When the aberrant sequela to victims in car crashes has been investigated, providers often overlook and concurrently underestimate the tissue pathology and resultant biomechanical failures of spinal ligamentous damages commonly known as �strain � sprain.� In addition, the courts have been �blinded� by rhetoric in allowing this pathology to be deemed transient. There is an ever growing body of scientific literature that verifies strain – sprain as permanent pathology, which is the standard being taught in today�s medical and chiropractic academia.
In addition, strain � sprain as sequela to whiplash, renders a 25% whole person impairment based upon the American Medical Association�s Guide to the Evaluation of Permanent Impairment fifth and sixth editions.
Contents
Whiplash Associated Disorder Sequela Injuries
Juamard, Welch and Winkelstein (2011) reported:
��Rear end accelerations have been used to study the response of a variety of soft tissues in the cervical spine, including the facet capsular ligament. For simulations of whiplash exposures, the strains in the capsular ligament were found to be two � five times greater than those sustained during physiological motions of the cervical spine. In a similar but separate study, the facet joints of the cervical spine�s that were previously exposed to a whiplash injury ridden exercise under low � level tension and found to undergo elongations nearly 3 times greater than on exposed ligaments for the same tensile loads. Those capsular ligaments were also found to exhibit greater laxity after the purported injury. Since increased laxity may be linked to a reduction in the joints ability to stabilize the motion segment during sagittal motion, this finding suggests that whiplash exposure may alter the structure of the individual�s tissues of the facet, such as the capsular ligament, and/or the mechanotransduction processes that could maintain and repair the ligamentous structure. Accordingly, such an injury exposure could initiate a variety of signaling cascades that prevent a full recovery of the mechanical properties of the tissues of the facet joint.� (Pg 15)
Simply put, if we focus on the last sentence above, this �prevents a full recovery of the mechanical properties of the tissues of the facet joint,� which is referencing the ligaments of the spine that make up the tissues of the facet joint. In lay terms; it means that once injured, a joint is permanently damaged and it is demonstrable on x-rays with an extension and flexion view that does not have to show a full dislocation. Therein lies the core of the issue. Most radiologists are not trained in the latest literature on biomechanical tissue failures and therefore underreport the pathology.
Last month I attended a presentation by Michael Modic MD, Neuroradiology, a nationally renowned educator in neuroradiology who focuses on spondylolisthesis (vertebral segmental abnormal movements) and I asked a simple question �why don�t radiologist report more on abnormal positioning due to biomechanical failure as a result of ligament pathology� and his answer was �because their training focuses more on disease pathology.� Although I agree that is critical, so are biomechanical failures that lead to chronic degeneration, which is epidemic in our society. Simply look at the posture of our elderly for verification and much of that started with a simple �fender bender� years ago where the strain-sprain was either undiagnosed or deemed transient and not treated.
Ligament Pathology Diagnosis and Prognosis
The above scenario is why the American Medical Association values ligament pathology at 25% whole body impairment. There is also a growing body of doctors who are trained and credentialed in Spinal Biomechanical Engineering that understand how to create a diagnosis and prognosis, along with treatment plans around ligament pathology and fully understand the long-term effects of damaged facet joint tissues. These doctors are currently educating, based upon the current scientific literature their respective radiology communities to be able to diagnose and document the full extent of the injuries sustained.
We must also recognize that there is a significant amount of evidence in the scientific literature that verifies ligamentous damage as permanent and refutes the rhetorical claim of �transient.� In the end, it must be the facts of human physiology verified by science that sets the standards of healthcare and not deceptive rhetoric at any level.
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:
Cocchiarella L., Anderson G., (2001) Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, AMA Press
Juamard N., Welch W., Winkelstein B. (July 2011) Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions, Journal of Biomechanical Engineering, 133, 1-31
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.
Gray hair could be an early warning sign of heart disease. Hiccups that won’t go away may foreshadow cancer. Sometimes your body sends seemingly unrelated signals that something is wrong.
Since the key to treating most health problems is to catch them early, it can pay off big time to spot the tip-offs. And the first thing to check out is your skin.
“Skin is the only organ of the body that you wear on the outside,” says dermatologist Dr. Robert Brodell. “Since it’s connected to internal organs through blood vessels, nerves and other things, it can be like a window to see what’s going on inside.”
Here are 10 symptoms and what they may really mean:
Rash on shins: Formally called necrobiosis lipoidica diabeticorum (NLD), a raised red-brown patch with yellow blotches could mean that you have diabetes or are poised to get it. “Sometimes we see this in patients and know they are diabetic before they know it themselves,” says Brodell, chairman of the dermatology department at the University of Mississippi Medical Center. “In some cases, their blood sugar is normal, but over the next six months to two years, they develop diabetes.”
Splinter hemorrhages: They look like thin red splinters running lengthwise under fingernails and could be caused by endocarditis, a bacterial infection of the heart valves. “You wouldn’t think that someone looking at fingernails could detect what could be a significant heart problem,” Brodell tells Newsmax Health.
Rash on eyelids: This violet-hued rash is a symptom of dermatomyositis, an inflammatory muscle disease that is associated with various forms of cancer, most commonly ovarian. Other symptoms include raised scaly bumps on knuckles and ragged cuticles that separate from the nail.
Skin discoloration: The most common is jaundice, a yellowing of the skin that is a classic symptom of hepatitis and other liver conditions. Less known is a darkening of the skin in creases and old scars that may indicate an adrenal gland problem, such as Addison’s disease.
Tender nodules on shins: A condition called erythema nodosum is marked by red swollen bumps on the front of the legs. Brodell says that while they are sometimes a reaction to medications or oral contraceptives, they could also be a warning of the inflammatory pulmonary disease sarcoidosis.
Persistent hiccups: For most of us, this spasm of the diaphragm is an annoying but harmless problem. But when hiccups last two days or more, they could be an early warning sign of deadly esophageal cancer.
Shoplifting: If your elderly mom or dad starts getting sticky fingers, it could be a sign of a certain type of dementia. A study published in the Journal of the American Medical Association’s Neurology details how people with frontotemporal dementia lose their sense of societal conventions and may take items in shops without paying for them.
Color blindness: The inability to distinguish between different hues is a sign of Parkinson’s disease. Other odd symptoms of the neurological disorder are writing smaller and swimming in circles.
Earlobe wrinkle: A diagonal crease in one or both earlobes has long been linked to heart disease. Also called “Frank’s sign” after Dr. Sanders T. Frank, the physician who first made the association, this odd symptom has been supported in several studies, though no one has yet to figure out why.
Gray hair: A touch of gray is another early warning sign of cardiovascular problems, regardless of age and other factors, according to a recent study by Egyptian researchers. Heart disease in general can generate several seemingly unrelated symptoms, including bleeding gums, swollen feet, frequent urination at night, uncontrollable head bobbing, yellow spots on eyelids…and the list goes on.
“The reason that heart disease has so many varied symptoms may be because there are many types of heart disease that will present in different ways,” explains Dr. Richard Greenberg, a cardiologist at Temple University Hospital in Philadelphia, Pa. “Another reason is that the circulatory system is connected to every cell in the body, so it follows that symptoms of heart disease could show up anywhere.”
When it comes to stomach discomfort during exercise, forget that old adage “no pain, no gain.” New research suggests that excessive strenuous exercise may lead to gut damage.
“The stress response of prolonged vigorous exercise shuts down gut function,” said lead author Ricardo Costa.
“The redistribution of blood flow away from the gut and towards working muscles creates gut cell injury that may lead to cell death, leaky gut, and systemic immune responses due to intestinal bacteria entering general circulation,” Costa added. He’s a senior researcher with the department of nutrition, dietetics and food at Monash University in Australia.
Researchers observed that the risk of gut injury and impaired function seems to increase along with the intensity and duration of exercise.
The problem is dubbed “exercise-induced gastrointestinal syndrome.” The researchers reviewed eight previously done studies that looked at this issue.
Two hours appears to be the threshold, the researchers said. After two hours of continuous endurance exercise when 60 percent of an individual’s maximum intensity level is reached, gut damage may occur. Costa said that examples of such exercise are running and cycling.
He said heat stress appears to be an exacerbating factor. People with a predisposition to gut diseases or disorders may be more susceptible to such exercise-related health problems, he added.
Dr. Elena Ivanina is a senior gastroenterology fellow at Lenox Hill Hospital in New York City. She wasn’t involved with this research but reviewed the study. She said that normal blood flow to the gut keeps cells oxygenated and healthy to ensure appropriate metabolism and function.
If the gut loses a significant supply of blood during exercise, it can lead to inflammation that damages the protective gut lining. With a weakened gastrointestinal (GI) immune system, toxins in the gut can leak out into the systemic circulation — the so-called “leaky gut” phenomenon, Ivanina said.
But, she underscored that exercise in moderation has been shown to have many protective benefits to the gut.
“Specifically, through exercise, patients can maintain a healthy weight and avoid the consequences of obesity,” she said. Obesity has been associated with many GI diseases, such as gallbladder disease; fatty liver disease; gastroesophageal reflux disease (GERD); and cancer of the esophagus, stomach, liver and colon. Regular moderate physical activity also lowers the risk of cardiovascular disease, type 2 diabetes and depression.
To prevent exercise-related gut problems, Costa advised maintaining hydration throughout physical activity, and possibly consuming small amounts of carbohydrates and protein before and during exercise.
Ivanina said preventive measures might help keep abdominal troubles in check. These include resting and drinking enough water. She also suggested discussing any symptoms with a doctor to ensure there is no underlying gastrointestinal disorder.
Costa recommended that people exercise within their comfort zone. If you have stomach or abdominal pain, “this is a sign that something is not right,” he said.
Individuals with symptoms of gut disturbances during exercise should see their doctor.
The study authors advised against taking nonsteroidal anti-inflammatory drugs — including ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) — before working out.
Costa said there’s emerging evidence that a special diet — called a low FODMAP diet — leading up to heavy training and competition may reduce gut symptoms. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAPs are specific types of carbohydrates (sugars) that pull water into the intestinal tract.
The International Foundation for Functional Gastrointestinal Disorders suggests consulting a dietitian familiar with FODMAP diets. Such diets can be difficult to initiate properly on your own, the foundation says.
Costa also said there’s no clear evidence that dietary supplements — such as antioxidants, glutamine, bovine colostrum and/or probiotics — prevent or reduce exercise-associated gut disturbances.
The study results were published online recently in the journal Alimentary Pharmacology & Therapeutics.
Wallpaper may contribute to sick building syndrome, a new study suggests.
Toxins from fungus growing on wallpaper can easily become airborne and pose an indoor health risk, the researchers said.
In laboratory tests, “we demonstrated that mycotoxins could be transferred from a moldy material to air, under conditions that may be encountered in buildings,” said study corresponding author Dr. Jean-Denis Bailly.
“Thus, mycotoxins can be inhaled and should be investigated as parameters of indoor air quality, especially in homes with visible fungal contamination,” added Bailly, a professor of food hygiene at the National Veterinary School of Toulouse, France.
Sick building syndrome is the term used when occupants start feeling ill related to time spent in a particular building. Usually, no specific illnessor cause can be identified, according to the U.S. National Institutes of Health.
For the study, the researchers simulated airflow over a piece of wallpaper contaminated with three species of fungus often found indoors.
“Most of the airborne toxins are likely to be located on fungal spores, but we also demonstrated that part of the toxic load was found on very small particles — dust or tiny fragments of wallpaper, that could be easily inhaled,” said Bailly.
Mycotoxins are better known for their occurrence in food. But “the presence of mycotoxins in indoors should be taken into consideration as an important parameter of air quality,” he said.
The study was published in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.
Creating an increasingly energy-efficient home may aggravate the problem, Bailly and his colleagues said.
Such homes “are strongly isolated from the outside to save energy,” but various water-using appliances such as coffee makers “could lead to favorable conditions for fungal growth,” Bailly explained in a society news release.
Eating fish at least twice a week may significantly reduce the pain and swelling associated with rheumatoid arthritis, a new study says.
Prior studies have shown a beneficial effect of fish oil supplements on rheumatoid arthritis symptoms, but less is known about the value of eating fish containing omega-3, the researchers said.
“We wanted to investigate whether eating fish as a whole food would have a similar kind of effect as the omega 3 fatty acid supplements,” said the study author, Dr. Sara Tedeschi, an associate physician of rheumatology, immunology and allergy at Brigham and Women’s Hospital in Boston.
Generally, the amount of omega 3 fatty acids in fish is lower than the doses that were given in the trials, she said.
Even so, as the 176 study participants increased the amount of fish they ate weekly, their disease activity score lowered, the observational study found.
In rheumatoid arthritis, the body’s immune system mistakenly attacks the joints, creating swelling and pain. It can also affect body systems, such as the cardiovascular or respiratory systems. The Arthritis Foundation estimates that about 1.5 million people in the United States have the disease, women far more often than men.
The new study, which was heavily female, draws attention to the link between diet and arthritic disease, a New York City specialist said.
“While this is not something that is new, per se, and it was a small trial, it does raise an interesting concept of what you eat is as important as the medications you take,” said Dr. Houman Danesh.
“A patient’s diet is something that should be addressed before medication is given,” added Danesh, director of integrative pain management at Mount Sinai Hospital.
When his patients with rheumatoid arthritis ask about diet, he said he often suggests they eat more fish for a few months to see if it will help.
“I encourage them to try it and decide for themselves,” he said, explaining that study results so far have been mixed.
In this case, the majority of study participants were taking medication to reduce inflammation, improve symptoms and prevent long-term joint damage.
Participants were enrolled in a study investigating risk factors for heart disease in rheumatoid arthritis patients. The researchers conducted a secondary study from that data, analyzing results of a food frequency questionnaire that assessed patients’ diet over the past year.
Consumption of fish was counted if it was cooked — broiled, steamed, or baked — or raw, including sashimi and sushi. Fried fish, shellfish and fish in mixed dishes, such as stir-fries, were not included.
Frequency of consumption was categorized as: never or less than once a month; once a month to less than once a week; once a week; and two or more times a week.
Almost 20 percent of participants ate fish less than once a month or never, while close to 18 percent consumed fish more than twice a week.
The most frequent fish eaters reported less pain and swelling compared to those who ate fish less than once a month, the study found.
Researchers can’t prove that the fish was responsible for the improvements. And they theorized that those who regularly consumed fish could have a healthier lifestyle overall, contributing to their lower disease activity score.
While they were unable to get specific data on information such as patients’ exercise, its benefits are proven, Tedeschi said.
She acknowledged that fish tends to be an expensive food to purchase. For those unable to afford fish several times a week, Danesh cited other options.
“In general, patients should eat whole, unprocessed foods,” he said. “If you can’t for whatever reason, an omega 3 pill is a second option.”
Because the study was not randomized, researchers were unable to make definite conclusions, but they were pleased with what they learned.
One finding that impressed Tedeschi “was that the absolute difference in the disease activity scores between the group that ate fish the most frequently and least frequently was the same percentage as what has been observed in trials of methotrexate, which is the standard of care medication for rheumatoid arthritis,” she said.
The findings were reported June 21 in Arthritis Care & Research.
Emmanuel Korir has been named a semifinalist for college track and field’s highest individual honor, The Bowerman Award, the U.S. Track and Field and Cross Country Coaches Association (USTFCCCA) announced Thursday.
Korir wrapped up his freshman season with a sweep of both 800m national titles. The Kenyan is the first Miner to win the 800m NCAA title since Peter Lemashon outdoors in 1978, and the first to achieve the feat at both NCAA Indoors and Outdoors in the same year.
The All-American holds school records in the indoor 800m (1:46.75), the outdoor 800m (1:43.73) and the outdoor 400m (44.53). Korir is one of three athletes in the world to run a sub-45 400m and a sub-1:44 in the 800m.
Three finalists will be announced on Thursday, June 22 from the following list of semifinalists:
KeAndre Bates, junior, jumps, Florida
Edward Cheserek, senior, distance, Oregon
Christian Coleman, junior, sprints/jumps, Tennessee
Grant Holloway, freshman, hurdles/jumps, Florida
Fred Kerley, senior, springs, Texas A&M
Josh Kerr, sophomore, mid-distance, New Mexico
Emmanuel Korir, freshman, mid-distance, UTEP
Ioannis Kyriazis, junior, throws, Texas A&M
Filip Mihaljevic, junior, throws, Virginia
Lindon Victor, senior, combined events, Texas A&M
For more information on UTEP track and field, follow the Miners on Twitter (@UTEPTrack) and Instagram (uteptrack).
New UTEP Tennis Head Coach Ivan Fernandez announced his first two signees on Friday. Erandi Martinez Hernandez and Alisa Morozova will join the Miners for the 2017-18 season.
Martinez Hernandez graduated from Monterrey Institute of Technology and Higher Education, a prestigious high school in Mexico City. She has been ranked among the top-five under-18 players in Mexico and has won three Grade 1 tournaments in both singles and doubles.
Hernandez reached the semifinals of the Masters Championship, a qualifier for a Women’s Tennis Association (WTA) Tournament in Mexico, and reached the quarterfinals at the Tampico International Tournament last August, where she faced several players that are now playing Division I tennis.
“I have been recruiting Erandi for a couple of months already,” Fernandez said. “I know that she’s got a lot of wins in Mexico against players that are now in Division I, so I have a really good idea of the level that she’s going to bring to the program. She’s very solid in singles and doubles and I think that she’s going to be a great addition to this team, especially having competed against a lot of collegiate players. She’s going to come in with a lot of international experience and she has been highly ranked in Mexico for her whole career. I definitely expect her to make an immediate impact in the lineup.”
Morozova recently graduated from the Gusev Secondary School in Russia, where she has been ranked among the top under-18 players the last three years. Morozova represented the Yaroslavi Regional Team as the No. 3 singles player and has won more than 10 Russian Federation Tournaments in singles and doubles.
“I spoke with Alisa’s sister a little bit and she told me that if she had been playing here in the U.S. she would have a UTR [Universal Tennis Rating] of 9 or 10, which is a very high level,” Fernandez said. “Her sister, who played for four years at St. John’s and just graduated, told me that she would probably play in the middle of the lineup at St. John’s, who just won their conference and went to the NCAA Tournament. Alisa is a very young player but she is very well-rounded. She’s also going to be capable of playing in the middle of the lineup here. We’re very fortunate that we were able to get her in so quickly and get her signed right away. She’s a very solid player, she’s going to mature and keep developing and both she and Erandi will definitely be in the lineup as true freshmen.”
UTEP claimed two superlative Conference USA track and field honors as Emmanuel Korir and Tobi Amusan were named C-USA Male and Female Track Athletes of the Year, announced by the league office on Friday afternoon.
“Both athletes are very special and talented. He [Korir] was the best candidate for our league and would most likely do very well other top conferences as well,” head coach Mika Laaksonen stated. “A lot of work goes into these things and Tobi worked incredibly hard over these past two years and she absolutely deserves this award, they both do.”
Korir ran a world best 1:14.97 in the 600m earlier this year at the New Mexico Cherry & Silver meet, which was his first race on an indoor 200m banked track. The freshman followed that up by capturing the NCAA title in the 800m (1:47.48) at the same track in Albuquerque, N.M., with a time of 1:47.48. The freshman is one of three athletes in the world to run an outdoor sub-45 400m and a sub-1:44 in the 800m.
The Kenyan native won the NCAA outdoor title in the 800m (1:45.03) and is the first Miner to win both titles in the same year.
Amusan was the leading scorer for the Miners with 25 points at the C-USA Indoor Championships and notched a meet record in the 60m hurdles with a time of 8.01. The sophomore helped her team win its third consecutive conference title. Amusan qualified to the NCAA Indoor Championships in the 60m hurdles where she notched a sixth-place showing.
The outdoor season started with a bang, as she set a school record (12.63) in the 100m hurdles at the UTEP Springtime meet. She followed that with a first-place finish at the 2017 Clyde Little Field Texas Relays in the 100m hurdles, setting a meet record time of 12.72. The Nigerian native scored 24.5 points at the C-USA Outdoor Championships leading the women’s team to its first ever outdoor conference title.
Both athletes were named semifinalists for college track and field’s high individual honor, The Bowerman Award. The women’s three finalists will be announced on Wednesday, June 21 and the men’s finalists will be announced Thursday, June 22.
For more information on UTEP track and field, follow the Miners on Twitter (@UTEPTrack) and on Instagram (uteptrack).
Offensive lineman Will Hernandez was named to the 2017 Athlon Sports Preseason All-American third team on Tuesday.
The senior comes back after a stellar season where he garnered AP All-American second team, FOX Sports’ All-American second team, All-Conference USA first team and Pro Football Focus Best Pass Protector honors. The lineman has started all 37 games in his career for the Miners at the left guard position.
He led the offensive line that paved the way for Aaron Jones to rush for a single-season program-record 1,773 yards, while Jones also became UTEP’s all-time leading rusher last season. The Miners averaged 185.5 rushing yards per game and scored 20 touchdowns on the ground.
Hernandez is one of two student-athletes from C-USA that makes an appearance on the Athlon Sports All-American team. The Las Vegas, Nev., native also was named to the Athlon Sports Preseason All-C-USA first team.
Teammate Alvin Jones also garnered Athlon Sports All-C-USA first team recognition, while Devin Cockrell and Terry Juniel received second team honors. Jones was appointed to the 2016 All-C-USA second team after leading team in tackles 93 (44 solo). He ranked fourth in the league in tackles per game (9.3) and added 6.0 tackles for loss (28 yards), 2.5 sacks (22 yards) and a pass breakup.
Cockrell started all 12 games last season and ranked fourth on defense, while leading all defensive backs with 58 tackles (31 solo). He added 3.0 tackles for loss, a pass breakup, a quarterback hurry and a fumble recovery. The senior led team with 10 special team’s tackles (seven punt return tackles)
Juniel returns to the Miners special teams unit as the starting punt returner. The specialist was the team’s leading punt returner, tallying 203 yards on 22 returns (9.2 avg.), with a pair of long returns of 43 yards. Juniel led C-USA in punt returns and return yards. The junior returned nine kickoffs for 164 yards (18.2 avg.) with a long of 26 yards.
UTEP’s center Derron Gatewood and punter Alan Luna also received recognition on the All-C-USA Preseason fourth team.
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.�� (http://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.
Contents
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 (http://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.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
