LIgament/Tendon Injuries & Prolotherapy

Ligament Injuries

   People usually seek out my services for chronic symptoms after trying other treatment approaches, often with limited success. For many of these clients with chronic symptoms I began to see a reoccurring pattern: muscle weakness/pain, poor joint control/stability, poor proprioception (balance, coordination, "muscle awareness" )as well as muscle tightness and/or excessive joint mobility. Coincidentally I have also experienced similar deficits with my own injury history. Through my research, experience and observation I concluded that injuries to ligaments often produce multiple functional deficits and symptoms, and left untreated can lead to chronic pain, disability and poor athletic performance.

Anatomy of a Ligament

   Basic anatomy teaches that ligaments and tendons are tough, dense fibrous structures that bind bones together, yet allow for joint translation. When ligaments are injured - stretched primarily, they do not return to their original length - they lose their structural integrity. Since they are so dense, blood supply necessary for healing isn't always adequate. This means a joint that was once stable and mobile now has excessive movement and this excessive movement leads to multiple symptoms.

    To understand this in simple terms think of any moving, mechanical component like hinges on a door or the steering mechanism in your car. Proper functioning of these components is dependant on exact fitting tolerances that allow good mobility between the pieces (joint). If there is excessive joint movement (poor fitting tolerances) the forces acting on the joint will not be properly dissipated or transferred, instead the joint will eventually break down from excessive movement between the parts. In other words the door will no longer open or shut right and your car won't travel in a straight line.

   Unlike a car your body has a complex communication network in your nervous system. With the injured ligaments and excessive joint forces your nervous system responds by sending pain signals from the injured ligaments and joint stresses, triggering muscle tightness which can be a compensatoryresponse for the lack of joint integrity. The most significant issue I see is muscle function is inhibited leading to weakness, atrophy and poor joint control - which reinforces the vicious cycle of continued ligament stress and joint degeneration. This makes sense from a practical standpoint. It would not be safe for you to drive your car fast, on a highway or on a twisting road if your steering mechanism was worn out and loose. The body shuts down muscle function as a way or preserving itself from future injury by limiting how much force your muscles can generate or tolerate. This is why ligament injuries are so devastating to athletes who require maximal exertion and endurance.

The Injury Process

So how do these injuries happen? Most often it is an acute, traumatic episode like a fall, car accident or sports injury where ligaments/joints undergo excessive force that stretches them beyond their elastic tolerance. The other scenario is a repetitive strain type of injury like poor postural habits where progressive joint forces over time lead to lengthened ligaments. People that practice stretching exercises like yoga, gymnastics and dance are more susceptible to injuring ligaments. There are genetic and constitutional predispositions as well. Women are generally more flexible and have less muscle mass than men. Women also have hormones that effect ligament tension (SI joint pain being common for pregnant women as the result of ligament relaxation and the added stresses of carrying a fetus.)Young adults and children are generally "looser" and some people are just born with more joint mobility.

Ligament Injury Diagnosis & Rehab   

   The difficulty with treating these injuries first of all lies in the fact that minor to moderately severe ligament injuries are not easily identified with diagnostic equipment or appreciated by many health care providers as a significant component in muscluloskeletal pain scenarios. Treating ligament injuries with manual therapy techniques such as joint mobilization will be marginally successful without a rigorous exercise program. Chiropractors traditionally treat joint subluxation - joint misalignment by manipulating joints back into "proper" alignment. Ligaments are the primary restraint to joint movement and position. As stated above joint position is dependant on ligament tension, muscle function and nervous system function. A joint will not stay in proper alignment without addressing these multiple factors.

My Approach to Ligament Injuries

   In my practice I place great emphasis on assessment techniques that determine ligament, joint, muscle and nervous system function. My treatment approach utilizing manual therapy, movement reeducation, body awareness and exercise can be effective in treating ligament injuries. However, considering the insidious nature of the injury process it can take a very motivated individual (athlete) a long time to see significant improvement on more severe cases. And then there needs to be consistent, diligent efforts made to maintain whatever level of function has been attained. It is a constant effort fighting against the body's inherent nervous system response to shut down function. My frustration with the lack of significant progress with these cases has led me to consider the role of ligament injections and prolotherapy as a possible aid in speeding recovery from these injuries.

Prolotherapy

This web site has good, basic information about prolotherapy.

www.prolotherapy.com

This article was the cover story of BioMechanics magazine

Sweet Relief Prolotherapy

Tendonitis or Tendonosis?

   This link is for an exceptional sports medicine book "Clinical Sports Medicine" by Peter Bruckner & Karim Khan. http://www.clinicalsportsmedicine.com. There is great information in this book clarifying the differences between these two tendonopathies. Why is this important? The diagnosis of tendonitis is often made by default without a clear understanding of the nature of the injury/healing process, These authors argue lognstanding tendon pain is not inflammatory in nature but from a degnerative process - tendonosis. Treatment options differ dramatically between these two conditions which is why many people suffer for extended periods of time assuming they have tendonitis.