Anterior Cruciate Ligament (ACL) Injury In Dogs - Explaining the Joint and the Ligament

When a dog has been diagnosed with a torn anterior cruciate ligament (ACL) the attending veterinarian will probably suggest surgery to correct the problem.

Unfortunately, veterinarians sometimes use language that is difficult for the average dog owner to understand. This, along with the stress that the dog owner is under, makes it difficult to make appropriate decisions for the dog.

Here is what is involved in an ACL (anterior cruciate ligament) injury and its repair, explained in plain English:

In canine patients, the ACL is properly called a CCL, or cranial cruciate ligament. The term ACL refers to the same structure, but in humans. I'll be using the proper term, cranial cruciate ligament, or CCL, from here on out.

The dog's knee joint (the joint where the cranial cruciate ligament resides) is called the stifle joint. The stifle joint is composed of three major bones; the femur (thighbone in humans), the tibia (shin bone in humans), and the patella (knee cap in humans). The ends of these bones are surrounded by cartilage, the slippery stuff that allows for movement. They sit together in a fluid called joint fluid, and there is a seal around the joint called a joint capsule.

The CCL sits inside the joint, with another ligament called the caudal cruciate ligament. These ligaments cross each other, which is where the name cruciate (meaning cross) comes from. This is important later when explaining joint function.

Also in the joint are two shock absorbers called menisci (the plural of meniscus). When the stifle joint is viewed in an X-Ray, the femur and tibia appear to be separated by space - but the femur actually sits atop the meniscus - it's just that ligaments are not visible by X-Ray - so the CCL doesn't show up on an X-Ray.

The function of the stifle joint:

The stifle joint is a complex joint; but here's an analogy that might help: Think of the stifle as a hinge that can only swing two ways, forward and backward; not laterally. The center of the hinge is inside of the stifle joint. When it swings forward, it bears weight. When it swings backwards (in the swing phase of gait motion) it is non-weight bearing.

As you know, when you walk, only one foot is on the ground at any one time. The cranial and caudal cruciate ligaments are there to keep the femur in alignment with the tibia during motion. These two ligaments, which are in the shape of an X, maintain appropriate contact between the two bones.

The CCL attaches in the back of the femur and comes forward to attach to the front of the tibia. The caudal cruciate ligament attaches on the front of the femur, and goes backwards to attach to the back of the tibia. Where they cross each other is the "hinge" point.

Once you understand this, you can will have the basis to understand what happens when the cranial cruciate ligament ruptures.

Osteoarthritis of Knee Diagnosis and The Healing Process

Among the most frequent joint diseases is osteoarthritis of knee. It occurs when the cartilage suffers gradual wear and tear. According to doctors, the cartilage is a cushion layer situated between the knee bones. Also called the degenerative joint disease, osteoarthritis could as well affect other body joints. When the cartilage deteriorates, the knee joint feels stiff and sore. In the last steps of the disease, the pain and discomfort is unbearable. Consequently, the sick person could hardly walk steadily or even try to move his or her knee freely. Since the cushion between two bones no longer exists after degeneration, any movement will cause friction. This is because the bones will grind against each other. The result is intolerable soreness and discomfort.

The causes of osteoarthritis are numerous. However, not all the cases of the disease are necessarily similar, in terms of severity and frequency. The following is a brief outline of the known causes:

• Chances of developing osteoarthritis are high if you have had a serious knee injury in the past

• Being overweight is a good cause of many diseases, including this one. This is because heavy weight pressurizes the joints, as you walk. Consequently, the cartilage layer will slowly wear away

• Some cases of degeneration joint disease is gender specific

• Aging is generally the main cause of weaker joints, which eventually result to osteoarthritis

Several knee diseases show up closely related symptoms. Therefore, if you diagnose your problem, you are likely to be very incorrect. The most recommended action to take is to visit your doctor. He or she is in a position to examine your knee expertly. If you have this disease, you will generally have the following symptoms:

• Knee join soreness, stiffness and unbearable discomfort

• You will find walking as a punishment. If the knee joint cannot withstand your body weight, you cannot move properly.

• The cartilage degeneration continues to occur, as you try to figure what is happening to your knees

It is very important that you always take your health seriously. If you notice the above signs, do not take chances. Visit your doctor right away. This is fastest method of preventing more damage to the knee joints. When the physician is performing diagnosis, he or she will ask you to talk about your knee pain. In short, he or she will find out how worse the soreness gets, if, you workout and then rest. The doctor is much more likely to examine the problem with leg movement. Do not fear the check up exercise.

Your doctor might squeeze the joint slightly, but he or she may recommend an instant X-ray of the knee. The X-ray shows the exact cause of the soreness and discomfort. As some of you already know, osteoarthritis of knee disease is broad. To find out if a patient has other types of this disease, the doctor might take a blood sample. The treatment procedure could differ from patient to patient. Nevertheless, doctors recommend therapies to alleviate the knee joint pains. Generally, he or she will ask you to do the following:

• After a walk or any form of knee exercises, you should always take your time to rest

• For twenty to thirty minutes, you could place an ice cube on the painful parts of the knee. Do this everyday to minimize inflammation. It will ease the pain too.

• Take a specific over the counter cure. Never decide personally the medicine to pick between ibuprofen and acetaminophen. The doctor should guide you

• For stronger muscles and joints, you need to focus on special exercise. You need to work with a practitioner, who understands osteoarthritis of knee disease very well.

• In severe cases, physicians prescribe surgery.

How I Treated Arthritis in My Pony, Ben

My little pony Ben who was 13 h.h. that I had from a young child suffered from arthritis in his old age, Ben had a knee injury he had before I had him and I loved him to bits.

When the arthritis started to effected him he was around fifteen years of age, this is when he started to have slight joint puffiness , now this might sound strange to you but if you have a pony with this condition putting them into complete retirement could be the worst thing you could do because joints need strengthening muscles to protect them but with your vets assistance with a regular exercise program tailored to your horse or ponies needs and age, you can increases his joint-fluid circulation and get his nutrients up while getting wastes out, this will help keep his cartilage as healthy as possible. Whilst keeping his appetite up, his digestion system working properly and his attitude of well being going nicely.

Specific nutrients added to your horse or ponies nighttime feed can have a significant impact on his joint health, consult with your vet for a list of these and get him or her to help you put together a diet plan with supplements like I did as this can really help a lot.

Never change your horses diet without consulting with your vet first as this can be damaging.

I worked Ben's affected joint passively, all that this means is that I used a range-of-motion exercises to en-courage cartilage and soft-tissue healing in his inflamed joints that decreased his scar-tissue formation as this is what causes a loss of range of motion. I used a blend of aromatherapy oils and took the advice of a physiotherapist friend at the time on the best way to do this, so I was self trained but now you can get the information on the internet by using your search engine, but one of the main things to do is to gently massage, bend and straighten the affected joint or joints between 7 to 10 times.

This is the mixture I used watered down.

1) Black pepper: Commonly used for stimulating the circulation, muscular aches and pains.

2) Yarrow oil: Used to reduce joint inflammation.

3) Geranium oil: Used as a circulation tonic.

4) Juniper oil: Used as an anti-rheumatic.

5) Lavender oil: Brilliant even on its own for rheumatisms and for muscle's pain.

6) Lemon oil: Is well known for its stimulating antiseptic powers as well as being very good for arthritis.

Do you love your pony enough to have it living in your house? I did and it was the most marvelous and rewarding experience.

I used to take Ben for walks every day just like you would a dog on a lead. Ben loved to go down to the beach in the summer and would go into the sea with me, or should I say alongside me to swim, this I believe also helped him a lot, plus of course he loved doing this, he was after all one of the family. He especially liked his aroma therapy bath when we got home. I have very found memories of the way he would lift his upper lip and laugh at me when I washed him down, and run around after me like a spring chicken in the garden. Ben's last summer was such a happy one a real treasure in my minds eye.

Towards the end of Ben's life, and he lived to 32 years of age, he needed warmth in the winter because of his arthritis, so for the last winter of his life Ben slept on a huge mattress in front of our oil fired central heating radiator in our kitchen, now he could go in and out as he please into the garden, as he could open the door himself, and believe it or not he could also close it when he came back into the house. He never did a dirty in the house, and yes my kitchen door was a half stable one with an easy latch for Ben to use.

I do hope that this article helps another horse lover out there to make the most out of the later years they have with their horse or pony as I did with Ben.

Why You Need A Hinged Knee Brace

As the name suggests, this brace has a hinges in it. These hinges make the brace different from a general knee brace whose material is made from cloth. The general types are used to provide basic protection and support. A hinged knee brace provides advanced support and protection.

How a hinge knee brace is made

This brace has metal reinforcements that are connected from one end of the brace to another using hinges. Two or three hinges are most commonly used to give a stable brace. A hinge brace can either cover a thigh's lower section, upper region of the leg, or the whole knee cap region. Materials used in the brace are fabric, neoprene, various types of metal, and elastic.

This brace protects the knee from crashes and slips leading to injury. Depending on its model and make, a hinge brace can cost between $30 and $300. These braces are found in numerous colors from white, to classic black, to modern blue. With the braces strapped, you can engage in a preferred sport for longer periods of time without worrying of an injured knee. There are hinge knee braces that are tailor made for basketball of football players.

Common ligament injuries

ACL injury is a common ligament injury. It occurs when you twist without feet movement, change directions suddenly, or slow down quickly. This can lead to partial or complete tear of the ligament.

When the outside region of a knee joint is struck, it can lead to MCL injury. The knee may buckle causing the inside area to widen. When this ligament is over-stretched, it can lead to tearing or injury.

PCL is another ligament that can be injured. This may occur when there is direct impact on the front of the knee, for example, during football. When the knee is hyper-extended, it can also lead to PCL injury.

These injuries cause the knee to become unstable. Pivoting, twisting, or turning will become painful. There will be difficulty walking up or down the stairs. These injuries therefore need a brace support to facilitate healing of the ligaments. A hinge knee brace is ideal for such cases. This brace will keep your knee from twisting or bending. The brace protects your knees by controlling their range of movement. The hinges allow for adjustment on how far the leg should flex and extend.

The dynamic feature of this brace allows motion in spite of the hinges that give a rigid support to the knees. The purpose of the hinged knee brace is to control movement and give a stable support to a knee joint. The brace can also be used in case of a knee injury or surgery.

Play Doctor With an Online Surgery Game

If you have ever wondered what it would be like to operate on a person's heart or how a doctor may operate on a person's knee, you may not have to wonder for long. One of the many kinds of games you can now find online and play for free is a surgery game. This kind of a game comes in many variants and can be played either as a serious game that educates you on the intricacies and complexities of surgery or as a wacky game that makes you do crazy things with a person's body or organs.

There are a number of free games that focus on surgery online and finding them is pretty easy. You will find that there is a surgery game for the body part you are most interested in learning about or in experimenting on. There are games that make you operate on a person's heart, a person's brain, a knee, a hip and many more. Of course, those who aspire to become surgeons in the future can get their basic operation lessons at a early age and in a fun way with these games that both children and adults can play.

If you are into morbid games that show people operating on others with the use of tools that are not used in regular surgery, then you will be glad to know that there are a lot of those online too. There is a surgery game that gets you to use unconventional surgical tools to operate on your patients and these can include such weird items like a pizza cutter, a stapler, salad tongs, a kitchen knife and even a cigarette lighter. This weird yet fun game can prove to be very addictive and very funny at the same time as you try to work your way into the surgical business with the help of these tools.

Knee Maintenance and Care For Runners - Go Easy!

The human "second gear" is perhaps the most natural, simple, and effective form of exercise for our species. Walking, of course, is an excellent way to improve heart, respiratory, joint, muscular, and digestive health. Running simply pushes this benefit to a higher level. The whole body clicks into overdrive: it is the flight response used for centuries by our ancestors. Add some adrenaline to our run, and we leave our pursuers in a cloud of dust. These days, we mostly have a "personal best time" as our adversary. Yet we must also be careful; other adversaries exist that cannot be ignored.

One of the main complaints of both first-time runners and their seasoned counterparts is knee pain. Running puts considerable strain on the knee joint. If a runner is new to the sport, it is easy to over-train at the beginning. Take it slow, build your leg and joint strength. Establish a base of knee stability to prevent injury down the road. Experienced runners who are working on adding mileage for a new race distance should also take care: 10-kilometer conditioning and strength needs to be carefully modified if a 26-mile marathon is the goal. Knees will adapt to this new challenge if given the stability to do so. If two miles of moderate running cause pain at first, back off and rest. Give the knees time to stabilize.

Stability is essential to keep the knee working properly. Correct leg muscle development, obtained through gradual increase of mileage and intensity, will create stability. The quadriceps (on the front of the thighs) and hamstrings (on the back of the thighs) work in conjunction with each other, pulling on different areas of the knee at the same time. If these muscles are developed correctly, the knee joint will glide over and under itself without undue strain. Let's not forget the tiny, yet indispensable patella, as well. This engineering marvel glides over the front of the knee, adding stability and providing a liaison between thigh and lower leg bones. Thus the knee has been described by medical literature as being three articulations in one: draw a circle in the air with your toe, and you get the idea.

If more than a casual couple of miles per week are the runner's goal, it is mandatory that he or she invest in correct running shoes. People come in all shapes and sizes. Some people pronate, or roll the weight of their body to the inside edge of the foot. Others supinate, or roll the weight to the outside edge. Men and women even have different angles from hip to knee. This is why there are specific running shoes by gender. The best way to be fitted for running shoes is to visit a store that provides treadmill analysis. A shoe fitter will watch, or even video, the runner's heel strike to determine what kind of shoe is best to support the customer's body and running style. Yes, these shoes will probably be twice as expensive as the bargain-rack pair. However, to a runner, healthy, pain-free knees are well worth the price.

Novel Methods of Injury Rehabilitation: How to Heal Fast Starting From the Bottom Up

With time, we learn. Advancements are made daily, but sometimes the original concept is better. Injury rehabilitation is a great example of both progression and regression. In this article, I will show you when "out with the old, in with the new" is good for lower body rehab, and when it's best to "get rid of the new, and go back to the old!" Here we go...

Treat Ankle Injuries with METH

Let me start by telling you about my experience with METH.

The date: Tuesday July 19, 2011

The place: my backyard

It was a hot summer day, and I decided to finally trim the branches that were rubbing against my shed. I hopped on the fence behind the shed, did what I had to do, then I jumped down. The distance was a little further than I expected, and I ended up rolling my ankle over some river rock.

At first, no pain. A few hours later, lots of pain! There was no time for discomfort, though. I had a slew of training sessions ahead of me. But as the night progressed, so did the swelling and pain! By the time the last person left I could barely move, let alone walk. That's when I took action.

The standard procedure for an injury like this involves anti-inflammatories and pain-killers along with RICE: rest, ice, compression, and elevation.

What did I do?

Almost the exact opposite!

No rest and no compression - I used movement with traction instead. According to Dr. Tim McKnight (2010), rest will lead to atrophy and weakness and may disrupt balance and proper body positioning. Furthermore, compression can shut down blood flow to the area; whereas, traction will release the pressure and movement will encourage blood that is rich with healing factors, such as oxygen and white and red blood cells, to flow to the area. In addition, movement with traction reduces pain, enhances lymphatic removal of inflammation, improves flexibility, and restores normal joint alignment.

Absolutely no ice - I used some moist heat instead. Again, the key is blood flow. If you want something to heal, it requires blood! Do not slow down this process with ice. However, I did use varying degrees of elevation throughout the process. I learned this procedure from Dick Hartzell, co-author of the book Don't Ice that Ankle Sprain. (Keep in mind that this procedure is for grade 1 or 2 sprains only.)

I term this approach METH: movement, elevation, traction, and heat.

Did I take anti-inflammatories and pain-killers? Well, yes and no. I took proteolytic enzymes (natural anti-inflammatories), and I took them by the boatload on an empty stomach.

The end result: no pain and full function the next day, full leg workout 2 days later, and medicine ball circuit at a local soccer field 4 days later. This injury was rehabilitated in mere hours, not days or weeks. I bet you if I used the RICE approach, it would have taken much longer!

Bottom line: Forget RICE, do METH instead to heal injuries fast!

Volume Training for Knee Rehabilitation

Now we'll cover knee injuries, specifically post-surgery rehabilitation of knee injuries... but first let's touch on a topic that is very popular in strength training, volume training.

There are many excellent volume routines out there. One of the most popular systems involves the 10 sets of 10 reps method, like the German Volume Training (GVT) protocol that was introduced in the July 1996 issue of Muscle Media 2000. This type of routine is geared toward rapid and maximum hypertrophy - a lot of size in a short period of time!

Is it a new concept?

Not really. You will see this system scattered among the literature over the decades from various sources. For instance, in a paper originally published in the Russian journal Teoriya i Praktika Fizicheskoi Kultury, authors Vaitesehofsky & Kiselev (1989) discuss a protocol involving 10 sets of 10 pull-ups where the weight is reduced every second set (i.e., additional loading is used to start such as 9kg, then down to 6kg, then 3kg, and then body weight to finish) or the grip is altered in the latter sets to draw new, unfatigued fibers into work. Long-time Ironman contributor George Turner outlined a similar approach in his Real Bodybuilding audiotape series in the nineties.

What does this have to do with injury rehabilitation?

Well, think about it for a second. What are three things you need to reestablish after an injury, especially post surgery? If you said range of motion (ROM), muscle mass and strength, then you are correct. The quicker you can achieve these objectives, the quicker you can return to your activities of daily living and/or athletic endeavors. Intensity initially will be low because strength levels are low (pain and inflammation can inhibit strength), but in order to accomplish your objectives in short order, you must repeat a sufficient stimulus frequently. A volume training routine may fit the bill nicely if it is conducted properly.

You with me so far?

Okay, let's take a Pulp Fiction moment and go off on a tangent.

The Famous DeLorme Scheme

If I asked what the most popular set/rep scheme in strength training is, most people would respond with 3 sets of 10 reps. It seems to be the universal training prescription, but where does it come from?

The concept stems from a 1948 paper by Dr. Thomas DeLorme and Dr. Arthur Watkins where they recommend 3 sets of 10 reps using a progressively heavier weight in the following manner:

Set #1 - 50% of 10 repetition maximum
Set #2 - 75% of 10 repetition maximum
Set #3 - 100% of 10 repetition maximum

In this scheme, only the last set is performed to the limit. The first two sets can be considered as warm-ups. A few years later in their 1951 book Progressive Resistance Exercise, DeLorme & Watkins state: "By advocating three sets of exercise of 10 repetitions per set, the likelihood that other combinations might be just as effective is not overlooked." Still, the majority of trainees today automatically adopt the 3x10 scheme as if it were written in stone.

The Not-So-Famous DeLorme Scheme

Now, let's take a little journey back in time to 1945 when the same Dr. Thomas DeLorme unleashed a powerhouse of a paper titled "Restoration of muscle power by heavy-resistance exercises" published in the Journal of Bone and Joint Surgery. Back then, far more than 3 sets were recommended per exercise with great results. The clinical observations made on 300 cases showed a "splendid response in muscle hypertrophy and power, together with symptomatic relief", as DeLorme put it. Why change the system then? We'll explore that a little later, but first things first...

The 1945 DeLorme method consisted of 7-10 sets of 10 reps per set for a total of 70-100 repetitions each workout. The weight would start off light for the first set and then get progressively heavier until a 10RM load was achieved. The workouts were short (on average about half an hour), but they were repeated frequently during the week. In GVT, for instance, each body part is trained once in a 5-day period. With the 1945 DeLorme system, the injured body part is trained once a day for 5 days straight! Of course, the difference is due to the direct relationship between intensity and recovery - the greater the intensity, the more recovery is necessary, and vice versa.

If you adopt this approach, will you be sore initially?

Yup!

Will the soreness subside after a week or so?

Yup!

Will you be ecstatic with the improved hypertrophy, strength, mobility, and function after just a few weeks while others are complaining that they can barely move and are in an extreme amount of pain?

Yup!

Now, here is where it is important to read the entire paper and not just the abstract. DeLorme insists that a pulley system (common with most selectorized machines today) must not be used. Instead, use an iron boot, plate-loaded machine, or simply ankle weights to overload the terminal end of knee extension. This method will increase the overload on the vastus medialis oblique (VMO) muscle, a prime stabilizer of the knee (weakness of this muscle can impair function and cause pain of the knee.)

Of course, there are many ways to skin a cat. Terminal knee extension can be performed as a more "functional" closed kinetic chain (CKC) movement (i.e., standing with a band or cable attachment strapped behind the knee or by performing a low amplitude step-up) rather than the seated, open kinetic chain (OKC) option mentioned previously. However, DeLorme points out that weight-bearing exercises produce symptoms of pain, thickening, and fluid in knee joints that are controlled by weak, atrophied muscles. It may be best to implement CKC movements only after strength is matched in both limbs through the use of non-weight-bearing OKC movements.

Also, many patients are told to stop all activity until the pain goes away. I do not agree! I have talked about this issue many times in the past so I won't dwell on it much further; however, if you feel that you should rest the area, get some treatment here and there, and everything will return to normal, think again! You can do all the soft tissue work in the world to try to break down fibrotic tissue - the muscle will still be weak, atrophied, and hard! If you truly want to make progress, stop "pampering" the muscle and start exercising with progressive resistance. DeLorme makes that quite clear.

Back to the question: Why change from as many as 10 sets to only 3 sets?

This is what DeLorme & Watkins (1948) had to say: "In the initial publications concerning progressive resistance exercise, 70 to 100 repetitions were advocated, the repetitions being performed in 7 to 10 sets with 10 repetitions per set. Further experience has shown this figure to be too high and that in most cases a total of 20 to 30 repetitions is far more satisfactory. Fewer repetitions permit exercise with heavier muscle loads, thereby yielding greater and more rapid muscle hypertrophy."

That sounds reasonable, but before we go on let's establish two relationships:

1. There is an inverse relationship between intensity and volume (i.e., the higher the intensity, the lower the volume, and vice versa).


2. There is an inverse relationship between intensity and frequency (i.e., the higher the intensity, the lower the frequency, and vice versa).

If intensity starts to increase yet the frequency stays the same, something has to give! At a higher intensity, one all-out 10RM set can be performed 5 days a week. It's really only a total of 5 sets spread throughout the entire week. (Yes, I know that there are 3 sets performed each workout, but as mentioned earlier the first two sets are merely warm-ups.) Contrast 5 sets to as many as 50 sets (although not all of those 50 sets are taken to the limit), and you'll quickly realize why the 1948 "3x10" method was considered superior to the 1945 "10x10" method, but hold on a second. DeLorme still experienced quite a bit of success with that original method, and I do believe that it still has merit and can provide a "more satisfactory" result if it is implemented in a specific manner.

Here it goes: If intensity increases and volume stays the same, the variable that must decrease is frequency to allow for sufficient recovery. Using the 10x10 method may in fact be more superior if the frequency is altered as follows:

Stage #1: 5 days a week (Mon, Tues, Wed, Thurs, Fri)
Stage #2: 4 days a week (Mon, Tues, Thurs, Fri)
Stage #3: 3 days a week (Mon, Wed, Fri)
Stage #4: 2 days a week (Mon, Thurs)
Stage #5: 1 day in a 5-7 day period

Now, how long each stage will last will depend on the individual and their injury, but the key is to make progress each week and once that starts to stagnate, it's time for the next stage. Think of it as progressive resistance meets regressive frequency! By Stage #5, muscle strength, mass and ROM should be back to normal - this is the frequency used in most volume training routines.

Try this new twist to the original concept introduced by Dr. DeLorme over 60 years ago.

Here are some take-home points:

• Read an entire study not just the abstract, and as much as possible check the references.


• The 10 sets of 10 reps method is by no means a new method, nor is it meant strictly for bodybuilders. This form of volume training may be an excellent way to rehabilitate an injury.


• The primary objective during injury rehabilitation is to restore muscle strength, hypertrophy and range of motion. Endurance training can be counterproductive to these objectives and should only be implemented when strength of the limbs involved are approximately equal.


• During injury rehabilitation, pursue active (not passive) treatment with the use of progressive resistance exercises conducted at regular intervals with maximum effort.

Captain Thomas L. DeLorme, M.D., a renowned orthopedic surgeon at Massachusetts General Hospital, developed some novel methods to speed up the rehabilitation of injured soldiers during World War II. A true pioneer in the strength game, Dr. DeLorme passed away on June 14, 2003 at the age of 85, but his concept of progressive resistance exercise lives on today.

References available upon request.