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Mechanize better ligament and muscle and tendon scars

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The transformation of a damaged tissue in an efficient structure conjunctiva usually goes by the destruction of an anarchic scar followed by a "mechanization" progressive. Trying to take stock of the various techniques available to complete this process. In light of several studies, thanks to the advice of experienced practitioners and using our good scientific sense, trying to clarify the modes of action and indications for each of these methods. Explore further the potential synergy between mechanical stress and nutrient intakes in order to promote healing.

Limit fibrosis formation!

A violent macrotraumatisme is causing bleeding causing the arrival of nonspecific cells. In emergencies, they are trying to produce a fibrous tissue interposition. When the accumulation of strain, the cleansing process of the injured areas cause local inflammation followed by fibroblast invasion. Again, repair bad driving may be the cause of an anarchic fibrous tissue without high mechanical efficiency.

Reduce bleeding!

Minimize bleeding is the first the first step in the fight against fibrosis. A surgeon removing a huge clot in a large muscle damage easily imagine that an anarchic tissue interposition would probably have scar office! Sometimes it is the aspiration of the hematoma or hemarthrosis which is the saving gesture. But in the absence of intervention or puncture the GREC (G = Ice, R = Rest, E = Elevation, C = Compression) contributes effectively to drain the blood effusion. When strict immobilization is required, the risk of joint stiffness is particularly limited when introduced after complete disappearance of the swelling.

Control inflammation.

Within 2 days following trauma, it is usual to advise against the use of anti-inflammatory. Indeed, like aspirin, but to a lesser extent, they inhibit platelet aggregation and increase bleeding. According to some practitioners, the focus of lesion debridement through inflammatory processes would be useful for improving healing. The chronology of acute inflammatory phenomena helps justify the latency requirement. Neutrophils begin to invade Locations 2 hours after the trauma. They reach a peak 2 to 4 hours later. They release collagenase and elastase for the "digest" the damaged fibers. Macrophages then arrive. They disposing of waste by phagocytosis for 24 to 48 hours. Prescribed from the third day and for at least 4 days, NSAIDs would avoid the installation of a chronic inflammatory syndrome source of permanent tissue damage or anarchic fibrous scarring. DAHNERS (1) showed that the anti-inflammatory brought maximum benefit on the healing of ligament in rats if they were prescribed at 6 days post-traumatic.

In case of strain, the reasoning is neighbor although the term tendinopathy will be imposed to replace the tendinitis. Indeed, the suffix "itis" indicates inflammation more than exist in reality. However, old tendon fibrosis again become painful when they injure in favor of a mechanical overdrive. Each microl├ęsion then raise a local inflammatory process often causes a beneficial remodeling! Therefore, NSAIDs may be the basic treatment of tendinopathy. In practice, during the 48 hours of pain caused by d├ęfibrosante technical or sporting activity, it is recommended to respect the "cleaning" inflammatory. Two days later, it would be logical to advocate approximately 4 days of NSAIDs to prevent the formation of a new anarchic fibrosis.

Check the mechanical stress

A study by BOORMAN (2) showed the deleterious effect of a full stop. It causes uncontrolled fibrosis at the origin of a reduction in the mechanical efficiency of the conjunctiva structure with disorganization of collagen fibers. The neo-ligament is more distensible and more fragile as would a smaller, thinner elastic. The capital may lack occasioned a veritable "nonunion ligament" responsible for chronic laxity. More often, there is the persistence of a capsular inflammation low noise gradually evolving into a scar and fibrous thickening.

As part of sprains, no study seems to make the point with the most efficient mobilization modalities. Only the demonstrated superiority splints directs us to preserve the spontaneous movement in nontraumatic sector. The good scientific sense invites us to undertake early rehabilitation including drainage and gentle and painless mobilization in all physiological mobility sectors. Regarding muscle damage, a baseline survey was conducted by Plaghki (3). He placed a muscle fascial ground material in a bag always inserted in a living rat paw. The spontaneous movement of the animal enabled him to find, several months later, muscle cells and well oriented myofibrils. JARVINEN (4) showed that early mobilization after a breakdown favored resorption of the hematoma, the formation of new blood vessels and the regeneration and alignment of muscle fibers.

Massages Deep Transverses

It is conceivable that the MTP have a mission to break the fibrous scars anarchic and stimulate the repair process. Gehlsen (5) showed that MTP increased the number of fibroblasts available for debridement and conjunctiva restoration. Conventionally, the MTP are not essential to optimize natural healing: they are indicated in cases of pain compared to a fibrous area, continuing beyond the usual recovery period. However, the experienced field physiotherapists "rub" is often a bit earlier and more consistently ligaments and muscles during healing. However, it is advisable to wait for the disappearance of the swelling is at least ten days after trauma that caused bleeding. Areas of bony insertions ligament or tendon accessible finger proposes a "basement hard" potentiating technique. They are in fact a good indication to the MTP.

Shock waves

The shock waves are typically considered "super MTP". ROMPE (6) showed that this technique caused, thanks neovascularization, proliferation of tenocytes and regeneration of tendon structures.

It is customary to push the indications of shock waves to the old scar and fibrosis. However, apparently Recently tendon suffering often correspond to reactivate old fibrosis. If the examination or imaging confirmed, percussion are effective. Areas of bony insertions respond poorly to this "very energetic" method. Patellar tendinitis advanced exception to the rule. Indeed, the inevitable mobility of this bone probably dampens party in the impact of the shock waves. In addition, the shin, rather matching fascia injury, readily benefit from this method. For land practitioners shock waves or MTP can be followed without scruple a work eccentric or plyometric sport. If the pain gives way to warm up, it is likely that these activities combine synergistically to contribute to the 'mechanization' conjunctiva.

the laser

The laser is a beam of light waves emitted in phase. It spreads without distractions and can carry considerable energy. In contact with tissue, the latter is transformed into heat or mechanical force. These phenomena are well described by MORDON BRUNETAUD and (7) of the INSERM LILLE.

From 50 to 60 degrees fibrous proteins denature photocoagulation. Subsequently, we observe debridement and interesting healing process for treating scars anarchic in sports traumatology. Above 100 ┬░ occurs photosection fabric by carbonizing organic molecules. It is used in surgery. The laser energy causes the ionisation of many atoms. The electrons accumulate and create an electric field. The pressure gradient gives causing molecular and micro-shock waves explosions. Fibrosis is broken. Healthy tissue may appear after cleansing and healing.

The mode of action of the laser guide us towards its indications. This effectively shows defibrosing. It nevertheless differs somewhat MTP and shock waves. His indolence enables earlier use. In broad sweep, it allows to overcome such diffuse adhesions observed after the extensive bleeding.


The vibrating platforms cause vertical movement whose frequency varies between 30 and 50 hertz. The vibrations can be considered as a succession of micro-stretching. The stretch reflex can support a higher load at 20 hertz. After 15 to 30 seconds of work at this intensity, this reflex is exhausted and inhibits. This phenomenon promotes muscular and fascial relaxation. SANDS (8) in 2006, showed that the vibrations provide an amplitude gain in high-level gymnasts. Comparably, it is conceivable that the result sedation contractures "protective pseudo" in the vicinity of fibrotic scars. In this context, the vibrations would prove more effective than a slow stretch not involving the stretch reflex. Indeed, vibration "m├ęcaniseraient" more effectively than a connective enraidi tensioning. Combined with other rehabilitation techniques, a "workshop vibrations" could integrate with the management of tendinopathy and fibrous muscle damage. Of course, studies are needed to confirm these indications and establish treatment protocols.

Stretching and eccentric work.

Of course, these stresses further damage fibrotic scarring anarchic. But, in addition, they guide the tendon and muscle healing in the axis constraints. Fahlstr├Âm (9) showed in 2003 that the originator protocol Stanish enabled clinical improvement in 89% of corporeal tendinopathy and only 32% of enthesopathies. Shalabi (10) shows an increase in volume in MRI tendon at the end of the same management.

Conventionally, the rest is needed in acute tendinitis and immediately after an injury to a muscle. Some doctors believe that premature stress can cause real "fibrous nonunion" type of tendon or muscle cysts. In practice, sports traumatology, field practitioners offer a discount in early but gradual restraint, guided by the rule of non pain. The terms of the eccentric work can be subtly dosed. The internal running, low resistance and especially the slowness of the gesture used to mechanize without attacking. A distance, when "anarchic hypercicatrisation" was formed, the effective working eccentric, does not exclude pain! It becomes energetically defibrosing as MTP or shock waves. It revives the Stanish dogma: "No pain, no gain."

The pursuit of sports.

In most cases, continue the sport is authorized and even recommended. In case of injury, the young footballers PSG still have a maintenance protocol of fitness. One of the golden rules is to separate the physiological stress of biomechanical constraints. For example, cycle helps maintain his heart and muscles without imposing eccentric loads tendon. Achilles tendon and patellar tendinopathy does not suffer and enjoy a fresh mechanization. Even in this context, the eccentric sporting practices are not prohibited, they contribute to the harmonious healing! The injured can begin plyometric work with the help of Archimedes; he was invited to water aerobics and jumping in the water. Shortly after, the time course and increasing speed is a "no hypocrite" rehabilitation. It allows to renew gradually with the specific constraints of the discipline. It takes the pain disappear and reappear warming up during or after exercise. In this case, we consider that the anarchic adhesions formed upon standing were sold early in the year. His pursuit has not aggravated the injury but, on the contrary, contributed to the tissue mechanization!

An optimized power supply.

A balanced diet contributes to the development of a quality connective. Adequate hydration improves drainage poorly vascularized tissue. The body of the tendon is considered "vascular dead end." It benefits of good hydration to optimize metabolic exchanges and eliminate uric acid crystals or cholesterol that might accumulate. In practice, we can advise injured athletes to drink to always have clear urine.

An insidious metabolic acidosis climate promotes the formation of uric acid crystals aggressive for the connective fibers. It is recommended to move towards alkalizing diet. But beware, fruits and vegetables, especially citrus fruits and tomatoes are not discouraged! On the contrary, despite their slightly acid taste, the metabolism of these food product a significant amount of citrate and malate particularly alkalizing. The bicarbonate waters such as Vichy or Badoit are welcome. However, it is imperative to avoid sodas and sweets protons big producers. To a lesser extent, it is recommended limit other acidifying foodstuffs. It is advisable to reduce red meat 3 to 4 weekly rations. The hard cheeses will be readily replaced with other dairy products.

An adequate intake of micronutrients

Zinc and copper to the structure and function.

FAVIER (11) recalled that zinc was the cofactor of over 200 METALO-enzymes involved in protein and nucleic anabolic processes. It helps to stabilize the spatial form of many proteins. Copper is the coenzyme of lysyl oxidase involved in the synthesis of collagen and elastin. For electrical connection with organic macromolecules, copper forms "biochemical bridges" or "cross link" between many connective tissue proteins. Thus it contributes to the cohesion of tissues. These two trace elements also activate many inflammatory proteins. In cases of trauma and excitement of these processes, they are requisitioned. The dietary intake of zinc (meat, eggs, dairy products) and copper (liver, cereals, legumes) can be occasionally insufficient. A relative deficiency may develop. Copper and zinc are then unable to ensure their functional or structural missions. That could justify a temporary complementation oligotherapy.

Silica for the architecture of the connective

Silica Molecular architect

Silica is another key architect of our tissues. It is present in large quantities in the earth's crust but also in our connective. There are 4.5 billion years, the slips of clays in the vicinity of the sea would have been the scaffolding behind the organization of organic life. These structures have formed true "informational matrices" essential for the polymerization of proteins and nucleic acids. Huguet (12) in 1991 recalls the involvement of the silica in the macromolecular structure of the connective tissue.

Silica: Cell architect

The silica was also involved in cellular organization. The stromatolites are curious mounds minerals strip appeared there 3.5 billion years. Rich in silica and calcium carbonate, they house the filaments of the first cyanobacteria. These buildings have contributed to the appearance and organization of multicellular life. These sheets of silica and calcium carbonate were the first exoskeletons, both structural and protective. Thus, for billions of years of living connective, either bone or flexible, is built around mineral components!

Silica: inorganic and organic architect

Silica has more ink than the calcium, integrated in body tissues. In fact, silicon is adjacent to the carbon in the periodic table of Mendeleev. This ambivalence silica between organicity and minerality is such that NASA does not rule out looking for living beings formed around the silicon to carbon instead. Like him, he can establish connections 4 with hydrogen, nitrogen or carbon. Its electrons are less available and the connection is not quite covalent. In fact, the macromolecules of the connective connected by the silica form a "plasma" elastic. They slide slightly on each other. This "flexible cohesion" is essential to the restoration of a connective quality, fit in their particular mechanical stress to the musculoskeletal system.

Silica: animal and vegetable architect.

Food provides us with silica. Present in the earth's crust, it passes in moderate amounts in certain mineral waters. Indeed, it remains soluble at very low dilution, less than 10 mg / l. In addition, silicon polymerizes and loses its bioavailability. Plants benefit of the silica present in the soil. It lacks the use to structure their "cellulosic connective". In fact, it is found in abundance in the stems, leaves, roots and seeds of envelopes. Unfortunately, the low digestibility of these structures significantly alter the absorption of the silicon content in fruits, vegetables or whole grains. After injury to the musculoskeletal system, to promote the harmonious connective healing, it seems appropriate to consider supplementation with a readily bioavailable silica.


1 THE Dahners, JA Gilbert, GE Lester. The effect of a nonsteroidal Antiinflammatory drug on the healing of ligaments. The American Journal of Sports Medicine, 1988.

2 RS Boorman, NG Shrive, CB Frank. Immobilization Increases the vulnerability of rabbit medial collateral ligament autografts to creep- Journal of Orthopaedic Research, 1998.

3 L Plaghki. Myogenesis and regeneration of skeletal muscle - Journal of Physiology (Paris), 1985.

4 M Jarvinen - Healing of a crush injury in rat striated muscle. 3. A micro-angiographical study of the effect of early mobilization and immobilization on capillary ingrowth Acta Pathol Microbiol Scand [A], 1976.

5 GM Gehlsen, RS Ganion, R Helfst. Fibroblast responses to variation in soft tissue mobilization pressure - Medicine & Science in Sports & Exercise 1999

6 Rompe JD, CJ Kirkpatrick Kuellmer K, M Schwitalle. Dose-related effects of shock waves on rabbit tendo Achillis - Journal of bone and attached surgery- British volume -1998.

7 JM Brunet, Mordon S, T Desmettre, C Beacco. The therapeutic applications of lasers - Photonic Orsay, 2002 -

WA 8 Sands, JR McNeal, MH Stone, EM Russel, M Jemni. Flexibility Enhancement with Vibration: Acute and Long-term. - Medicine & Science in Sports & Exercise 2006

9 M Fahlstr├Âm, Jonsson P, R Lorentzon, Alfredson H. Chronic Achilles tendon bread Treated with eccentric calf-muscle training - Knee Surgery, Sports Traumatology, Arthroscopy, 2003

10 A Shalabi, M Kristoffersen-Wilberg, L Svensson- Eccentric Training of the gastrocnemius-soleus in Complex Chronic Achilles tendinopathy Results in Decreased tendon issue and Intratendinous Signal as Evaluated by MRI
American Journal of Sports Medicine, 2004.

A 11 Favier. Medical-surgical encyclopedia. 10 p. Paris .1990.

Huguet 12 C, F Regnier, R Said. Trace elements in medicine and biology.
Chappuis P (ed) -Tech & Doc, Paris, 1991.

To know more:

Internal Medicine. Principles and Practice. DAVIDSON.
MALOINE Editions.

Sports medicine for the practitioner. Hugues Monod.
DWIS Editions

The recent ligament injury. Jacques Rodineau Gerard Saillant.
Editions MASSON

Where is life? Marie Christine Maurel.
Editions THE APPLE.

Human origins. Erick SEINANDRE.
Editions LAROUSSE.

Recommended dietary allowances for the French population. Ambroise MARTIN.
Editions TEC and DOC

The ABCs of trace elements. Nicolas BLES.
GRANCHER Editions.

Silicon. Discreet health Architect. Michel MASSON.

Thanks for the transmission of knowledge and experience, to

Tania BELLOT. Traumatology Sport Centre La Defense. 92800 PUTEAUX.

Sylvie BESH. Orthopaedic Surgery. Hospital MERCY-SALPETRIERE. 75013 PARIS.


Jacques DE LECLUSE. rehabilitation and sports traumatology service. National Hospital SAINT MAURICE. 94415 SAINT MAURICE.

Franck LEGALL. National Technical Centre of Football. CLAIREFONTAINE 78120.

Author: Dr St├ęphane Cascua
Sports Traumatology Centre of Defence.
Patio Pyramid. 92800 PUTEAUX

Doctor St├ęphane CASCUA. - 24 janvier 2009.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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The Iroman lack of iron, the other sports too!

Doctor St├ęphane CASCUA.

Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.

When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.

Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.

When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.

You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!

That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.

The bone is strengthened or crack in contact sports

Doctor St├ęphane CASCUA.

Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.

Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.

Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.

Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.

Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!

In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.

After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.

If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.

Technical cruciate ligament

By Dr. Nicolas Lefevre

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