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Metro: Saint Marcel
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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.
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.
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.
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.
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.
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.
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 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.
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."
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!
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.
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 - bibsciences.org
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.
Internal Medicine. Principles and Practice. DAVIDSON.
Sports medicine for the practitioner. Hugues Monod.
The recent ligament injury. Jacques Rodineau Gerard Saillant.
Where is life? Marie Christine Maurel.
Editions THE APPLE.
Human origins. Erick SEINANDRE.
Recommended dietary allowances for the French population. Ambroise MARTIN.
Editions TEC and DOC
The ABCs of trace elements. Nicolas BLES.
Silicon. Discreet health Architect. Michel MASSON.
Tania BELLOT. Traumatology Sport Centre La Defense. 92800 PUTEAUX.
Sylvie BESH. Orthopaedic Surgery. Hospital MERCY-SALPETRIERE. 75013 PARIS.
Herv├ę OF LABAREYRE. Clinic LILAC. CEPIM. THE LILAC 93260.
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
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