Ligaments hold our joints together. When the joint moves in a certain way, the ligament may be stretched. We rely on the flexibility of these ligaments so that when the joint moves, the ligament handles the stretch well. However, if there is a sudden movement and the ligament is stretched beyond its ‘comfort zone’, the ligament can become strained or even torn. This can happen with a sudden trauma such as a twisting movement with a sudden stop. As we age, the ligaments tend to lose their flexibility and suppleness. Due to the increased ligament stiffness with aging, ligament injury can occur with less trauma and we are susceptible to injury with repetitive strain, which entails no obvious trauma.
Muscles are made of fibers that contract to help our bones move. These muscle fibers have a spongy quality, which would make it difficult to get a firm attachment to the bone that it moves. The muscle fiber changes to a tendon, which is a firmer fiber that gives a stronger attachment to bone, which makes the muscle more powerful. The tendon tends to bear much of the stress when the muscle contracts so it is more prone to injury than the muscle.
If you see a picture of muscle in an anatomy textbook, you will notice that the muscle is a nice beefy red (pardon the pun) while the tendons and ligaments are white or yellow. This is because the muscles get a very rich blood flow but the tendons and ligaments have minimal blood flow. This is bad news for the tendons and ligaments. First, the lack of blood flow makes them susceptible to injuries. Second, when injury occurs, the injured tissue relies on blood flow to deliver the nutrients and growth factors that heal the injury. With less blood flow, ligament and tendon injuries heal more slowly. I know that I have painted a very bleak picture thus far but the good news is that there is a solution for the injured tendons and ligaments.
When a muscle is strained, the muscle tissue may often respond to stretching techniques and even massage to regain its flexibility. An example of a muscle injury is a strained hamstring. While these can be very painful and limit one’s activity for a few weeks, the hamstring usually resolves in 4-6 weeks. The enhanced muscle blood flow helps this recovery.
On the other hand, with a tendonitis, the recovery will be much slower and there are instances when the injury does not heal. An example of a tendon injury is tennis elbow. Tennis elbow is a repetitive strain injury to the tendons of the forearm extensors. These are the muscles that help bend the fingers and wrists back as if you were raising your hand to motion someone to stop. The tendons for these muscles all come together and insert on the outside of the elbow called the lateral epicondyle. That’s why the medical term for tennis elbow is lateral epicondylitis.
When these forearm muscles are overworked, usually on a chronic or ongoing basis, the fibers at the tendon bear much of the load and are strained beyond their capacity. As these fibers weaken some of them may tear, causing pain.
Another important principle to keep in mind is that tendons are often strained because the ligaments that support the joints are also weakened. So back to our tennis elbow example, there are 2 ligaments around the elbow, which are often strained or weakened in tennis elbow. When these ligaments weaken, that puts more strain on the tendons during elbow motion. This creates the conditions for tennis elbow to develop.
One of the hallmark treatments for tennis elbow is a steroid injection. This has the benefit of reducing pain and inflammation at the area of the injured tendon. This treatment often provides relief but unfortunately, the relief is usually temporary. That is because the steroid soothes the pain but does not treat the underlying biomechanical problem. So unless someone changes the way they use their arm, the same straining forces that lead to the initial tennis elbow will still be present and the pain will recur. Furthermore, there is literature to support the idea that steroid weakens the tendon so that the chances for long-term healing are actually decreased with a steroid injection.
Prolotherapy involves placing a dextrose solution around the injured tendons and ligaments. This stimulates a reaction in the tissue that stimulates blood flow and the migration of healing growth factors that migrate to the injured area. The injured tendons and ligaments respond by growing stronger. Thus the relief obtained from prolotherapy is long-term, not short-term. That is because prolotherapy is a solution, which is a fix in contrast to steroid injections, which is a band-aid.
The effectiveness of prolotherapy is based on sound biomechanic principles. In approaching every tendonitis, it is important to understand the forces that are acting on the tendon and the joint that the tendon crosses. Due to tunnel vision, there is a tendency to focus on the injured tendon and try to aim treatment at just that tendon. By looking at the broader picture and understanding what forces are contributing to the increased tendon strain, we can more effectively treat the underlying problem. When we treat a tendonitis, we treat the injured tendon and any weakened ligaments. This not only strengthens the injured tendon but also corrects the forces that lead to the tendonitis in the first place.
Another key aspect of prolotherapy that complements its effectiveness is that it is very safe. As opposed to a steroid injection, which suppresses body functions and has to be limited due its toxicity, prolotherapy stimulates the body’s healing reactions so it can be repeated if necessary and can be used for multiple areas of pain. Arthritic joints respond beautifully to prolotherapy because weakened ligaments are a strong factor in the pain caused by these joints. Prolotherapy treats those ligaments, thus reducing the arthritic pain.
While nobody wants to have pain from a tendonitis, a ligament injury or arthritic joint, it is good to know that prolotherapy, which addresses the cause and not just the symptom, is available as a safe, effective option to treat that pain.