Information on Tendon/Ligament Recovery
1. Overview for recovery, a new model
2. Self-help strategy
3. Case account (Julia L.), a new model for recovery
4. Tissue changes in the healing process
 


1. Overview for recovery

The standard medical view of a serious ligament or tendon injury is that non-surgical treatment has almost no chance of success once the injury has become chronic. I have found that people in chronic cases who have exhausted the standard physiotherapy and are facing surgery can have a viable option for recovery (portrayed thoroughly in the book).

The vital elements of the author's approach for healing from these sports and overuse injuries are:

  • The healing capacity of tendons/ligaments is greater than seen in the standard medical model
  • A fresh view of healthcare principles in a new approach to chronic injury
  • Manual therapy offers major benefits for recovery in serious cases
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2. Self-help strategy

Learn to find a baseline for experiencing the area around the ligament or tendon as fully relaxed. Prolonged excessive tension around an injury is very common and is an obstacle to recovery. Relaxation of the area can be enhanced by mild heat (sometimes in alternation with cold), exercise not straining the area and involving the whole body, use of imagery, baths, biofeedback or meditation. 

A skilled manual (hands-on) therapy session (with much caution for direct pressure in an injured area) can deeply relax the area. Once you experience relaxation, you can monitor the area on an ongoing basis with this baseline as a comparison to sense when it is doing well or becoming overly tight. Your memory of the relaxed state is a body experience and recalling it will reduce tension. 
( From book's chapter on "Self-Help Strategies") 

With any serious injury, medical consultation is advisable.

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3. Case account ( Julia L.), a new model for recovery

Julia L. is a lifelong dancer who was very discouraged when she initially consulted me for a persistent problem with her right knee. A tall woman of 42 and now co-chair of a University dance department, she had stopped her workouts and was unable to demonstrate for her classes. 

Fifteen months earlier, when starting to dance after prolonged sitting on the floor of a cold studio, she noticed pain and stiffness of her posterior, lateral knee which became a constant ache and burning sensation. This had continued and worsened despite various medications, physiotherapy, chiropractic, and periods of rest. 

She was unable to bend her knee with any weight-bearing without weakness and a lot of pain. She was quite disconsolate as she had been forced to reduce her teaching schedule and worried about her future in the profession to which she was very devoted. 

An MRI scan revealed a substantial tear of the biceps femoris (lateral hamstring) tendon behind the knee joint. Four months after the initial injury two orthopedic surgeons felt there was no longer a realistic hope of recovery with conservative care. They proposed surgical repair of the tendon. 

In November, 1996, Julia agreed to my suggestion of three weekly treatments to see if the structural/osteopathic therapy I practice could help her injury. I found significant swelling of her posterior knee, along with adhesion, weakness, "stringiness", and a twisted alignment pattern of the tendon fibers as well as a palpable divot in the tendon where it had been torn. I used gentle techniques to specifically free, align, and tone the tendon fibers, as well as freeing restrictions of her lower spine and lower abdominal viscera. 

Julia was co-operative in maintaining reduced activity levels and a moderate exercise program. We both noticed that gradually her range and ease of knee joint mobility was increasing, swelling and inflammation was reduced, and pain was subsiding.

After 5 weeks the frequency of treatments was reduced to 2 and then 3 week intervals. I continued to treat restrictions of her calf muscles and fascias, damage to the neighboring popliteal tendon, and a stubborn fixation of the ankle joint and cuboid bone in her left foot. 

After 10 weeks (January) she could climb a flight of stairs without pain and comfortably walk one mile with moderate hills. She was optimistic enough to be choreographing a piece in which she hoped to dance. With continued manual therapy techniques the tendon fibers had been re-aligned, their tone strengthened, adhesions almost eliminated, and the defect in the tendon was filling in well. 

At sessions in February and then in early April Julia could extend her knee completely and flex it to 110 and then 135 degrees comfortably with weight-bearing (within 5 degrees of normal). She was demonstrating for her classes with progressive ease and increasing her workouts. I found that the torn part of the tendon was very close to being intact and that the texture of the whole tendon was more resilient, "bouncy", with almost no laxity. 

Treatments went to one -month intervals and in September, 1997, Julia received two orthopedic evaluations of her knee as being normal. At that time she was very relieved and happy to resume a full teaching and workout schedule. She continued to feel quite well as of January, 1998. 

Julia's story (in Chapter One of Tendon and Ligament Healing) is very hopeful considering the extent and duration of her tendon injury. Hers was one of the large numbers of seriously damaged tendons and ligaments which become chronic. The primary techniques I used in Julia's case (and in all of my practice) are the osteopathic methods of Strain-Counterstrain, cranial and visceral osteopathy, and Fascial Release, as well as Body-Mind Centering. Also utilized are techniques from Zero Balancing, and from acupressure therapy. 

All of the methods individually and sometimes in combination have valuable aspects for treatment of tendons and ligaments, illustrated in the book. (the cases are from William Weintraub's practice)

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4. Processes and tissue changes during healing

I directly observed all these changes for the tendon/ligaments during recovery from sports and overuse in each of the case accounts:

  • reduction of excessive cross-linkage and adhesion of its fibers, bundles of fibers, and surrounding structures
  • reduction of excessive muscular and fascial pulls on it
  • restoration of normal mechanics to its adjacent joint(s)
  • improved vascular flow through the area
  • reduced inflammation
  • restoration of its normal parallel fiber arrangement
  • improved, normalized neural function (e.g. localized decrease of hyper-reactivity)
  • restoration of adequate length, deformability (pliability) and extensibility
  • proper modeling and re-modeling of its tissues
  • decreased laxity - increased strength, tone, resiliency.
Tendon and Ligament Healing also portrays other changes observed in the healing process, and relates all of them to hands-on osteopathic-style therapy methods which may assist these improvements -- illustrating them in seventeen case accounts, two with thorough flow charts.

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About the Book | About the Author | Recovery Information | Resources | Glossary | Purchase 

Copyright © 2003 William Weintraub, M.S.
Prefaces by Fritz Frederick Smith, M.D. and Jean-Pierre Barral, D.O.

Second, revised edition by Paradigm Publications