Image provided by: University of Oregon Libraries; Eugene, OR
About Applegater. (Jacksonville, OR) 2008-current | View Entire Issue (Nov. 1, 2008)
Applegater November-December 2008 19 EARL’S PEARLS Old saws and new lights on soft-tissue injuries BY EARL SHOWERMAN, M.D. Soft tissue injuries can include contusions, or when pain symptoms keep you awake. Plaster or deep bruises, muscular strains and joint ligament fiberglass splints may be needed for several weeks sprains. Tendonitis is another common soft tissue after a serious sprain or strain. These devices are injury, most often caused by repeated micro trauma. designed to protect the joint from further injury All these types of injuries can be quite painful if not until it has healed enough to be stable under stress. incapacitating. The good news is they all usually Rehabilitation exercises generally speed the recovery respond remarkably well to the standard modalities of joint stability through range of motion and of treatment, which have been used for millennia, muscle strengthening exercises. dating back to the time of Hippocrates. The modern Immediate medical attention is recommended, acronym for this ancient clinical wisdom is RICE: however, if there is any deformity of the area, or if Rest, Ice, Compression and Elevation. Appropriate you are unable to move the joint or bear weight management using these principles far outweigh immediately after the injury. Surgery may even be the benefit of taking pain medications, which has needed if there is evidence of severe disruption of a never been shown to speed healing. joint. Immediate medical attention also is needed if R—Resting the injured area until the pain the area becomes numb, cold, blue, or more painful, and swelling are better is perhaps the most important or if there are signs of infection such as increased component of treatment, and often the most redness, swelling, and heat. neglected. While most minor soft tissue injuries will Until recently, I have thought these well-worn be much better after three days of limited activity, physical techniques with appropriate rehabilitation more serious sprains or strains may take weeks or were about it when it came to treating soft tissue months to heal and regain the full integrity of the problems. Then I was introduced to the benefits of affected joint or muscle. For instance, hobbling low-level laser light therapy (LLLT) and found it around on a seriously sprained ankle is a very bad to be remarkably effective in a very short time for idea precisely because it increases pain, swelling, several different kinds of shoulder joint problems. and tissue damage, while That LLLT is potentially preventing the connective While LLLT has yet to be broadly effective in a wide tissue the opportunity to variety of both medical embraced by medical heal. Because connective and dental problems tissue heals very slowly, practitioners in the U.S., in 2002 has been suggested by it was approved by the FDA for a badly sprained ankle recent case studies and may take up to a year to pain management and has gained review articles reported rehabilitate fully. in peer-reviewed a following in certain areas of I—Ice packs applied medicine, including sports professional journals every few hours for two from around the world. medicine. to three days is highly Although many of the effective in reducing pain, early studies suffered swelling, and further bleeding into injured tissues. from poor design and inadequate controls, LLLT Pain relief from cold applications is probably appears to be safe and effective in treating arthritic due to a “counter-irritant” effect because at first and injured joints, spine problems, carpal tunnel the pain increases with the cold pack, then it syndrome, various dental problems, including becomes slightly numb. The best way to apply cold gingivitis, herpes infections and TMJ, and as an treatments is with a plastic bag of crushed ice or adjunct to wound healing. a frozen pack. Chemical cold packs are a waste of The theory behind LLLT is that the pulsed money because they keep their cool for just a few laser light energy is “biostimulative,” that there are minutes. Cover your skin with a dry towel, apply cellular photoreceptors that absorb the light energy, the ice pack and wrap the pack in place with an which increases the levels of ATP, the cellular fuel elastic bandage to create a little compression, and that aids repair of damaged tissue by fibroblast cells. repeat for 30 minutes every two to three hours. The beneficial effects reported include enhanced Ice packs should be avoided, however, if you have synthesis of endorphins and reduced pain, as well chronic circulation problems. as reduced inflammation and swelling. An article in C—Compression helps reduce swelling the Journal of Rheumatology on the management of and restrict motion. An appropriately sized elastic neck disorders in 2007 found a course of LLLT to bandage wrapped snugly around the injured area be as effective as or better than all other conservative counters the progression of swelling and thus management strategies. reduces pain and hastens early recovery. However, While LLLT has yet to be broadly embraced elastic wraps do not stabilize severe joint injuries by medical practitioners in the U.S., in 2002 it was or provide mechanical protection. For this, a brace approved by the FDA for pain management and or rigid splint is much more effective. has gained a following in certain areas of medicine, E—Elevation is another means of reducing including sports medicine. Articles in this year’s pain and swelling. Keeping the injured part at or October issues of National Geographic Adventure above the level of the heart is the optimal position, and Life Extension magazines promoted the benefits since this promotes venous and lymphatic drainage of LLLT for a variety of problems. away from the injured site. All this I would come to understand personally Using these techniques for just two to three after embarking on a round of LLLT therapy last days can significantly change the progression and year for chronic rotator cuff tendonitis of my right duration of soft tissue injuries, although significant shoulder that had been a problem for about three joint sprains are often worse after the first few years. Following just two to three treatments of 30 hours as the swelling develops. Medicine to reduce to 40 minutes each, my shoulder felt better than it pain and inflammation such as acetaminophen or had for some time. After completing the five-week ibuprofen can be very useful, especially at night ten-treatment course, my shoulder had recovered Loyal Readers Please support our advertisers. They help us bring the Applegater to you. close to 95% of its function and was virtually pain free. Later in the year, I injured my left shoulder, landing on it when I fell off my mountain bike. After a week of fairly severe pain, only partially relieved by using a sling, ice packs and daily ibuprofen, I returned to the clinic for more LLLT, and after just six treatments over three weeks had close to 100% recovery. Finally, I also had excellent results with a short course of LLLT when I injured my knee backpacking this summer. Since this is a new technology not widely embraced by traditional practitioners and institutions, insurance coverage is uncommon. Still, for the cost of a diagnostic x-ray, I have received remarkable results from another form of energy; one that I believe will find its way into physician practices in the future. If it’s good enough for Paul Pierce, who injured his knee during basketball playoffs, underwent LLLT, and went on to become the NBA Finals MVP, then it’s good enough for me. Earl Showerman, M.D. • 541-899-8721