re:"tendon and ligament healing"Posted by jspeckman on 5/11/01 at hrmin (047462)
Wanted to recommend a book for general info puposes for those who might be interested in 'alternative' approaches, in this case manual therapies.
'Tendon and Ligament Healing' by William Weintraub. Mr. Weintraub utilizes a variety of manual manipulative methods in his practice, most taught to him by the osteopathic community. He also has a masters in biomechanics.
The book is fairly dense but written for lay and practitioner. He describes in detail the CW on tendon and ligament healing mechanisms along with his own theories. His opinion is that with proper conditions and/or therapies damage to these structures can heal with much less scar tissue, improved resiliency and improved function.
The book includes several detailed case histories, none of which concern PF directly but the longest describes a long standing and advanced case of achilles tendonitis with faulty foot mechanics part of the diagnosis and treatment plan. Using a variety of soft tissue manipulations the author documents a variety of positive non surgical results both in range of motion of ankle and related joints and improvement of function.
One of the impressive things mentioned is the authors claimed ability to differentiate with palpation areas within a traumatically damaged or improperly healed tendon or ligament structure that are either too tight and short or too lax and lacking stregth.
In reading posts about night splints and morning pain on this site it seems a general opinion that avoiding shrinkage or contracture of plantar fascial tissue attempting to heal isagoaloftreatment. This has always confused me somewhat. On one hand it seems important to avoid non resilient contracture which would seem to be more prevalent to further overstretching through hyperpronation stresses. On the other hand, most of us have decreased ligamentous support of the arches as a factor in the continuing stress and reinjury to the PF. It may be that our morning tightness is our bodies attempt to regain a shorter and more functional length to provide support of the arches and the deeper plantar ligaments after a day of stretching and overelongation of tissues. This point of view raises numerous other questions and problems that I don't have answers for. However, it has always seemed to me that a PF structure under continuous stress, strain and microtrauma during weight bearing conditions would have a tendency to 'creep' or deform in a pattern of increasing elongation which would deprive us of it's support function. It may be that our sleepytime healing pattern leading to morning tightness may be our bodies attempt (however adequate or no) to regain a normal resting tone.
A catch-22, does anyone with more technical expertise have any answers here?
Sorry about the ramble, the compelling thing about above book in regards to this is that the author claims to be able to palpate areas of laxity and contracture within the same structure. For example, in the case study involving achilles tendonitis he describes an area of the tendon that is torn and unhealed and nearby areas of the tendon that are too tight and full of scar tissue. He illustrates a bunch of techniques to encourage correct healing and proper tissue tone using the science of tissue remodeling as foundation(ccomplete with footnotes).
For those posters trying ART. I know little about this specific technique but my assumption based on discription is that it is derived from several soft tissue manipulation methods. This book explains many of these approaches and also warns that forceful fascial deep tissue type pressure to fragile or imcompletely healed tissues can be quite harmful. I once had some deep work done on my feet. The practitioner noticed a knot on the plantar surface of my cuboid bone, a site where I'd had an injury a year before which had left some instability which returned once he had released the knot. I believe it is a rare thing to find a practitioner of these types of methods who has the patience and knowledge to realize that all tissues don't need to be longer. Many times a tight structure is a compensation for hypermobility elsewhere, or vise versa, mistakes made here can be a setback in our healing.