LIGAMENT INJURY
Ross Hauser, M.D.

We think many patients and athletes and people suffering from chronic pain do not heal their initial injuries because of improper treatment. This improper treatment generally takes the form of one or all of the following recommendations: rest, ice, immobilization, anti-inflammatory medications, cortisone shots, taping, or bracing. The athlete and/or anyone suffering a soft injury should say: No to rest, No to ice, No to immobilization, No to anti-inflammatories, No to cortisone shots, No to taping, and finally, say No to bracing. If the athletes follow these seven no's they will be much more likely to heal sports injuries.
    
RICE treatment vs. MEAT
The R.I.C.E. treatment is the gold standard for pain management and sports injuries today. Just go to any emergency room or sports trainer with an acute ankle sprain or other ligament injury, and the injured person will be given these instructions: Rest, Ice, Compression, and Elevation. Most people would also receive instructions to take anti-inflammatory medications. This treatment is recommended because ligament sprains are sometimes accompanied by quite a bit of swelling. The premise with the RICE treatment is that the swelling and edema is harmful to the tissue. Where did such a preposterous idea originate?

Unfortunately, sports medicine specialists and athletic trainers fell into the trap that muscles were like tendons and that tendons were like ligaments. In high-energy trauma, the RICE treatment is essential for muscle injury because it can contain swelling. Swelling in the muscle causes decreased circulation which leads to still greater swelling and more tissue damage. RICE treatment is very effective at eliminating edema in muscle injury. What occurred in the early 1970s, unfortunately for the athletes of the world, is that sports medicine doctors and trainers started treating every injury as if it were a muscle trauma injury.

The main difference between muscles and ligaments is that muscles are massively strong structures with a tremendous blood supply, both outside and inside the muscle (this is why steak is red). Ligaments, on the other hand, are small tissues that have a poor blood supply both inside and outside of the ligament (why they appear white). Muscles, because of their good circulation, heal quickly and rarely cause a long-term problem, whereas ligaments, due to their poor blood supply, often heal incompletely and are the cause of most chronic sports injuries and pain. It is our opinion that nonhealing ligaments are the number one cause of early retirement in athletes.

The Small, Sensitive, Yet Mighty Ligament

Many of our muscles are mammoth structures, like the quadriceps. Ligaments, are generally less than one inch in length, and whose width is measured in millimeters. Yet these small structures must be mighty because they have the job of binding the bones together.

Ligaments have essentially no blood vessels of their own to bring them nutrients. Their nutrition must come from diffusion of nutrients, most likely from the joint itself. This should make it evident to you why ligaments are so easily injured. A joint is impacted during an athletic event. The small blood vessels to the joint are sheared. The little blood supply that the ligaments had is then cut off. The immune system reacting to the damaged caused to the joint wants to repair the damage, but can not do so if no immune cells can get to the area because of the poor or interrupted blood supply.

The blood supply to the ligaments is the worst at the point where the ligament attaches to the bone, called the fibro-osseous junction. This is the most common area injured in the athlete and is responsible for most lingering sports injuries. This is the exact site where Prolotherapy is administered.