Even for a ligament tear, the way we have always done it (surgery) doesn’t appear to be the best way

August 31, 2010
Category: Uncategorized

The news has subtly crept into the public consciousness. Muscle/ligament/ tendon tears are not always candidates for surgical repair. That is a huge paradigm shift for practitioner and patient alike who have been culturally conditioned to think in terms of structure rather than function. For example, researchers at Children’s Hospital in Boston have found it possible that ligament tears heal without surgery. Click here to read in further detail http://www.nytimes.com/2006/04/20/fashion/thursdaystyles/20Fitness1.html.

To best understand the concept of structure versus function, let’s consider an interesting study that appeared in the 2007 British Journal of Sports Medicine. A group of intensely trained young tennis athletes without any symptoms of pain underwent MRI scans. Twenty-eight of the thirty athletes showed abnormalities ranging from stress fractures, complete back fractures, herniated discs, spinal disc degenerations, and early signs of arthropathy or a diseased facet joint. Clearly, there were structural abnormalities but no functional problems for the tennis players. Click here to read further http://www.medicalnewstoday.com/articles/77082.php.
Now comes a recent study appearing in the New England Journal of Medicine about a widespread sports injury, tears to the ACL (anterior cruciate ligament) of the knee that commonly leads to surgical repair. Surgery to repair ACL tears amounts to $3 billion annually in the U.S. but that may be about to change. This new study suggests some patients may have non-surgical options to address their sports injuries.  A Danish university research team assigned young, active adults with ACL tears to therapy plus ACL surgical repair or therapy following by surgical repair later on, if it was needed.  The researchers found that therapy after ACL repair reduced surgical repair by 60 percent. 60% of $3 billion is a considerable savings. At two years post-injury, there were no differences in the function of those who had therapy versus those who underwent ACL surgery.
While the researchers noted a five-year follow up is needed, other orthopedic experts predict that as many as 50% of those with ACL tears could avoid surgery for ACL repair. The most telling reaction was that from the Mayo Clinic. Dr. Bruce Levy of the Mayo Clinic department of orthopedic surgery observed that the decision to pursue surgery for ACL repair should be an individual one rather than a one size fits all mentality that can pervade American medicine.
An increasing number of Americans have turned to integrative practitioners to pursue an individualized approach to their health rather the traditional cookbook approach of allopathic medicine. John Abramson, MD, author of Overdosed America, decries the lack of focus by primary care doctors on educating patients to make wise lifestyle choices rather than prescribe all patients with elevated cholesterol readings a cholesterol lowering medication. The same has become true of those with high blood pressure, high blood sugar readings, and so on. Integrative practitioners also favor functional testing to assess their patients’ health. Many a patient with debilitating gastrointestinal symptoms has been told their structure is normal. That is, their colonoscopy, upper and lower GI scans, barium enema study, and sigmoidoscopies are all normal. However, it is clear to the patient the function of their GI system is far from normal. Integrative medicine has pioneered functional testing of gastrointestinal health, liver health, thyroid health, and the like.
There is a lesson to all of us that function can trump structure. Those who suffer chronic back pain may be told they have a litany of structural abnormalities from their scans but that may not foretell functional problems. We have all been culturally conditioned to focus solely on structure regarding our health. We may be well served to consider function as well. If therapy can improve the function of our back or our knees, what goal is served to address structural abnormalities with surgery that may be needless?
We would also be remiss not to mention the complete lack of attention modern medicine places on nutritional support for healing. At the Swedish Medical Center in Seattle, there was a study of administering 2 grams of vitamin C/ascorbic acid to trauma patients admitted through the emergency room versus a control group who received no ascorbic acid. The difference in recovery time, healing, and decreased complications was significant. Dr. Frederick Klenner was an early pioneer in vitamin C for a variety of clinical uses; click here to read further http://www.megac.org/klenner.htm. There has been much focus in the medical literature on nutrients for joint, ligament, tendon, and bone health. When the trauma of a torn ligament or tendon occurs, why is it not commonplace to support the patient nutritionally?
Luke Bucci, PhD, MT, ASCP in his book Pain Free extensively reviewed the science behind the use of nutritional support to maintain healthy joints. Jason Theodosakis, MD has updated his best-selling book The Arthritis Cure several times to keep pace with the nutritional research for healthy joints. Nutritional status does matter when it comes to healthy joints, tendons, and ligaments.
There have been a number of pioneers in the use of therapies considered outside the mainstream such as prolotherapy. William Faber, DO of the Milwaukee Pain Institute introduced many to prolotherapy to address torn ligaments and tendons in his book Pain, Pain, Go Away. Ross Hauser, MD has written several best selling books including Prolo Your Pain Away on the topic of using prolotherapy to address back pain and ligament/tendon issues. Published studies in peer reviewed medical journals show that prolotherapy can even improve tendon strength to a level better than that before a tear.
The bottom line for all of us who may tear an ACL in our knee, experience back pain, develop joint arthritis, or the like is there is no one right way. Nutrition, physical activity, therapies to use the body’s responses to heal such as prolotherapy, are among many that can be used to maintain an active life free of pain.  Surgery may be necessary but often it is the line of first response when studies show it may be best left for later in our healing process.

Deborah Ray, MT (ASCP)

2 responses to “Even for a ligament tear, the way we have always done it (surgery) doesn’t appear to be the best way”

  1. Judy A. Meeks says:

    A year ago, my 94 yr old mother was incorrectly diagnosed (by her allopathic doctor) as having a simple torn rotator cuff in the right shoulder. After the physical therapy finished, she was unable to use the arm, the pain was worse and radiated down the arm to include the elbow.
    In reality everything in the shoulder was torn and the head of the upper arm was hanging about 3/4” out of place. It could be seen on the original x-rays that apparently the radiologist ignored.
    I was finally able to convince my mother to see an osteopath. He prescribed prolotherapy. After her fourth shot she is nearly pain free and is able to raise the “bad” arm as high as her left arm. Thank goodness for NON-ALLOPATHIC trained doctors.

  2. Elliott Smith says:

    In 1982 I had a completly torn achillies tendon. I’m sure though it was misdiagnosed by an orthopedic surgeon and the injury was treated as a sprain. 14 years later I torn the other one and I was innitially told its was a sprain at the er and innitially I cared for it as a sprain which is really bad for a torn achilles, but on the advice of others I went to a ( different ) orthopedic surgeon and he said yes its a torn achilles tendon and I had surgury, they said it was a complete tear. My laymans assesment of my two achilles tendons are that they are the same.

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