game they love!
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