Healing and Helping Orthopedic InjuriesOct 01, 2019 07:54PM ● By Ariana Rawls Fine
Did you know we can utilize complementary techniques, tools and resources to help orthopedic injuries heal, whether they require surgery or not? There are ways to strengthen the body with bodywork, nutrition and muscular strengthening or manipulation to proactively avoid injury.
“First and foremost, it is important to keep our joints moving as soon as we are physically able,” says Michelle Quigley, who practices advanced orthopedic massage and biodynamic craniosacral work in her Weston-based practice. “When we become ‘stuck,’ it becomes a pattern of tension. By bringing a client’s body back into balance and teaching them techniques to maintain that balance, I can help them stay away from recurring injuries.”
In orthopedic massage work, there is a constant assessment while working on a client as Quigley releases the tight muscles and encourages the long muscles to go back to their normal lengths. For example, a lot of back pain can be caused by continuously sitting, sleeping in the fetal position or otherwise not working this set of muscles. The gluteal muscles weaken because they are being used less. The lower back muscles then are overworked when the gluteal muscles aren’t activated and firing efficiently.
Another example deals with scar tissue after an injury or surgery. The fascia gets increasingly thicker the more it doesn’t move. Since scar tissue lies down along the line of motion, we need to keep moving the joint, otherwise the scar tissue is haphazardly laid out with an immobilized joint, Quigley says.
If someone comes in with an old strain or injury, massage can still help by working the muscle and then treating the microtear with multidirectional friction, contracting the muscle and lengthening to help scar tissue lay down in the correct line. Patients can also learn to strengthen and stretch at home to bolster the effects of the release gained from the massage treatment.
“So many symptoms of nerve-related diagnoses are caused by nerves that can’t glide or slide freely due to muscle or joint compression or restriction. Massage techniques, combined with gentle cupping, can free up the tissue surrounding the nerve—like unblocking a garden hose,” explains Quigley.
From an orthopedic perspective, there may be little or no meniscal damage evident on an MRI for a knee injury, for example. However, the joint above and below affect the functionality of how everything is working together, says Dr. Perry Perretz, a Georgetown-based osteopath. He uses osteopathy, acupuncture, prolotherapy and neurotherapy in his Advanced Pain Solution practice.
The pain could be caused by muscles recruited by the nervous system to work harder because of microtears. One of the treatment options Perretz uses for this issue is prolotherapy, a simple injection of sugar, which creates a distress signal to the body. When we simulate that trauma with the injection, the body reacts with inflammation, which is critical to the healing experience. Perretz points out that prolotherapy usually is best for those who are past the acute injury stage. The protocol is to locate the weak spots and inject them with sugar to trigger healing properties; it is a short visit with a couple of weeks in between visits to let the body heal.
“The osteopathic philosophy is about the body knowing how to heal itself; our job is to find what it needs,” says Perretz. “If the bone underneath is already scarred, the blood can’t efficiently get to the cartilage. Sometimes a surgery goes well at the level of the prosthesis but not so well at the suture area or the surrounding areas. A patient may not be healing well. Or maybe the general anesthesia worked well but the local may have worn off sooner, instigating a local trauma. Using neurotherapy, we can re-anesthetize the scar tissue to help reduce or eliminate leftover chronic pain. In essence, we shut off the signal that the hurt tissue is sending by resetting it.”
The business of healing is complex, says Dr. William G. Cimino, a board-certified orthopaedic surgeon specializing in foot and ankle reconstruction at Beach Road Orthopaedic Specialists and Physical Rehabilitation Center in Fairfield. He stresses how powerful an effect simple changes in basic behaviors can have on our health; if our bodies are physiologically better, we will heal better from orthopedic traumas. "We need to look at how we manage our time to create space for diet, exercise and family. A mindset of healing influences our ability to heal as well," he explains.
Cimino encourages good nutrition, including a multivitamin and close to 2,000 mg of vitamin C, which helps with collagen production and repairs, every day for healing orthopedic injuries. Many physicians recommend 2,000 IUs of vitamin D for general orthopedic health; the vitamin also helps with calcium absorption.
“One of the biggest impediments to orthopedic healing and maintenance is smoking. Among other issues, smoking inhibits vitamin C absorption. This can lead to a five-fold increase in complications from surgery, and wound healing is a big concern for smokers,” says Cimino.
“[Smoking] has been shown to adversely affect bone mineral density, lumbar disk disease, the rate of hip fractures and the dynamics of bone and wound healing,” said researchers Scott E. Porter, MD, and Edward N. Hanley, Jr, MD, in a 2001 study published in The Journal of the American Academy of Orthopaedic Surgeons.
Since the process of healing begins with inflammation, anti-inflammatory medications, such as prednisone and methotrexate, can suppress the healing process and the immune system’s ability to fight illness, says Cimino. Diabetes and even genetics can also determine how efficient the healing process will be. Dietary changes, such as eliminating gluten, may be suggested for those who experience inflammation, feelings of malaise or pain from certain foods.
“We need to remember that the physiological process of healing takes time. Those realistic expectations, a more positive general frame of mind, contentment with our social situation and other factors can help support our healing,” says Cimino.
Ariana Rawls Fine is a writer and contributor to Natural Awakenings Fairfield/Housatonic Valley. She resides in Stratford with her family.
Perry Perretz, DO
William G. Cimino, MD
Specialists and Physical Rehabilitation Center