Is it Ligament Damage or Muscle Damage?

Ligament Damage

This is a question I hear from clients when I tell them they’ve damaged their ligaments and it may take longer than it would take to heal the same degree of muscle damage.

In order to fully answer this question I have to explain a little further about ligaments first…

Let’s Define Ligaments.

Ligaments are tough, small bands of connective tissue joining bone to bone. More importantly, they provide support and structure to a joint. Ligaments are made up of many fibers of collagen, a strong dense material providing the joints with strength.

They even provide feedback to the brain, telling us what position our joints are in without us having to look.

So How Badly Can They Be Damaged?

Just like a muscle, there are varying degrees of damage that can happen to ligaments. Grade one damage is where a few fibers are damaged, causing local pain in the joint. Especially in any movement that the ligament would support.

Grade two damage consists of a lot more fibers being damaged. This causes a significant amount of swelling at that area as well as restricted movement and high pain.

Grade three is a complete tear of all of the fibers. This means that the joint is no longer supported and the ligament is no longer intact. This often, but not always, requires surgical intervention to repair the damage.

How Do They Heal?

Like any damage to the body, once the inflammation stage is over, the body begins to lay down new muscle and scar tissue.

Think of it like playdoh. At first it’s nice, soft and workable. But, if you leave it alone for too long or don’t apply proper stresses to it, it becomes very hard. Therefore, it’s essential that the joint is slowly moved and stretch to return to its full range of motion.  Did you know they used to cast shoulders after an injury and cast knees after a surgery! Doing this causes a great deal of stiffness and muscle wasting. Now you’ll noticed these same patients are in removable splints or braces to allow them to get out of the protective, yet damaging immobilization so they can move and speed up recovery.

It then needs to be strengthened so that everything in that area (ligaments, tendons and muscles) can add more protection to the joint.

This is a common mistake that we see time and time again here at my clinic. Mostly with ligament injuries and especially with ankles…. A runner or sports player suffers a grade one or two ligament damage and simply ices it and rests.

All this does, is harden that scar tissue. This means that 2 to 3 weeks later it might be okay to walk on, but as soon as any stress is placed on the joint, it causes pain and restriction in the range of motion.

As a result, this makes our job twice as hard as we have to loosen up and stretch this scar tissue. Unfortunately, it also takes twice as long to repair the damage, compared to if we’d seen it 4-5 days following the initial damage.

Repeated damage is something that we see a lot of too. In this case, the ankle has too much movement because the ligaments are overstretched as a result of the repeated injury.

This makes the problem even more difficult due to the fact that even though you may feel ok, there is a high risk of re-injury.

In cases like these, I like to use this rule… if it just feels ‘alright’ or ‘ok’ then it isn’t… wait until it feels strong.  Meaning, if just walking is your goal then you are probably fine.  But if you want to return to running, cutting, twisting, jumping or changing directions then you need to be strong.

To answer the original question, just like muscles, ligament damage can be repaired. BUT it’s essential to start within 10 days of the injury once the the new tissue begins to grow. This will allow the new fibers and scar tissue to be molded correctly and thus strengthened according to the needs of the individual’s body, sport or daily life.

P.S If you’re experiencing a sports injury, click here to download my free sports injury report which includes actionable tips that I give to my patients here at Preferred Physical Therapy:

 

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Nick Hunter, PT, DPT

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