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Strain or tear

post #1 of 29
Thread Starter 
After tweaking it during a bike crash & subsequent flight yesterday, my left inside knee is stiff and tender. I'm wondering how to self evaluate the level of damage.

It so happened that shortly after climbing back up the 15 or so feet of a 45° slope I slid down after bouncing off a log from the launching I received after hitting a root with my up hill crank arm, I received an on trail evaluating from an MD. All of the tests she performed did not indicate ligament damage, but illustrated the 1/4-1/2" forward movement of my left lower leg versus the right (from and old soccer hyper extension???). With pressure on the foot and outward pushing there is substantial pain. This wasn't a test performed by the MD. There isn't much, if any, swelling. I was able to ride for another 2 1/2 hours with no pain as long as I did not push the the knee outward or inward while pedaling or 'technical' riding/balancing/cranking.

Are there any 'self tests' I can perform to definitively rule out a tear? Any reason to ice it if there is little or no swelling?

Thanks for any insights. Vitamin I is my current best friend. :
post #2 of 29
I'm probably biased because I just had an ACL reconstruction and meniscus repair, but if you're worried about your knee, go have an orthopedic surgeon look at it. They can do an X-ray, an MRI if the results of the X-ray justify it, and you'll know what's up instead of just guessing.

Mike
post #3 of 29
mmckimson is correct. The only definitive test to rule out soft tissue tearing is MRI. There are no self tests or orthopedic tests (even when done by a doctor) that are accurate enough to determine that level of soft tissue injury.


Quote:
Any reason to ice it if there is little or no swelling?

Using ice or heat for any kind of injury today is a big question mark, in light of current knowledge.

What medical doctors often fail to tell the public are the benefits of many of these negatively-perceived symptoms like pain, swelling, and inflammation. In a healthy body, (one that is functioning properly) many of these symptoms serve a necessary role in the normal healing process.

Although we've been taught for decades to "bring down the swelling" and "decrease the inflammation," in many cases such advice is very bad advice for proper healing.

Inflammation is a healthy response to tissue injury. Without inflammation, wounds would never heal and infections would keep progressing unchecked. Inflammation starts a cascade of events including increased circulation to the area (causing the redness and heat), edema (swelling), and accompanying pain. The beneficial effects of these actions include dilution of bacterial toxins, entry of antibodies, delivery of nutrients and oxygen, and stimulation of the overall immune response.

Chronic inflammation is a different story... it's an inflammatory response that has gone unchecked and cannot complete its cycle. It forms the basis for rheumatoid arthritis, life threatening allergic reactions, and certain fatal kidney diseases.


Should you have iced your injury, Alpinord? It's hard to say. Perhaps the lack of swelling indicates that it wasn't a serious injury. But it also could indicate that the normal "swelling mechanism" wasn't functioning properly! Or... it could mean that your level of swelling bore little or no relation to the extent of injury.

In any case, certain research has shown that ice does not help an injury heal faster or better, and can in fact delay healing and cause the tissues to heal weaker as a result of suppressing these normal healing responses.


Hope this helps!
post #4 of 29
Thread Starter 
Thanks for the input. Interesting info about controlling inflammation. I'll probably wait at least a few days to see how it feels versus throwing money at it, especially 'if time will tell me something'. A light, spinning ride and possibly light weight lifting. Activity reduces the stiffness.
post #5 of 29
Quote:
Originally Posted by Baja View Post
Using ice or heat for any kind of injury today is a big question mark, in light of current knowledge.

What medical doctors often fail to tell the public are the benefits of many of these negatively-perceived symptoms like pain, swelling, and inflammation. In a healthy body, (one that is functioning properly) many of these symptoms serve a necessary role in the normal healing process.

Although we've been taught for decades to "bring down the swelling" and "decrease the inflammation," in many cases such advice is very bad advice for proper healing.

Inflammation is a healthy response to tissue injury. Without inflammation, wounds would never heal and infections would keep progressing unchecked. Inflammation starts a cascade of events including increased circulation to the area (causing the redness and heat), edema (swelling), and accompanying pain. The beneficial effects of these actions include dilution of bacterial toxins, entry of antibodies, delivery of nutrients and oxygen, and stimulation of the overall immune response.

Chronic inflammation is a different story... it's an inflammatory response that has gone unchecked and cannot complete its cycle. It forms the basis for rheumatoid arthritis, life threatening allergic reactions, and certain fatal kidney diseases.
Wow, interesting perspective. I've never looked at it that way. I've always looked at the bodies natural healing as the body self casting the injury, and gone the way of the spleen and gllbladder, necessary in the caveman but useless in the modern man.
The modern protocol is contrary to the natural healing process.
Rest Ice Compression Elevation and of course anti-inflamatories. Except rest, all are to reduce the bodies attempt to heal.
Now Therapist use RICE to reduce bloodflow, at the same time using electrical stimulation to increase bloodflow.... sounds silly.
Gotta think about this one.:
post #6 of 29
Hmm, whats the modern thinking about the old alternating hot and cold pump?
post #7 of 29
Quote:
Originally Posted by Ghost View Post
Hmm, whats the modern thinking about the old alternating hot and cold pump?
That depends on what you mean by "modern" thinking, Ghost.

In one frame of reference, "modern" thinking (re: health and healing) includes the notion that women can now take a pill to completely eliminate menstruation by suppressing the production of hormones normal to a woman's physiology. And doing so is supposedly "safe:"

http://www.medpagetoday.com/OBGYN/Pregnancy/tb/5739


This same "modern" thinking includes mandating a brand new experimental vaccine that's aimed at preventing cervical cancer:

http://www.cbsnews.com/stories/2007/...n2427919.shtml


The so-called "modern" medico-pharmaceutical idiocy we see above is based on a few essential fallacies that form the basis of "modern" medicine:

1) Living things, particularly human beings, are malfunctioning, faulty bags of chemicals that need doctors and drugs to function properly.

2) Symptoms are evidence that something is broken or "bad," and by treating the symptoms, you treat and eliminate the problem.

3) Sickness and disease is an "entity," a thing that enters into a human body, and consequently needs to be cut out, burned out, or dissolved with chemotherapies.

4) Natural, physiological functions of human beings such as menstruation, reproduction (birth), menopause, even aging... are all considered medical disease processes, and need to be handled/treated/eliminated by medical professionals.


So the philosophical question comes up: If you believe that your body can heal itself (can take in food, water, oxygen, electrical forces and convert those into new healthy living tissue to replace old or damaged tissue), and if it does that with or without any therapeutic intervention, then why should you apply ice or heat or Ben-gay or compression wraps to a non-traumatic injury? Is it because you think your body isn't intelligent enough or organized enough to heal that tissue itself?
post #8 of 29
Quote:
Originally Posted by Baja View Post
That depends on what you mean by "modern" thinking, Ghost.

Is it because you think your body isn't intelligent enough or organized enough to heal that tissue itself?
No, it's because I believe that my body has adapted as well it can, considering its environment, for the usual occurrences. It would not be efficient for it to adapt to unusual circumstances. I think that by producing an alternating pattern of hot and cold, I help my body deal with the injury. The heat draws in fluids, and the cold pumps them out, alternating the temperature increases the flow through. What's the harm in that? Optimum healing temperature not maintained? Something else?
post #9 of 29
Quote:
Originally Posted by Ghost View Post
Hmm, whats the modern thinking about the old alternating hot and cold pump?
That's been passe for several years. the current rule is never any heat the first day or 2, and 15 minutes on, 15 minutes off with the ice.
post #10 of 29
Quote:
Originally Posted by Ghost View Post
No, it's because I believe that my body has adapted as well it can, considering its environment, for the usual occurrences. It would not be efficient for it to adapt to unusual circumstances. I think that by producing an alternating pattern of hot and cold, I help my body deal with the injury.

Ghost, what do you mean by "unusual circumstances?"
post #11 of 29
An unusual circumstance would be things that most people avoid, like getting kicked and other things that would result in trauma and soft tissue injuries. I'm thinking that broken bones are better off without a high flow rate.
post #12 of 29
Quote:
Originally Posted by Ghost View Post
No, it's because I believe that my body has adapted as well it can, considering its environment, for the usual occurrences. It would not be efficient for it to adapt to unusual circumstances. I think that by producing an alternating pattern of hot and cold, I help my body deal with the injury.
Quote:
An unusual circumstance would be things that most people avoid, like getting kicked and other things that would result in trauma and soft tissue injuries.
I don't think I understand what you're saying, Ghost. Are you saying that a traumatic force that can cause injury is an "unusual circumstance," and that you don't think it would "be efficient for your body to adapt to those forces?"

IOW, you believe your body is incapable of properly healing itself of an injury unless you apply an alternating hot/cold pump?



Quote:
The heat draws in fluids, and the cold pumps them out, alternating the temperature increases the flow through. What's the harm in that? Optimum healing temperature not maintained? Something else?
Switching back and forth with applications of heat and cold to an injured area doesn't actually "increase flow" of bodily fluids. If anything, it causes disruption of the normal circulatory cycle.

Heat does not "draw fluids in," and cold definitely does not "pump them out."

Heat does tend to dilate blood vessels, and cold tends to constrict them, but that's something very different than "drawing in" and "pumping out," which is actually a complex set of physiological adaptations governed by your nervous system... not by topical applications of heat and cold.

IOW, your body's own physiology is intelligent enough to increase circulation to the injured area (via chemical, hormonal, and neurological mechanisms to dilate blood vessels for increased blood and fluid permeation) thereby increasing temperature to catalyze oxidation of toxins and poisons, increase cellular reproduction to replace the damaged tissue with new healthy tissue, and stimulate a host of other healing mechanisms... all without some outside authority (who has no idea what the temperature of any body part should be at any one time) to knock that whole process out of harmony with artificial applications of heat and cold.


So what's the harm in applying heat and cold? Well, as I described in previous posts, doing such things actually work against your body's own natural healing efforts. If you twist your ankle and it swells up, gets warm and red, and starts to hurt... it's supposed to! Why would you put ice on an area that your body is trying to make warmer? Not only that, if the heat or cold affects sensation of the injured tissue, now you interfere with another key component of your body being aware and able to communicate with itself.


So, you either must believe that 1) the body's natural healing mechanisms are perfectly designed to repair injured tissue without the interference of doctors, drugs, ointments, or thermal therapies screwing up the process... or 2) the body's healing mechanisms are dysfunctional or deficient, and hence damaging to injured body tissues.

If you believe the former, then you recognize the virtual uselessness, and potential hindrance, of applying outside therapeutic forces (like heat and cold) for simple, non-traumatic, non-life threatenting injuries. If you believe the latter, (like most "modern" medical doctors do) then there must be some fantastic explanation as to how human beings survived for thousands (millions?) of years without Neosporin, antibiotics, and medical knowledge of RICE and hot/cold pumps.


Quote:
I'm thinking that broken bones are better off without a high flow rate.
"High flow rate" of what?
post #13 of 29
Of blood and lymphatic fluid.

Actually I believe my body is very good at healing itself, much better than most Medical Doctors I have encountered. However that doesn't mean that there are not things that I can do to help it along. Physiotherapy exercises for instance, are surely beneficial.

The heat dilates vessels enhancing increased circulation. Cold constricts the area and reduces the swelling, the fluids that were present in the swelling leave the area to be replaced with fresh fluids in the next cycle.

I guess If you break your leg, you won't bother with a cast?
If you get a hernia, I suppose an operation is out of the question?
Would you take penicillin or other antiboitocs if you had gangrene?

I have found that alternate applications of heat and cold as well as gentle massage, seemed to have helped me recover from minor injuries in the past, but I am not a medical doctor, and have only anecdotal evidence.
post #14 of 29
Quote:
Originally Posted by Ghost View Post
Of blood and lymphatic fluid.
A broken bone needs increased blood flow and lymphatic drainage in order to lay down new bone tissue and carry away toxins and waste products from the chemical reactions involved in that process.

This is the reason ligaments and tendons heal so slowly... they don't have a direct blood supply, and must rely on surrounding interstitial fluid for nutrients and oxygen.


Quote:
Actually I believe my body is very good at healing itself, much better than most Medical Doctors I have encountered. However that doesn't mean that there are not things that I can do to help it along. Physiotherapy exercises for instance, are surely beneficial.
Yes, physical exercise, when appropriate, is surely beneficial for tissue that is healing and already-healthy tissue. But understand that the exercise itself does nothing to heal... and actually, does quite the opposite. Physical exercise destroys tissues, suppresses immune function, and is very toxic to the human body. The benefit you get from exercise comes from recovery... i.e., your body's adaptation and healing mechanisms after you overload it with the physical stress of exercise.

This article explains it very well:

http://www.sciam.com/article.cfm?art...B980A841890000


And realize that no doctor of any kind can heal anything... other than his/her own body.


Quote:
The heat dilates vessels enhancing increased circulation. Cold constricts the area and reduces the swelling, the fluids that were present in the swelling leave the area to be replaced with fresh fluids in the next cycle.
Did you ever injure a joint or surrounding muscle and have it swell up on you and get hot? That's the body's own thermogenic mechanisms at work, dilating the blood vessels and increasing metabolism and inflammation of the injured area.

Cold constricts the arteries and decreases blood perfusion to the injured area. It doesn't actually "reduce swelling," but instead interferes with the body's attempts to bring white blood cells, oxygen, and nutrients to the injured area.

But understand that the excess fluid from the swelling isn't stagnant. It's constantly circulating by incoming blood (which works fine if you don't artificially constrict the arterial vessels with an ice pack), and continual drainage of that fluid by the lymphatics. The body knows exactly how to supply the area with oxygen and nutrients, and carry toxins and metabolic wastes away, as long as you don't interfere with that process.

So while an ice pack may seem like a good thing because it "reduces swelling" and may decrease the pain, it actually weakens, prolongs, delays, and disrupts the normal chemical and detoxification processes that the body commences on its own.


Quote:
I guess If you break your leg, you won't bother with a cast?
Of course I'll get a cast.

But does the cast heal the broken bone, Ghost? Does a bandaid heal a cut?

Quote:
If you get a hernia, I suppose an operation is out of the question?
Depends on what kind of hernia, and what circumstances are present. I've witnessed the correction of an hiatal hernia with manual manipulation of the diaphragm and surrounding organs. But in most types of hernia, operations and mesh prosthetics are appropriate.

Quote:
Would you take penicillin or other antiboitocs if you had gangrene?
Again, it depends on which kind of gangrene and which circumstances. But probably not. If revascularization is not possible, then debridement or excision may be necessary.

Antibiotics alone are basically worthless to treat gangrene. (and hold very little value in treating anything else, for that matter, thanks to the medical profession's abuse of antibiotics for the past 30 years.) Since gangrenous tissue is ischemic, antibiotics cannot penetrate and perfuse into the tissue.

And keep in mind that your body makes its own antibiotics, Ghost. In fact, every antibiotic you will ever need can be found on the surface of your tongue.


For the record, I'm not trying to be combative or argumentative, Ghost. It just seems to me that you may have some significant misunderstandings (or misinformation) about how we humans actually heal injured tissue. I'm just offering some factual information about physiology.
post #15 of 29

The Use of Inflammation for Healing

Just came across this article this morning in one of my periodicals. It shows a practical application of exactly what I'm talking about on this thread:


http://www.chiroweb.com/columnist/hammer/


Note how there is no mention of applying heat or ice, which would wreak havoc on the complex, organized healing mechanisms taking place.
post #16 of 29
Baja, I take it you're a chiropracter?

If, so you have reinforced my opinion that chiropracters have no business calling themselves "doctors".

Nice use of the cbsnews article, BTW. Great red herring from a reputable medical journal.

At this point I'll stick with the rehab therapy that my surgeon perscribed. Which includes both heat and ice.
post #17 of 29
Thanks for your input, Harry.

So, what on this thread do you disagree with so strongly that it would cause you to attack my character, and that of my entire profession?

How is my link to the CBS article on vaccine mandation a "red herring?"
post #18 of 29
All you have to do is compared the number of amputated limbs and death by infection during the US civil War and compare it to modern day wars to see if antibiotics are effective.

If I get the clap, I'm taking drugs too!

AS to the broken bones, I would let it heal without the heat and cold therapy because the "natural" increased circulation would be sufficient, and the added effect would interfere with the fibroblasts laying down new bone.
post #19 of 29
Quote:
Originally Posted by Ghost View Post
All you have to do is compared the number of amputated limbs and death by infection during the US civil War and compare it to modern day wars to see if antibiotics are effective.

While that's a commendable observation, keep in mind the differences in hygiene and sanitation between then and now. Consider the technology and knowledge of surgical anatomy and pathology of the 1800's compared to now, and the environment these wounded soldiers were in back then: overall poor hygiene in the camps, lack of sanitation facilities, the cold and lack of shelter and proper clothing, the poor quality of food and water, the crowded conditions of the camps made them a breeding ground for pathogens and disease.

There were no attempts to maintain sterility between surgeries, because sterility and sanitation were not yet "common knowledge."

The sheer volume of injured soldiers often forced surgeons to perform amputations in 10 or 15 minutes.

Just look at this photograph of a Civil War hospital:






I doubt that antibiotic availability back then would have made any significant difference whatsoever.

And it's interesting to note how innovative Doctors like Lister, Semmelweis, and Pasteur were labeled "heretics" for suggesting their radical ideas of hygiene, to the point of being expelled from hospitals and medical societies. I can only imagine the folks back then wanting to take away their "Doctor" titles as well!

And today they are heralded as heroes, immortalized in the advancement of medical education forever.


Taking all that into consideration, antibiotics have played a very small role (albeit a role that is worthy of at least a tiny bit of recognition) in the treatment and prevention of infections. It's easy to give all the credit to antibiotics, even though they arrived so late on the scene... after the major causes and contributors to infection had already been decreased simply by improving the quality of environmental and nutritional conditions.


There you have it. Those are the facts, not just my own unfounded opinions.

But I have to say, I have profound admiration for the slick media and advertising tactics of the medico-pharmaceutical industry these past 40 or 50 years in hyping the value and necessity of their supposedly therapeutic agents and nostrums. They really have shaped the perceptions of the majority public into believing that human health and healing comes from their magic pills and potions.

That is an amazing level of influence.
post #20 of 29
Hygiene is very important in preventing infections. Unfortunately it doesn't do much once you are infected.

Let me get this straight. If you were diagnosed with syphilis you wouldn't take an antibiotic? Good luck with that!

I like to think a balanced perspective is best. You have control over some parameters, and there is an ideal environment in which your body will work best. You can help it or you can hinder it. I guess if you know no better, then the do nothing option might be safer, but it is not necessarily the best option. For example, letting a 102 F fever run its course is one thing, ignoring a 105 F fever doesn't make much sense.
post #21 of 29
Quote:
Originally Posted by Baja View Post
How is my link to the CBS article on vaccine mandation a "red herring?"
Perhaps you could enlighten me as to your intent in posting it?
post #22 of 29
Quote:
Originally Posted by Harry_Morgan View Post
Perhaps you could enlighten me as to your intent in posting it?
Certainly.

Ghost wanted to know what the "modern thinking" was on heat/cold pumping an acute injury.

Since "modern thinking" means different things to different people, I linked the vaccine article to point out the pseudoscience and danger of certain "modern" medical advice and practices. Mandating an experimental vaccine without knowing all the cellular and molecular damage it will cause teenage girls, and without any long term studies beyond 4.5 years (recognizing that the majority of cervical cancer cases happen in women between ages 30 and 50) is another clear example in a tremendous list of examples of the crudeness and barbarism of medico-pharmaceutical disease management.

Likewise with their aggressive marketing of a pill that eliminates menstruation, "treating" that healthy physiological cycle as if it were a disease too.

There are countless examples showing the overwhelming failure of the medical paradigm in dealing with health and healing issues... including the use of ice and heat in suppressing productive symptoms of injuries.


So... by explaining some basic physiological principles involved in the healing process, and comparing that directly to the heat/cold advice that is commonly given by medics, my intent was to point out how naive it is to blindly trust this sort of irrational advice just because a Doctor or surgeon gave it. Doctors of all kinds give bad advice all the time, and this heat/ice issue for musculoskeletal injuries is one of the most common.


So now... why should I be stripped of my "Doctor" title, Harry? Am I writing anything here that's false or illegitimate? You mentioned that I "reinforced" that opinion... maybe you had a bad experience in the past? Maybe you bought into some propaganda? I'm curious why you're so hostile toward Chiropractors.


Here's a fun idea for you, Harry: armed with just the few rudimentary facts about inflammation on this thread, go ask your surgeon and PT how the ice/heat therapy is supposed to be helping you. Ask them what would happen if you only did your rehab exercises and stopped using ice and heat. Surgeons love it when you ask them questions like that.
post #23 of 29
Baja,
Half of all graduating doctors graduate in the bottom have of their class.

There is a difference between blindly trusting and knowing what the opinion is. Not knowing the "modern medical thinking" is more akin to blind trust.

Since you seem willing to return to the original topic. Lets discuss how alternating 5 minutes on cold and 5 minutes on warm will affect the body's natural healing process for, oh, let's say, a bruised knee that has is swollen up to twice it's size due to being kicked on the outside of thigh during a fight.
post #24 of 29
Too far of a stretch for the vaccination line. It falls smack into the anti-medical propoganda line.

The article is in CBS, not a medical journal. It is about politics, not medicine. It is politics about vaccination, not sprain treatment.

Your response shows me that you understand little about medicine. Which is not surprising, considering you studied chiropractoring, not medicine. That is apparent in your responses here. If you understood immunization, you wouldn't be spouting your psuedo-scientific propoganda so readily.

If they are "facts" and not your opinion as you claim, then provide documentation to them. Preferably a meta-analysis of double blind studies or something equally scientifically rigorous.

I am sure that most chiropractors are well meaning, but the eduction is far less than a what is required of a doctor, and chiropratic is closer to naturopaths and other quackery than to science. I don't believe someone who gets a mail-order degree in naturopathy should be called a doctor, nor should someone with a 2 year degree in chiropractoring.

As far as my treatment goes, you can be quite assured that I ask and get detailed information on what treatment I am getting.

And as far as the natural inflammation is good, that's all well and good, unless compartment syndrome sets in.
post #25 of 29
Quote:
Originally Posted by Ghost View Post
There is a difference between blindly trusting and knowing what the opinion is. Not knowing the "modern medical thinking" is more akin to blind trust.
Yes. Exactly my point.

Quote:
Since you seem willing to return to the original topic. Lets discuss how alternating 5 minutes on cold and 5 minutes on warm will affect the body's natural healing process for, oh, let's say, a bruised knee that has is swollen up to twice it's size due to being kicked on the outside of thigh during a fight.
Didn't we already discuss this?

Check my response from June 21, 7:15 am.
post #26 of 29
Quote:
Originally Posted by Baja View Post
Didn't we already discuss this?

Check my response from June 21, 7:15 am.
Not in sufficient detail. Specifically how would gentle heating of the area increase the supply of blood, and lymphatic fluid, and how would intervening periods of cold help to rid the area of wastes. What would be the ideal temperature scenario?
post #27 of 29
Thread Starter 
What does an MRI typically cost?
TIA
post #28 of 29
Typically, about $700 - 800 for most MRI procedures, but sometimes up to $2000 - 3000. Most health insurance should cover it to help offset the cost.
post #29 of 29
Quote:
Originally Posted by Baja View Post
Typically, about $700 - 800 for most MRI procedures, but sometimes up to $2000 - 3000. Most health insurance should cover it to help offset the cost.
I just had one yesterday ... it was $520 (which seemed low to me), and my insurance covers 90%, and so it cost me $52. It was an open MRI, which I'd never had before (I've had 3 others).
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