When I went to school (back in the olden days) they taught me that ligaments did not heal and that they degraded when they were injured—and once they went bad—that was it. They also taught me that cartilage didn’t heal—especially the highland cartilage. That was amazing. The first research I have been able to discover on healing of ligaments was from 1916 by a medical researcher, a pathologist, named Bunting.

When I interned at Spears Hospital in the early 50’s, I watched ligaments regaining their elasticity. So I went back to my anatomy and physiology books to try to understand it. Even 100 years ago Gray’s Anatomy clearly spelled out that when you look at the composite make-up of muscles, ligaments, tendons, and cartilage—they are all made out of the same stuff.

The difference between a muscle and a ligament, a tendon, and a cartilage is only the relative amounts of each of the ground substances in them. In fact, some muscles and ligaments can’t decide whether they are muscles or ligaments. They have a mixed function. We also grade muscles and ligaments according to function, but from a cellular standpoint they are all the same stuff with different components. In fact, even bone is pretty much the same stuff. It just has more calcium in it than some of the others.

A good analogy might be concrete. If you look at the way concrete is made you realize some of it has a lot of sand, a little cement, and some gravel—and by changing the proportions of these three things they determine how hard the concrete will be.

A researcher by the name of Bunting, as early as 1916, and another researcher by the name of Krusen were writing about the fact that ligaments have both white and yellow fibers—and that the white fibers were very nonelastic and the yellow fibers were very elastic. What Bunting discovered through some research and tests he conducted is, when you rhythmically, repetitively manipulate ligamentous tissue—it causes more yellow elastin to be produced in the tissues.

Later on, some work was done on ligamentous tissue with mechanical manipulation in a tumbler-type unit and they found that just mechanically stimulating it caused some kind of chemical reaction to take place and some of the white fibers turned into yellow fibers—even in inert, dead tissue.

So, there is some question as to whether it is the mechanical or the neurological stimulation that causes this reformation of yellow elastin in ligamentous tissue. It was never resolved. As far as I can tell, the research died in about 1926 and no one else was interested—so we still don’t know for sure. But we do know that the physical stretching, movement, or manipulation of ligamentous tissue, at least in living people, causes more yellow elastic fiber to be formed and the joints to become more elastic.

Analogy: I have an analogy I use with patients. It’s one of those little stories that help determine whether patients stay for 3 treatments—or 30 treatments.

I wear a watch with an elastic watchband. And I say to the patient, “Do you see this watchband (and I’ll snap it)—it has solid steel here and it has springs in it which are elastic? Your ligaments are made up the same way. If I stretch this watchband way out—and overstretch it—the watch won’t fit tightly—it’s loose on my arm. It would still be as strong as it ever was—but wouldn’t be very tight.”

“The same thing happens with your joint. If you sprain it and overstretch the elastic part—and it starts to heal—the replacement fibers come in white instead of yellow and they don’t have very much elasticity and the joint tends to be very loose. Fortunately, there is a process called ‘tissue creep’ which causes the joint (if immobilized) to tighten. But it tightens with the wrong kind of tissue. It tightens with the white tissues which does not have the elasticity—then the joint is very immobile, stiff, but not very strong—and it can’t take the bumps of daily life. Every time you overstretch it a little bit you re-injure it. So you get a sprained ankle—and you say ‘my ankle is weak and every time I get on something a little unstable I hurt it again.’ Of course it does because it never got the elasticity built back into it. It’s the repetitive treatment that builds the elasticity.”

The Value of Intersegmental Traction

If you apply that concept to the spine you can see the tremendous importance and advantage of using a table with rollers—that gives enough action to the spine to thythmically stimulate, gradually stretch and stimulate the reformation of the yellow elastic tissue in the ligaments so that the joint (if loose) gets tighter, and if it is tighter it gets looser—not in the sense of being floppy loose—but in the sense of having the ability to be loose through the extensibility of the elastin in the fibers.

When you give a patient intersegmental traction and mobilizing manipulation—you are doing more than just stretching out adhesions, and you are doing more than stretching out the loose joints—you are actually rebuilding the elastin in the supporting structures of the joints so that as the fixations get stretched out they are not loose.

There has been some question about whether the repetitive manipulation of the spine and other joints stabilize or destabilize the joint. After all (if you think about it) doesn’t it seem logical that if you keep working the joint it will get looser?

They did some research on “knuckle-poppers.” You have heard all the tales about “don’t pop your knuckles because it will make your knuckles big and you will get arthritis in your hands, etc.” They went into nursing homes and found hundreds of people who popped their knuckles for the last 40 years and a bunch of “non-knuckle poppers”—and compared them to see if knuckle-popping made the joints unstable. Bottom line—knuckle popping is great for the joints of the hand. It makes for better joints—makes them more elastic—makes them flexible—and it doesn’t cause arthritis. It’s a wonderful treatment—and regardless of how you feel about it—the research shows that there is no question that popping your knuckles is really good for you.

If it’s good for your knuckles it is good for your spine. If you are dealing with someone who has the ligaments completely torn loose—that is probably not the time to keep manipulating it—you probably want to give it time to heal a little. Otherwise, you are not going to over-treat the patients—and you are not going to over-pop them. Knuckle-poppers pop their knuckles approximately 17 times a day on the average.

The bottom line is this: Joint manipulation is very good for the joints. And it is super for rebuilding the elastic tissue. I know they taught us that this is NOT the way it is. But anyone with an ounce of brains (if they think it through) has to see that very clearly.

Look at a ballet dancer. The dancer stretches a little bit more every day and soon the ballet dancer is kicking over his/her head—and his/her joints don’t get loose or unstable. If anything, they are more stable. They have a lot of elasticity—a lot of flexibility—and they are much more stable.

I want to cover one other concept that is very important. And that is some work that is being done in Canada regarding the regeneration of highland cartilage in the joints. They did some research at the University of Toronto. They wanted to find out what happened if they kept a joint in constant motion—how fast it would grind out the joint—especially if there was already a cartilage injury. So they took rabbits, opened their joints, and injured the cartilage in several different ways. Then they put them on a perpetual motion machine that kept their joints going 24 hours a day. They wanted to see how long it would take to burn out the joint. They got the greatest shock of their lives. The cartilage regenerated.

They have now found they do not have to keep it in continuous motion. They took the same rabbits (control groups) and put them in cage activity. When they just had active motion therapy, the cartilage did not regenerate. It appears you must go beyond the range of normal motion in the joint in order to stimulate whatever causes the generation. Normal range of muscle activity does not do it. It has to be in the passive ranges, the excessory movement ranges, and that can be achieved only through passive motion therapy. That’s why we don’t see cartilage regenerating in normal activities. You get up and exercise and you just don’t move the joint far enough to stimulate that response.

Two Important Concepts: Ligaments Can Be Restabilized and Cartilage Can Be Regenerated

That’s why we use things like motorized, mobilizing, manipulation. That’s why we use passive motion therapy. That’s why we use intersegmental traction.

There are a half-dozen different types of machines on the market—and you can purchase them at all different prices.

We promote this one—and actually we could sell any of them—so economic interest is not what is involved. We promote this one because we feel it does the best job of all the machines on the market today.

There are a couple of “mickey-mouse units” that just have little tiny rollers that roll back and forth and they are good for massage—but as far as I am concerned—they don’t get the rhythmical action you need to rebuild and rehabilitate the underlying ligamentous instability.

I want to talk about that because it is one thing to just do something like a processional caterpillar. (You know what they are—the caterpillars that go like elephants in the circus, nose to tail, and if you run them in a circle—soon you have a ring going—and they will follow each other forever. You can put food and water in the middle of the circle and they will die of starvation and dehydration before they will break that chain.)

We don’t want to be processional caterpillars in our treatment regimens. I don’t want you to do something because I say it works and it is good for your business—I want you to do it because you understand the underlying fundamental principle.

We are talking about ligament rehabilitation—and rhythmical exercise. Could you do the same thing by hand? Yes, you could. Our experience is that you need to flex a joint about 150 times. If you stand over a patient—and flex their spine—like a big jackhammer—in about an hour you will be through. This table does it about 15 to 16 times a minute—and in ten minutes you have the job done.

The “machine” does not get tired—and it works all day long. And the good thing about it is; insurance companies and patients pay for the treatment because it is very effective. It prevents people from having lots of recurrences and re-injuries—and they are willing to pay for the service.

This is smart equipment. After you have had it a while—and worked with it—you will really learn how to turn yourself into a “spinal magician.” But you must understand what you are doing to get the most out of the equipment. Otherwise, you’ll find yourself getting just average results—which will just give you an average practice—which is not what we are here for!

© MDC 2005