That's Dr. Toboggan to you.

If you have a bite or a suspected bite, you get two things on the first day. You get your first dose of vaccine as well as a weight based Immunoglobulin (Ig). Vaccines take time to work, and so to keep you from death the Ig is basically premade antibodies that will work to fight rabies immediately.

So Day 0 you get those and then you typically get boosters on Days 3, 7, and 14.

As others commented I think there has been like 1 rabies infected person who lived without treatment. That’s why bite or suspected bite or even remote possibility of exposure, get Ig and vaccine. If you wake up to a bat in your room, assume exposure.

By then you should be protected for about 3 years. If you work around bats you’ll get boosters after that point to help ensure you have circulating antibodies.

Source: I’m a doctor and I woke up to a bat in my room two years ago so I assumed exposure. And I’m alive still.

That article review link you sent was interesting. "...the premise of this review is based entirely on inductive reasoning. Additionally, consideration of lower-level of evidence literature and inconclusive literature was necessary."

Here's a group that seems to focus on this issue specifically:

https://www.hypermobility.org/hormones-and-hypermobility

"...studies have not demonstrated a clear relationship between the level of relaxin and the degree of laxity. Other factors must be involved."

Seems like a lot more research is warranted. But it could be very interesting.

Thanks for pointing that out. I didnt realize how early in pregnancy the Relaxin was released. However, I did do some research on the levels and while it does exist during a normal menstrual cycle, it is about 50 times higher during pregnancy. All the research I found recently in response to your post pointed me toward Estrogen being the main culprit in ligament laxity. But again, always open to new info so I love the questions your post raises.

Your claim regarding medical misogyny seems extraordinary however. Do you really feel that I hate women because of my post? I hope not.

That's such a great point. Selection Bias. The ones with the thicker ligaments were able to lift heavy weight or stayed in the sport. The ones with regular ligaments either tore their ACLs or dropped out. It would be like saying that playing basketball makes you taller. Great thought. Thanks

Love what I do. It's become more difficult to practice medicine with insurances dictating what you can and can not order. In a perfect world we could order tests as needed and figure things out without regard to cost. But we live in the real world, unfortunately.

I think there's some thought to the idea that the fatigue is in relation to the musculature in the knee, and once that fails to protect transition and rotation in the knee, then they tear the ACL. But look, we are constantly learning about the body and changing our thought patterns. Nothing is set in stone.

I've treated a multitude of BJJ athletes. No ACLs though. They are all monsters. Constant injury and constantly looking to get back on the mat to fight. Just monsters.

Very specific article looking at heavy weight lifting in very specific athletes. "All athletes in our study began training before or during their pubertal growth spurt." And not to be a complete jerk about it, but you've posted a few comments with this article, published in a journal that went out of business in 2014 and looking at 9 (NINE!) total weight lifters. I'm all for looking at new data, but this isn't it.

Tendons attach muscles to bones. Ligaments attach bones to bones. So any answers confusing the two need to be corrected. yersiniaD has the right answer.

While you are correct that hormonal changes have been found to have an effect in ligament strength, you are confusing normal estrogen and progesterone fluctuations with the hormone called Relaxin. Relaxin prepares the body for birth by loosening things up. But that’s only weeks before birth. Not during normal cycles. Do a google on that and you’ll learn more.

To your point though, female soccer players have the highest incidence of ACL tear in noncontact sports. For many reasons neuromuscular control, hormonal changes, and anatomical differences between male and female knees. There are specific physical therapy programs designed to help decrease injury in female athletes.

They suddenly fail.

Simple answer is that ligaments don’t bulk up the way muscles do. And while we’ve created multiple supplements and exercises to increase muscle mass, it’s the same ligament holding bones together. A 180lb high school kid who adds 50lb of muscle in college has practically the same ACL he always did.

ACLs typically fail with a pivot and valgus load to the knee. That’s a twist and the knee bends in toward the other knee, usually from a force like a tackle or other hit.

While ligaments don’t repair themselves as quickly and regularly as bone, they are living tissue so any micro trauma will typically result in repair. I haven’t read any literature on evidence showing cumulative injury to ACLs causing most injury.

Source: I’m an orthopaedic surgeon