Laurie's Blogs.

Laurie,

This has been on my mind for a while, and I really want to understand it.

As I understand it, a grade 1 sprain involves minimal disruption of fibers and no disruption to stability. So CAN these fibers "heal"? As in can we make the ligament as strong and robust as it once was? Do new fibers develop? If I have a grade 1 CCL strain, I've seen from your excellent handout that PA glides can "stimulate normal healing alignment". Does this mean the disrupted fibers align themselves as they heal? 

Am I correct that a grade 2 sprain with enough fiber disruption to result in instability, won't be able to "heal" and the best we can do for this situation is to strengthen the adjacent muscles to provide the best support to the joint that we can (assuming conservative management). 

In the case of a grade 1 sprain, how do I know when the ligament is healed enough to strengthening? I assume uphill walking can begin when the patient is pain free and back to FWB. Is this correct?

I appreciate your help in understanding this healing process.

Best regards,

R

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Hi R,

So... Grade 1 - yes these fibres can heal, and if all goes well, heal just as well as previous.  New fibres to develop, and 'low loads' of normal stress through the affected structure can help them to align  properly.

Grade 2 can heal, but it will be weaker.  Unfortunately, grade two can be anything from a small tear in the sheath to just hanging on by a thread... And, there is a huge difference between the 'heal-ability' of the two!  So absolutely muscular support is key to stability.

Grade 1 - start to strengthen asap!

Grade 2 - pain management for about a week, and then start to strengthen (easy at first and progress as tolerated)

Some degree of strengthening can occur at pretty much any stage... you just slowly build up

When you say uphill walking, you must be thinking of a specific type of case - CCL? - you don't say, so I am only guessing.... 

If I had a grade 1 CCL, then I'd start the first week with 3-leg stands, cavaletti's, backing up... and modalities for ligament healing.  Then by week 2 you could likely add in more strengthening.  As long as it is specific / controlled / slow & within tolerance...it should be good!

Does that make sense?  Is it helpful?

Laurie

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Laurie,

This is tremendously helpful! I'm so grateful for your taking the time to respond. I think a blog post on general approaches to healing ligaments would be SO helpful. This information is hard to find in this kind of clarity. This will help me help my patient. Thank you.

Best regards,

R