What are the tendons and ligaments and their injuries?
Tendons are fibrous connective tissues that attach muscles to bones and other structures. Their collagenous fibers are arranged fairly regularly. Tendons appear white because they are relatively avascular (not rich in blood vessels) and therefore have a poor blood supply. A tendon can vary in shape from short and stocky (such as “Tennis Elbow” tendons) to long and slender (Achilles tendon).
Ligaments are bands or sheets of strong, fibrous, connective tissue. Their main function is to connect the articular ends of bones, forming support for the joints. Hinge joints such as the knees need collateral ligaments to support the relatively lax joint capsule. Ligaments facilitate motion (by release of stored elastic energy) and limit motion as well. Similar to the tendons, the ligaments are avascular. However, because ligaments are innervated richly by both mechanoreceptors and sensory receptors, they are a frequent source of pain, such as acute sprains.
A strain is defined as a stretched or injured tendon. A sprain is a stretched or injured ligament. Blood flow is vital to the body’s healing process and, because tendons and ligaments have naturally poor blood supply, incomplete healing may result after an injury to that structure. Incomplete healing results in decreased strength. The tendon and ligaments, normally taut and strong, become relaxed and weak. The weakened tissues, often riddled with scars after injuries, then become the source of the chronic pain.
Inflammation and healing: What is the connection?
A commonly accepted mode of treatment known as RICE is prescribed by most medical practitioners for an acute injury of a ligament or tendon. The treatment consists of Rest, Ice, Compression, and Elevation in order to immobilize the joint and decrease the swelling. The short-term result of this treatment is a reduction in pain. For the treatment of soft tissue injury, however, the RICE treatment decreases blood flow preventing immune cells from getting to the injured area. This impairs the healing process, causes greater pain long-term, and increases the chance of incomplete healing of the injured tendon or ligament.
All tendon and ligament injury involve inflammation. Inflammation is the body’s reaction to a local injury. Healing an injured area is dependent on the blood supplying inflammatory cells to repair the damaged tissues. Poor blood flow proportionately reduces healing. Treatment with ice and Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen decreases the blood flow even further thus hampering the body’s capability to heal the injured tissue. Although steroid injections may help some acute cases, often they provoke quite a strong reaction lasting one or two days. There is also a tendency toward a higher rate of recurrence because of scarring that has not been removed although inflammation has been temporarily inhibited.
Healing of an injured tissue progresses through a series of stages: inflammatory, fibroblastic, and maturation. The inflammation initiates the healing process by activating immune cells from the blood vessels. Then the fibroblasts are formed from local cells or other immune cells in the blood. They are the “carpenters” of the body, which form new collagen tissue, the building blocks of new ligaments and tendons. The maturation phase of healing continues many months after the fibroblastic stage. Proper fitness program can further increase the new collagen fibers in density and diameter, resulting in increased strength thus preventing from recurrence.
How and why does our treatment work?
Our proven treatments consist of “cross-fiber” massage, electro-acupuncture (maybe waived for needle-phobic patient), and low-level laser therapy. Cross-fiber massage, otherwise known as “transverse friction,” bears no relationship to conventional massage. It re-initiates the inflammatory process of a scarred tendon or ligament. Acupuncture induces the release of endorphin, a body natural painkiller, and relaxes the muscles associated with the tendons. Often a tight muscle may be a culprit of a tendon injury of unknown cause. Then low-level laser is applied to the injured area to increase the production and release of adenosine triphosphate (ATP), which helps increase blood circulation, stimulation and production of collagen, reduction of swelling and pain, and ultimately in the regeneration of healthy tissue. Low-level laser therapy is completely safe and the laser equipment is FDA-cleared.
How many treatments and how often?
Each session (twice a week) lasts about 60 minutes and 6 to 10 sessions may be necessary. The end result is complete healing of the tissues and elimination of chronic pain.
Clinic Cases …
Chronic shoulder painHistory: Patient M, 70-years old, complaining of left shoulder pain. Was diagnosed with tendonitis 2 years ago. Past treatments included four cortisone shots and many types of anti-inflammatory drugs. The pain still comes every time she lifts her arm. Also lack of strength in her arm – can’t hold up the arm long.
Diagnosis: Chronic supraspinatus tendonitis
Treatment plan: Cross-fiber massage, electro-acupuncture, and low-level laser therapy. 2 times a week for up to 5 weeks.
Results: Completely free of pain in six treatments.
Chronic knee pain
History: Patient M, a 58-year old male complained of right knee pain for 26 years. Last MRI and arthroscopic surgery found nothing abnormal. His lumbar MRI also was unremarkable. His doctor prescribed Morphine and Neurontin and found the drugs only “took the edge off.”
Diagnosis: Orthopaedic exam found both lateral and medial collateral ligaments were sprained and may have adhered to the bone.
Treatment Plan: Due to his golfing schedule the patient only allowed one week for treatments. We decided on everyday treatment for one week. Treatment modalities included cross-fiber massage, electro-acupuncture, and low level laser therapy.
Results: Patient was completely free from 26 years of pain after seven treatments!