Reducing or Eliminating Pain by Restoring Joint Integrity & Function Using A Variety of Non-Surgical Approaches
What is the problem?
To effectively & properly eliminate pain from a joint, muscle, ligament, or tendon, you must first determine what is causing the pain and what tissues are damaged. Most physicians rely on various imaging studies (x-rays, CT scans, MRIs, &/or ultrasound) to diagnose a problem. Sorry, but that is not the proper way to go about it. Imaging studies are FAR from perfect and, although they can be helpful when in doubt, the proper way to determine the cause of a problem and the extent of the damage is by a combination of a good history and hands on musculoskeletal examination. Unfortunately, few physicians are well versed in hands on musculoskeletal exams.
Understanding the anatomy and physiology of the joint complex, along with the history of traumatic and/or repetitive motion injuries is crucial. In reality, most (85+%) of all musculoskeletal injuries that become chronic involve damaged ligaments or tendons.
What are the sources of chronic pain and dysfunction?
The problem with damaged ligaments or tendons is that they typically do not heal back to 100% of their pre-injury strength. There are many reasons for this, however, it isn't necessary to go into those here, instead we will focus on various methods to assist the body in healing itself.
In the vast majority of situations when ligaments and tendons are injured, they are strained or sprained and not completely torn. This leads to a reduction in the stability of the joint involved. The nerves associated with sensing the movement and stability of that joint send messages to the brain that the joint is unstable or at least less stable than it had been. The brain reacts in the only logical, self-protective fashion it can by sending messages to the surrounding muscles to tighten to help protect the joint. It is all about survival and the brain interprets that increased instability as a threat to your survival due to a reduction in the ability to move and protect yourself.
These partially contracted muscles do a pretty good job of stabilizing the joint BUT they cannot sustain steady states of increased contraction without there being a significant cost. The cost is reduced movement of that joint along with a buildup of lactic acid that irritates nearby nerves thereby causing pain, congestion, and inappropriate, non-functional inflammation.
When a muscle stays in an increased state of partial contraction for any length of time, it causes compression or constriction of the tiny capillaries that transport nutrients and oxygen to the muscle. This means that although the muscle is in a state of partial contraction and needs MORE nutrients and oxygen, it will actually get less than what it should be getting at rest. All the muscle relaxers, anti-inflammatory, and pain medications in the world will not correct this situation.
What are the Methods & Procedures to repair the damaged joint?
Prolotherapy to the rescue:Ultimately, the best, most appropriate, and long-term solution is to strengthen the damaged tendon & ligament attachments and any other connective tissue structures that are the source of the ongoing pain and joint dysfunction. Sometimes the muscles & nerves also need to be treated and supported to achieve full resolution. Many things have been tried to accomplish this and only a few have been proven to work. Prolotherapy is the most researched and documented technique known to do just that. Even the more recent and well-publicized techniques of PRP (platelet rich plasms) and Stem Cells are really modifications of prolotherapy. Do they work? Yes, because the underlying technique of prolotherapy works. These solutions can help the tissues to heal faster but not necessarily better (and at a much greater cost).
Prolotherapy is a technique that uses a syringe to inject a safe, irritant solution at very precise locations to "trick" the body into thinking that a new injury occurred right where it failed to heal properly. This sets up a chemical messaging system (using cytokines) to attract and activate fibroblasts to the site of dysfunction. Once the fibroblast arrive at the site of 'new injury' designated by the injections, the fibroblasts turn on and start to produce collagen which helps to repair the unstable joint structure by essentially 're-welding' and strengthening the ligament and tendon attachments that were previously damaged and failed to heal completely. Typically, it will take several sessions to reach full resolution over a period of a few months. The number of treatments are a function of how bad the damage is and an individual's healing capacity.
A quick recap:Most, if not all injuries, whether they be from a single traumatic injury or due to chronic wear and tear (repetitive motion injuries), involve damaged ligaments or tendons. They do not heal back to pre-injury levels in most cases for a variety of reasons. Prolotherapy is a simple procedure that stimulates the body to reactivate and continue the healing process by directing the body's healing energy to the specific location needed. Although the approach has been documented to be over 90% effective in hundreds of studies since 1937, versions of it were successfully applied going back to Hippocrates and possibly further to ancient China.
The first clinical study of the technique of Prolotherapy (then called sclerotherapy) for joint pain was published in 1937. Since then there have been hundreds of studies confirming a 87-96+ % success rate. More recently, other solutions have been used such as PRP (platelet rich plasma) and stem cells. As previously mentioned, they are simply modifications of prolotherapy that can magnify the healing process. In select cases either of these or a variety of other biologically active solutions can be used although these substances greatly increase the overall cost of the procedure.
FYI, there is a non-injection option that can also be used in select areas. It has not been studied anywhere nearly as much as prolotherapy, but it will help and may do the job in those that are complete needle phoebes.