Surgery is the default treatment for ACL injuries in Australia. But it’s not the only way
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The anterior cruciate ligament (ACL) is an important ligament in the knee. It runs from the thigh bone (femur) to the shin bone (tibia) and helps stabilise the knee joint.
Injuries to the ACL, often called a “tear” or a “rupture”, are common in sport. While a ruptured ACL has just sidelined another Matildas star, people who play sport recreationally are also at risk of this injury.
For decades, surgical repair of an ACL injury, called a reconstruction, has been the primary treatment in Australia. In fact, Australia has among the highest rates of ACL surgery in the world. Reports indicate 90% of people who rupture their ACL go under the knife.
Although surgery is common – around one million are performed worldwide each year – and seems to be the default treatment for ACL injuries in Australia, it may not be required for everyone.
What does the research say?
We know ACL ruptures can be treated using reconstructive surgery, but research continues to suggest they can also be treated with rehabilitation alone for many people.
Almost 15 years ago a randomised clinical trial published in the New England Journal of Medicine compared early surgery to rehabilitation with the option of delayed surgery in young active adults with an ACL injury. Over half of people in the rehabilitation group did not end up having surgery. After five years, knee function did not differ between treatment groups.
The findings of this initial trial have been supported by more research since. A review of three trials published in 2022 found delaying surgery and trialling rehabilitation leads to similar outcomes to early surgery.
A 2023 study followed up patients who received rehabilitation without surgery. It showed one in three had evidence of ACL healing on an MRI after two years. There was also evidence of improved knee-related quality of life in those with signs of ACL healing compared to those whose ACL did not show signs of healing.
Regardless of treatment choice the rehabilitation process following ACL rupture is lengthy. It usually involves a minimum of nine months of progressive rehabilitation performed a few days per week. The length of time for rehabilitation may be slightly shorter in those not undergoing surgery, but more research is needed in this area.
Rehabilitation starts with a physiotherapist overseeing simple exercises right through to resistance exercises and dynamic movements such as jumping, hopping and agility drills.
A person can start rehabilitation with the option of having surgery later if the knee remains unstable. A common sign of instability is the knee giving way when changing direction while running or playing sports.
To rehab and wait, or to go straight under the knife?
There are a number of reasons patients and clinicians may opt for early surgical reconstruction.
For elite athletes, a key consideration is returning to sport as soon as possible. As surgery is a well established method, athletes (such as Matilda Sam Kerr) often opt for early surgical reconstruction as this gives them a more predictable timeline for recovery.
At the same time, there are risks to consider when rushing back to sport after ACL reconstruction. Re-injury of the ACL is very common. For every month return to sport is delayed until nine months after ACL reconstruction, the rate of knee re-injury is reduced by 51%.
Historically, another reason for having early surgical reconstruction was to reduce the risk of future knee osteoarthritis, which increases following an ACL injury. But a review showed ACL reconstruction doesn’t reduce the risk of knee osteoarthritis in the long term compared with non-surgical treatment.
That said, there’s a need for more high-quality, long-term studies to give us a better understanding of how knee osteoarthritis risk is influenced by different treatments.
Rehab may not be the only non-surgical option
Last year, a study looking at 80 people fitted with a specialised knee brace for 12 weeks found 90% had evidence of ACL healing on their follow-up MRI.
People with more ACL healing on the three-month MRI reported better outcomes at 12 months, including higher rates of returning to their pre-injury level of sport and better knee function. Although promising, we now need comparative research to evaluate whether this method can achieve similar results to surgery.
What to do if you rupture your ACL
First, it’s important to seek a comprehensive medical assessment from either a sports physiotherapist, sports physician or orthopaedic surgeon. ACL injuries can also have associated injuries to surrounding ligaments and cartilage which may influence treatment decisions.
In terms of treatment, discuss with your clinician the pros and cons of management options and whether surgery is necessary. Often, patients don’t know not having surgery is an option.
Surgery appears to be necessary for some people to achieve a stable knee. But it may not be necessary in every case, so many patients may wish to try rehabilitation in the first instance where appropriate.
As always, prevention is key. Research has shown more than half of ACL injuries can be prevented by incorporating prevention strategies. This involves performing specific exercises to strengthen muscles in the legs, and improve movement control and landing technique.
Anthony Nasser, Senior Lecturer in Physiotherapy, University of Technology Sydney; Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology Sydney, and Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hold Me Tight – by Dr. Sue Johnson
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A lot of relationship books are quite wishy-washy. This one isn’t.
This one is evidenced-based (and heavily referenced!), and yet at the same time as being deeply rooted in science, it doesn’t lose the human touch.
Dr. Johnson has spent her career as a clinical psychologist and researcher; she’s the primary developer of Emotionally Focused Therapy (EFT), which has demonstrated its effectiveness in over 35 years of peer-reviewed clinical research. In other words, it works.
EFT—and thus also this book—finds roots in Attachment Theory. As such, topics this book covers include:
- Recognizing and recovering from attachment injury
- How fights in a relationship come up, and how they can be avoided
- How lot of times relationships end, it’s not because of fights, but a loss of emotional connection
- Building a lifetime of love instead, falling in love again each day
This book lays the groundwork for ensuring a strong, secure, ongoing emotional bond, of the kind that makes/keeps a relationship joyful and fulfilling.
Dr. Johnson has been recognized in her field with a Lifetime Achievement Award, and the Order of Canada.
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Krill Oil vs Fish Oil – Which is Healthier?
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Our Verdict
When comparing krill oil to fish oil, we picked the krill oil.
Why?
Both of these products are good sources of omega-3 fatty acids EPA and DHA, and for the specific brand depicted above, in both cases 2 softgels will give you the recommended daily amount (which is generally held to be 250–500mg combined omega-3s per day).
This brand’s fish oil gives more (640mg combined omega-3s per 2 softgels, to the same brand’s krill oil’s 480mg per 2 softgels), but since the krill oil is already in the high end of RDA territory, the excess beyond the RDA is not helpful, and not a huge factor. More quantity is not always better, when the body can only process so much at a time.
However, the krill oil gives some extra things that the fish oil doesn’t:
- Astaxanthin, a “super-antioxidant”
- and neuroprotectant, heart-healthy phospholipids
Additional considerations
We have declared “the winner” based on health considerations only. That’s a sticking point for us in all our writings; we’ll occasionally look at and mention other factors, but we know that health is what you’re here for, so that’s what we’ll always treat as most critical.
However, in case these factors may interest you and/or influence you to one or the other:
• The fish oil is about 30% cheaper financially
• The krill oil is a lot more sustainable environmentallyBack to the health science…
Read more:
• What Omega-3 Fatty Acids Really Do For Us
• Astaxanthin: Super-Antioxidant & NeuroprotectantWant some? Here for your convenience are some example products on Amazon:
(brands available will vary per region, but now you know what to look out for on the labels!)
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Heavy Metal Detox In A Pill?
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We have previous discussed assorted approaches to “detoxing”:
Detox: What’s Real, What’s Not, What’s Useful, What’s Dangerous?
Today we’re going to be looking at one we didn’t cover there, which is zeolite.
What is zeolite?
Zeolite is a mineral that occurs naturally and can also be synthesized, and it’s famous for absorbing other stuff from around it. Because of this property, it’s used in many things, including:
- Petrochemical catalysis
- Water treatment
- Nuclear waste reprocessing
- Cat litter
- Supplements (for detox purposes)
That’s, uh… An interesting list, isn’t it? So, we were curious as to whether this mineral that’s also used in fish tank filters is, in fact, overpriced gravel being sold to the gullible as a health supplement.
We had to do some digging on this one
Our journey didn’t start well, with this very dubious-looking paper being cited by a company selling zeolite supplements:
This immediately prompted two questions:
- Who is eating graphene?!* That stuff does not occur in nature (or at least; it hasn’t ever been found; the universe is a big place so it might exist elsewhere), has only relatively recently been synthesized, is very difficult to produce, is two-dimensional while being hard as diamonds, and exists only in truly tiny lab-made quantities worldwide. It would be orders of magnitude easier to find and eat uranium.
- Is this a reputable journal? Which question was easier to answer than the former one, and the answer is “no”; we hadn’t heard of this journal (ACTA Scientific), and neither it seems had most of the Internet, but we did find it on a list of predatory journals, here.
*The citation given in the above paper should by rights answer the question of who is eating graphene, since by rights they must have demonstrated it somehow, but it just doesn’t. Instead, it links to what it claims is a paper titled “Oxygenated Zeolite (Clinoptilite) Efficiently Removes Aluminum & Graphene Oxide”, but is in reality just someone’s blog post with a screenshot of an actual paper entitled “Novel, oxygenated clinoptilolite material efficiently removes aluminium from aluminium chloride-intoxicated rats in vivo”). Looking up this real paper in its real journal, it does not mention graphene.
All this to say: sometimes, unscrupulous people will just plain lie to you, which is why peer review is important, as is sourcing data from reputable journals. Which is what we do for you so that you don’t have to 🙂
It does, actually, work though (for heavy metal detox)
Notwithstanding the aforementioned bunk, we found this from a more reputable publisher:
❝In this study, we have presented clinical evidence supporting the use of an activated clinoptilolite (zeolite) suspension to safely and effectively increase the urinary excretion of potentially toxic heavy metals in healthy volunteers without negatively impacting the electrolyte profiles of the participants.
Significant increases in the urinary excretion of aluminum, antimony, arsenic, bismuth, cadmium, lead, mercury, nickel and tin were observed in the subjects participating in the two study groups as compared to placebo controls.❞
Also good for the gut and against inflammation
Specifically, it’s good for gut barrier integrity, i.e., against “leaky gut syndrome”:
❝Twelve weeks of zeolite supplementation exerted beneficial effects on intestinal wall integrity as indicated via decreased concentrations of the tight junction modulator zonulin.
This was accompanied by mild anti-inflammatory effects in this cohort of aerobically trained subjects.❞
May also be good against neurodegenerative diseases
If it is (which is plausible), it’ll probably because of removing heavy metals and improving gut barrier integrity—in other words, the things we just looked at in the two reputable peer-reviewed studies we examined above.
But the science is young for this one; here’s the current state of things:
Zeolite and Neurodegenerative Diseases
Is it safe?
Safety reviews have found it to be safe, for example:
Critical Review on Zeolite Clinoptilolite Safety and Medical Applications in vivo
However, if you are taking regular medications, we recommend checking with your pharmacist or doctor to ensure that zeolite will not also remove those medications from your system!
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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Viruses aren’t always harmful. 6 ways they’re used in health care and pest control
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We tend to just think of viruses in terms of their damaging impacts on human health and lives. The 1918 flu pandemic killed around 50 million people. Smallpox claimed 30% of those who caught it, and survivors were often scarred and blinded. More recently, we’re all too familiar with the health and economic impacts of COVID.
But viruses can also be used to benefit human health, agriculture and the environment.
Viruses are comparatively simple in structure, consisting of a piece of genetic material (RNA or DNA) enclosed in a protein coat (the capsid). Some also have an outer envelope.
Viruses get into your cells and use your cell machinery to copy themselves.
Here are six ways we’ve harnessed this for health care and pest control.1. To correct genes
Viruses are used in some gene therapies to correct malfunctioning genes. Genes are DNA sequences that code for a particular protein required for cell function.
If we remove viral genetic material from the capsid (protein coat) we can use the space to transport a “cargo” into cells. These modified viruses are called “viral vectors”.
Viruses consist of a piece of RNA or DNA enclosed in a protein coat called the capsid.
DEXiViral vectors can deliver a functional gene into someone with a genetic disorder whose own gene is not working properly.
Some genetic diseases treated this way include haemophilia, sickle cell disease and beta thalassaemia.
2. Treat cancer
Viral vectors can be used to treat cancer.
Healthy people have p53, a tumour-suppressor gene. About half of cancers are associated with the loss of p53.
Replacing the damaged p53 gene using a viral vector stops the cancerous cell from replicating and tells it to suicide (apoptosis).
Viral vectors can also be used to deliver an inactive drug to a tumour, where it is then activated to kill the tumour cell.
This targeted therapy reduces the side effects otherwise seen with cytotoxic (cell-killing) drugs.
We can also use oncolytic (cancer cell-destroying) viruses to treat some types of cancer.
Tumour cells have often lost their antiviral defences. In the case of melanoma, a modified herpes simplex virus can kill rapidly dividing melanoma cells while largely leaving non-tumour cells alone.
3. Create immune responses
Viral vectors can create a protective immune response to a particular viral antigen.
One COVID vaccine uses a modified chimp adenovirus (adenoviruses cause the common cold in humans) to transport RNA coding for the SARS-CoV-2 spike protein into human cells.
The RNA is then used to make spike protein copies, which stimulate our immune cells to replicate and “remember” the spike protein.
Then, when you are exposed to SARS-CoV-2 for real, your immune system can churn out lots of antibodies and virus-killing cells very quickly to prevent or reduce the severity of infection.
4. Act as vaccines
Viruses can be modified to act directly as vaccines themselves in several ways.
We can weaken a virus (for an attenuated virus vaccine) so it doesn’t cause infection in a healthy host but can still replicate to stimulate the immune response. The chickenpox vaccine works like this.
The Salk vaccine for polio uses a whole virus that has been inactivated (so it can’t cause disease).
Others use a small part of the virus such as a capsid protein to stimulate an immune response (subunit vaccines).
An mRNA vaccine packages up viral RNA for a specific protein that will stimulate an immune response.
5. Kill bacteria
Viruses can – in limited situations in Australia – be used to treat antibiotic-resistant bacterial infections.
Bacteriophages are viruses that kill bacteria. Each type of phage usually infects a particular species of bacteria.
Unlike antibiotics – which often kill “good” bacteria along with the disease-causing ones – phage therapy leaves your normal flora (useful microbes) intact.
Bacteriophages (red) are viruses that kill bacteria (green).
Shutterstock6. Target plant, fungal or animal pests
Viruses can be species-specific (infecting one species only) and even cell-specific (infecting one type of cell only).
This occurs because the proteins viruses use to attach to cells have a shape that binds to a specific type of cell receptor or molecule, like a specific key fits a lock.
The virus can enter the cells of all species with this receptor/molecule. For example, rabies virus can infect all mammals because we share the right receptor, and mammals have other characteristics that allow infection to occur whereas other non-mammal species don’t.
When the receptor is only found on one cell type, then the virus will infect that cell type, which may only be found in one or a limited number of species. Hepatitis B virus successfully infects liver cells primarily in humans and chimps.
We can use that property of specificity to target invasive plant species (reducing the need for chemical herbicides) and pest insects (reducing the need for chemical insecticides). Baculoviruses, for example, are used to control caterpillars.
Similarly, bacteriophages can be used to control bacterial tomato and grapevine diseases.
Other viruses reduce plant damage from fungal pests.
Myxoma virus and calicivirus reduce rabbit populations and their environmental impacts and improve agricultural production.
Just like humans can be protected against by vaccination, plants can be “immunised” against a disease-causing virus by being exposed to a milder version.
Thea van de Mortel, Professor, Nursing, School of Nursing and Midwifery, Griffith University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Eating on the Wild Side: – by Jo Robinson
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The author is an investigative journalist, and it shows here, as she leaves no stone unturned in her quest for the truth in the face of many food myths.
She covers a lot of “popular wisdom” things that are varyingly true or false, or sometimes even both—in the case of food lore that’s a good rule of thumb, but has notable exceptions (e.g. “more colorful and/or darker-colored fruits/vegetables contain more nutrients”, which is a very good rule of thumb until one meets a cauliflower, for example).
She also covers food preparation myths, and how, to give one example, in spite of the popularity of “less cooked is better”, in some cases certain cooking methods will indeed destroy nutrients; in others, certain cooking methods will improve nutritional availability. Either by destroying an adjacent antinutrient (e.g. phytates), or by breaking something down into a more manageable form that our body can absorb. Knowing which is which, is important.
The book is organized by kinds of food, and does exclusively cover plants, but there’s more than enough material for any omnivore to enjoy.
The style is… Journalistic, it would be fair to say. Which is not surprising, given the author. But it means that it is written in a fairly narrative way, to draw the reader in and make it an enjoyable read while still being informative in all parts (there is no padding). In terms of science, the in-the-prose science is as minimal as possible to still convey what needs to be conveyed, while 25 pages of bibliography stack up at the end to show that indeed, this journalist cites sources.
Bottom line: this is a really enjoyable book, packed with a wealth of knowledge, and is perfect to uplift your cooking by knowing your ingredients a little more intimately!
Click here to check out Eating On The Wild Side, and, enjoy!
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Why You Can’t Just “Get Over” Trauma
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Time does not, in fact, heal all wounds. Sometimes they even compound themselves over time. Dr. Tracey Marks explains the damage that trauma does—the physiological presentation of “the axe forgets but the tree remembers”—and how to heal from that actual damage.
The science of healing
Trauma affects the mind and body (largely because the brain is, of course, both—and affects pretty much everything else), which can ripple out into all areas of life.
On the physical level, brain areas affected by trauma include:
- Amygdalae: becomes hyperactive, keeping a person in a heightened state of vigilance.
- Hippocampi: can shrink, causing fragmented or missing memories.
- Prefrontal cortex: reduces in activity, impairing decision-making and emotional regulation.
Trauma also activates the body’s fight or flight response, releasing stress hormones like cortisol and adrenaline. These are great things to have a pinch, but having them elevated all the time is equivalent to only ever driving your car at top speed—the only question becomes whether you’ll crash and burn before you break down.
However, there is hope! Neuroplasticity (the brain’s ability to rewire itself) can make trauma recovery possible through various interventions.
Evidence-based therapies for trauma include:
- Eye Movement Desensitization and Reprocessing (EMDR): this can help reprocess traumatic memories and reduce emotional intensity.
- Trauma-focused Cognitive Behavioral Therapy (CBT): this can help change unhelpful thought patterns and includes exposure therapy.
- Somatic therapies: these focus on the body and nervous system to release stored tension.
In this latter category, embodiment is key to trauma recovery—this may sound “wishy-washy”, but the evidence shows that reconnecting with the body does help manage emotional stress responses. Mind-body practices like mindfulness, yoga, and breathwork help cultivate embodiment and reduce trauma-related stress.
In short: you can’t just “get over” it, but with the right support and interventions, it’s possible to rewire the brain and body toward resilience and healing.
For more on all of this from Dr. Marks, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- PTSD, But, Well…. Complex.
- Undoing The Damage Of Life’s Hard Knocks
- A Surprisingly Powerful Tool: Eye Movement Desensitization & Reprocessing
Take care!
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