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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Do we need animal products to be healthy?
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Do we need animal products to be healthy?
We asked you for your (health-related) perspective on plant-based vs anima-based foods, and got the above-pictured spread of answers.
“Some or all of us may need small amounts of animal products” came out on top with more votes than the two more meat-eatery options combined, and the second most popular option was the hard-line “We can all live healthily and happily on just plants”.
Based on these answers, it seems our readership has quite a lot of vegans, vegetarians, and perhaps “flexitarians” who just have a little of animal products here and there.
Perhaps we should have seen this coming; the newsletter is “10almonds”, not “10 rashers of bacon”, after all.
But what does the science say?
We are carnivores and are best eating plenty of meat: True or False?
False. Let’s just rip the band-aid off for this one.
In terms of our anatomy and physiology, we are neither carnivores nor herbivores:
- We have a mid-length digestive tract (unlike carnivores and herbivores who have short and long ones, respectively)
- We have a mouthful of an assortment of teeth; molars and premolars for getting through plants from hard nuts to tough fibrous tubers, and we have incisors for cutting into flesh and (vestigial, but they’re there) canines that really serve us no purpose now but would have been a vicious bite when they were bigger, like some other modern-day primates.
- If we look at our closest living relatives, the other great apes, they are mostly frugivores (fruit-eaters) who supplement their fruity diet with a small quantity of insects and sometimes other small animals—of which they’ll often eat only the fatty organ meat and discard the rest.
And then, there’s the health risks associated with meat. We’ll not linger on this as we’ve talked about it before, but for example:
- Processed Meat Consumption and the Risk of Cancer: A Critical Evaluation of the Constraints of Current Evidence from Epidemiological Studies
- Red Meat Consumption (Heme Iron Intake) and Risk for Diabetes and Comorbidities?
- Health Risks Associated with Meat Consumption: A Review of Epidemiological Studies
- Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality
- Meat consumption: Which are the current global risks? A review of recent (2010-2020) evidences
If we avoid processed and/or red meat, that’s good enough: True or False?
True… Ish.
Really this one depends on one’s criteria for “good enough”. The above-linked studies, and plenty more like them, give the following broad picture:
- Red and/or processed meats are unequivocally terrible for the health in general
- Other mammalian meats, such as from pigs, are really not much better
- Poultry, on the other hand, the science is less clear on; the results are mixed, and thus so are the conclusions. The results are often barely statistically significant. In other words, when it comes to poultry, in the matter of health, the general consensus is that you can take it or leave it and will be fine. Some studies have found firmly for or against it, but the consensus is a collective scientific shrug.
- Fish, meanwhile, has almost universally been found to be healthful in moderation. You may have other reasons for wanting to avoid it (ethics, environmentalism, personal taste) but those things are beyond the scope of this article.
Some or all of us may need small amounts of animal products: True or False?
True! With nuances.
Let’s divide this into “some” and “all”. Firstly, some people may have health conditions and/or other mitigating circumstances that make an entirely plant-based diet untenable.
We’re going light on quotations from subscriber comments today because otherwise this article will get a bit long, but here’s a great example that’s worth quoting, from a subscriber who voted for this option:
❝I have a rare genetic disease called hereditary fructose intolerance. It means I lack the enzyme, Aldolase B, to process fructose. Eating fruits and veggies thus gives me severe hypoglycemia. I also have anemia caused by two autoimmune diseases, so I have to eat meat for the iron it supplies. I also supplement with iron pills but the pills alone can’t fix the problem entirely.❞
And, there’s the thing. Popular vegan talking-points are very good at saying “if you have this problem, this will address it; if you have that problem, that will address it”, etc. For every health-related objection to a fully plant-based diet there’s a refutation… Individually.
But actual real-world health doesn’t work like that; co-morbidities are very common, and in some cases, like our subscriber above, one problem undermines the solution to another. Add a third problem and by now you really just have to do what you need to do to survive.
For this reason, even the Vegan Society’s definition of veganism includes the clause “so far as is possible and practicable”.
Now, as for the rest of us “all”.
What if we’re really healthy and are living in optimal circumstances (easy access to a wide variety of choice of food), can we live healthily and happily just on plants?
No—on a technicality.
Vegans famously need to supplement vitamin B12, which is not found in plants. Ironically, much of the B12 in animal products comes from the animals themselves being given supplements, but that’s another matter. However, B12 can also be enjoyed from yeast. Popular options include the use of yeast extract (e.g. Marmite) and/or nutritional yeast in cooking.
Yeast is a single-celled microorganism that’s taxonomically classified as a fungus, even though in many ways it behaves like an animal (which series of words may conjure an amusing image, but we mean, biologically speaking).
However, it’s also not technically a plant, hence the “No—on a technicality”
Bottom line:
By nature, humans are quite versatile generalists when it comes to diet:
- Most of us can live healthily and happily on just plants if we so choose.
- Some people cannot, and will require varying kinds (and quantities) of animal products.
- As for red and/or processed meats, we’re not the boss of you, but from a health perspective, the science is clear: unless you have a circumstance that really necessitates it, just don’t.
- Same goes for pork, which isn’t red and may not be processed, but metabolically it’s associated with the same problems.
- The jury is out on poultry, but it strongly appears to be optional, healthwise, without making much of a difference either way
- Fish is roundly considered healthful in moderation. Enjoy it if you want, don’t if you don’t.
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Power Plates – by Gena Hamshaw
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Superfoods are all well and good, but there are only so many ways one can reasonably include watercress before it starts becoming a chore.
Happily, Gena Hamshaw is here with a hundred single-dish vegan meals, that are not only nutritionally balanced as the subtitle promises, but also, as the title suggests, are nutritional powerhouses too.
In the category of criticism, some ingredients are not so universally available as others. For example, depending on where you live, your local supermarket might not have freekeh, gochujang, or pomegranate molasses.
However, most of the recipes have ingredients that are easy enough to source in any medium-sized supermarket, and for the ones that aren’t, we do recommend ordering the ingredient online and trying something you might not otherwise have experienced—that’s an important thing in life, after all!
Bottom line: if you’d like plant-based meals that are packed full of nutrients and are delicious too, this is a top-tier recipe book.
Click here to check out Power Plates, and enjoy a wide variety of plant-based cuisine!
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The Worst Way to Wake Up (and What to Do Instead)
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Not everyone is naturally inclined to be a morning person, but there are things we can do to make things go more easily for our brains!
Cause for alarm?
Dr. Tracey Marks, psychiatrist, explains the impact of our first moments upon awakening, and what that can do to/for us in terms of sleep inertia (i.e. grogginess).
Sleep inertia is worse when waking from deep sleep—and notably, we don’t naturally wake directly from deep sleep unless we are externally aroused (e.g. by an alarm clock).
Dr. Marks suggests the use of more gradual alarms, including those with soft melodies, perhaps birdsong or other similarly gentle things (artificial sunlight alarms are also good), to ease our transition from sleeping to waking. It might take us a few minutes longer to be woken from sleep, but we’re not going to spend the next hour in a bleary-eyed stupor.
For more details on these things and more (including why not to hit “snooze”), enjoy:
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Want to learn more?
You might also like to read:
Take care!
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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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Pine Bark’s Next-Level Antioxidant Properties
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Pine Bark’s Next-Level Antioxidant Properties
Pine bark extract has been used by the indigenous peoples of N. America for a very long time, to treat a variety of ailments.
This one falls into the category of “things from traditional medicine that eventually got investigated and their scientific worth noticed by people from outside of those cultures”.
Not all pine trees!
If you happen to have pine trees near you, be aware that without sufficient botanical knowledge, you could find yourself bark-harvesting from the wrong tree—but many species of pine do have these qualities.
Useful (for this purpose) pine trees include, but are not limited to:
- Pinus banksiana
- Pinus massoniana
- Pinus pinaster
- Pinus radiata
- Pinus resinosa
- Pinus strobus
…which is already a fair list, but there are dozens more that have not been studied, and/or found lacking in medicinal qualities, and/or just didn’t make our list here today.
What does it do & How does it work?
We sneakily put those two questions together today because it’s easiest to explain in one:
The Pinus family in general has powerful antioxidant qualities, and not just like blueberries or coffee (wonderful as those are).
Rather, it has:
- Phenolic acids: these are the polyphenols found in many plant foods rich in antioxidants. These are great, but they aren’t the exciting part here.
- Catechins: these aren’t classified as antioxidants, but they are flavonoids that do the same job in a slightly different way
- Procyanidins: another class of flavonoids, and this is where pine bark really comes into its own
And yes, as ever, “those three things that always seem to come together”, it having these antioxidant properties means it is also anti-inflammatory and anti-cancer:
…and anti-aging:
Pleiotropic Effects of French Maritime Pine Bark Extract to Promote Healthy Aging
…which does of course mean that it almost certainly fights age-related cognitive decline, though studies for that have been animal studies so far, such as:
- Pine Bark Polyphenolic Extract Attenuates Amyloid-β and Tau Misfolding in a Model System of Alzheimer’s Disease Neuropathology
- Neuroprotective and Anti-Inflammatory Effects of Pinus densiflora Bark Extract in Gerbil Hippocampus Following Transient Forebrain Ischemia
- Neuroprotective Effects of Korean Red Pine ( Pinus densiflora) Bark Extract and Its Phenolics
- Pine bark treatment decelerates plaque development and improves spatial memory in Alzheimer’s disease mice
Where to get it?
As ever, we don’t sell it, but here’s an example product on Amazon for your convenience; we recommend shopping around though, as prices vary a lot!
Enjoy!
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Why are people on TikTok talking about going for a ‘fart walk’? A gastroenterologist weighs in
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“Fart walks” have become a cultural phenomenon, after a woman named Mairlyn Smith posted online a now-viral video about how she and her husband go on walks about 60 minutes after dinner and release their gas.
Smith, known on TikTok as @mairlynthequeenoffibre and @mairlynsmith on Instagram, has since appeared on myriad TV and press interviews extolling the benefits of a fart walk. Countless TikTok and Instagram users and have now shared their own experiences of feeling better after taking up the #fartwalk habit.
So what’s the evidence behind the fart walk? And what’s the best way to do it?
Exercise can help get the gas out
We know exercise can help relieve bloating by getting gas moving and out of our bodies.
Researchers from Barcelona, Spain in 2006 asked eight patients complaining of bloating, seven of whom had irritable bowel syndrome, to avoid “gassy” foods such as beans for two days and to fast for eight hours before their study.
Each patient was asked to sit in an armchair, in order to avoid any effects of body position on the movement of gas. Gas was pumped directly into their small bowel via a thin plastic tube that went down their mouth, and the gas expelled from the body was collected into a bag via a tube placed in the rectum. This way, the researchers could determine how much gas was retained in the gut.
The patients were then asked to pedal on a modified exercise bike while remaining seated in their armchairs.
The researchers found that much less gas was retained in the patients’ gut when they exercised. They determined exercise probably helped the movement and release of intestinal gas.
Walking may have another bonus; it may trigger a nerve reflex that helps propel foods and gas contents through the gut.
Walking can also increase internal abdominal pressure as you use your abdominal muscles to stay upright and balance as you walk. This pressure on the colon helps to push intestinal gas out.
Proper fart walk technique
One study from Iran studied the effects of walking in 94 individuals with bloating.
They asked participants to carry out ten to 15 minutes of slow walking (about 1,000 steps) after eating lunch and dinner. They filled out gut symptom questionnaires before starting the program and again at the end of the four week program.
The researchers found walking after meals resulted in improvements to gut symptoms such as belching, farting, bloating and abdominal discomfort.
Now for the crucial part: in the Iranian study, there was a particular way in which participants were advised to walk. They were asked to clasp hands together behind their back and to flex their neck forward.
The clasped hands posture leads to more internal abdominal pressure and therefore more gentle squeezing out of gas from the colon. The flexed neck posture decreases the swallowing of air during walking.
This therefore is the proper fart walk technique, based on science.
What about constipation?
A fart walk can help with constipation.
One study involved middle aged inactive patients with chronic constipation, who did a 12 week program of brisk walking at least 30 minutes a day – combined with 11 minutes of strength and flexibility exercises.
This program, the researchers found, improved constipation symptoms through reduced straining, less hard stools and more complete evacuation.
It also appears that the more you walk the better the benefits for gut symptoms.
In patients with irritable bowel syndrome, one study increasing the daily step count to 9,500 steps from 4,000 steps led to a 50% reduction in the severity of their symptoms.
And just 30 minutes of a fart walk has been shown to improve blood sugar levels after eating.
What if I can’t get outside the house?
If getting outside the house after dinner is impossible, could you try walking slowly on a treadmill or around the house for 1,000 steps?
If not, perhaps you could borrow an idea from the Barcelona research: sit back in an armchair and pedal using a modified exercise bike. Any type of exercise is better than none.
Whatever you do, don’t be a couch potato! Research has found more leisure screen time is linked to a greater risk of developing gut diseases.
We also know physical inactivity during leisure time and eating irregular meals are linked to a higher risk of abdominal pain, bloating and altered bowel motions.
Try the fart walk today
It may not be for everyone but this simple physical activity does have good evidence behind it. A fart walk can improve common symptoms such as bloating, abdominal discomfort and constipation.
It can even help lower blood sugar levels after eating.
Will you be trying a fart walk today?
Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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