SOFT TISSUE INJURIES In 2005, it was concluded that no treatment currently exists to restore an injured tendon or ligament to its normal condition. In addition the current standard of ligament research, in 2013 it was concluded that ligaments do not feel independently, but damage ligaments are a direct cause of osteoarthritis and biomechanical dysfunction (abnormality of joint mechanics). The latest research has also concluded that ligament damage or sprains is the key element in osteoarthritis and not simply aging or wear and tear on the joint. Thus, it is now clear based upon the scientific evidence that a soft-tissue injury is a connective tissue disorder that has permanent negative sequella, and is the cause of future arthritis. This is no longer a debatable issue, and those in the medical legal forum who are still arguing “transient soft tissue injuries� are simply rendering rhetoric out of ignorance and a possible ulterior motive because the facts clearly delineate the negative sequella based upon decades of multiple scientific conclusions. The caveat to this argument is that although there is irrefutable bodily injury with clear permanent sequella, does it also cause permanent functional loss in every scenario? Those are two separate issues and as a result of the function of ligaments, which is to connect bones to bones the arbiter for normal vs. abnormal function is ranges of motion of the joint. That can be accomplished by either a two-piece inclinometer for the spine, which per the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition (p. 400), is the standard (and is still the medical standard as the 6th Edition refers to the 5th for Ranges of motion). The other diagnostic demonstrable evidence to conclude aberrant function is to conclude laxity of ligaments through x-ray digitizing. Both diagnostic tools confirm demonstrably loss of function of the spinal joints. References: 1. Sprains, Strains and Other Soft Tissue Injuries (2015) American Academy of Orthopedic Surgery, Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=A00111 2. Connective Tissue Disorders (2015) National Institute of Health, Retrieved from: http://www.nlm.nih.gov/medlineplus/connectivetissuedisorders.html 3. Woo S, Hildebrand K., Watanabe N., Fenwick J., Papageorgiou C., Wang J. (1999) Tissue Engineering of Ligament and Tendon Healing, Clinical Orthopedics and Related Research 367S pgs. S312-S323 4.Tozer S., Duprez D. (2005) Tendon and Ligament: Development, Repair and Disease, Birth Defects Research (part C) 75:226-236 5. Hauser R., Dolan E., Phillips H., Newlin A., Moore R. and B. Woldin (2013) Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics, The Open Rehabilitation Journal (6) 1-20 6. Cocchiarella L., Anderson G., (2001) Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, AMA Press 7. White et al. Clin Ortho Relat Res, 1975;(109):85-96 8. Hauser et al. Dolan, Phillips, Newlin, Moore Woldin, B.A.(2013) Ligament injury and healing: A review of current clinical diagnostics and therapeutics. The Open Rehabilitation Journal, 6,1-20.
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Dr. Kenneth Bahoora has been a treating physician in Nevada and for 17 years. He graduated from Life University in Atlanta Georgia where he received his diploma as a doctor of chiropractic. He is credentialed and received specialized knowledge in accident reconstruction, spinal biomechanical engineering, spinal MRI interpretation, MRI physics, providing impairment ratings utilizing AMA Guides (5th & 6th Editions), examining and triaging the trauma patient and neurodiagnostic interpretation protocols. He lectures to doctors and the legal community on subjects including but not limited to trauma and injury protocols and crash dynamics and the trauma victim. He can be reached for further explanation at kmbdc@elitechiro.net or at 702-204-4240. Dr. Mark Studin teaches at the doctoral level as an adjunct assistant professor of chiropractic at the University of Bridgeport, College of Chiropractic, and an adjunct assistant professor of clinical sciences at Texas Chiropractic College. He also teaches at the graduate medical level as a clinical presenter credentialed by the Accreditation Council for Continuing Medical Education in Joint Sponsorship with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences along with being credentialed nationally for chiropractic post-doctoral education in a broad range of clinical subjects. He can be reached at DrMark@AcademyofChiropractic.com or at 631-786-4253.