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Chronic Joint Pain and/or Instability |
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Many people consult a physician because of continuous or recurring pain in a joint, or joint instability. Often, chronic pain arises from a damaged tendon or ligament, or from a group of damaged structures. Ligaments hold one bone to another. They allow bones to move, but only to a point. Tendons attach muscles to bones. Tendons and ligaments are made of remarkably strong material. They are subjected to huge forces during our everyday motions. If ligaments are stretched or damaged, then movements that stress the
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damaged ligament will cause pain. If damage is severe enough, pain can be continuous. Damaged ligaments often become stretched, somewhat likeoverstretched rubber bands. Since the job of a ligament is to hold bones in position, allowing them to move in a very defined and limited range of motion, the ligament now cannot do its job properly. The bones are able to move abnormally, causing pain, instability, and other problems. If a tendon is damaged, then pain with movement, or muscle spasm, often occur. Either a damaged tendon or ligament can become a ‘trigger point’, causing everything from migraines to referred pain considerable distance from the damaged structure. Sometimes, the main problem is not pain, but simply instability of the joint, particularly in the knee and shoulder.
When you go to a physician for evaluation of pain in a joint, or in a region such as a hip or low back, it often seems unusually difficult to get a diagnosis of the actual source of the pain. Is the pain caused by the bulge in the disk, pressure on a nerve, postoperative scar tissue, a bone spur, bursitis, arthritis, muscle strain, etc, etc., etc.? Or is your pain arising from an unhealed ligament or tendon injury? Often imaging studies are ordered. The are two problems with imaging studies. First, they rarely demonstrate a damaged ligament or tendon. Only the rotator cuff and knee ligaments are large enough to show up well enough to evaluate on MRI. Otherwise, damaged structures simply do not show up on films. So, you get a film and no significant abnormality is seen. You get a diagnosis of bursitis, lumbosacral strain, arthritis, tendonitis, etc., and you get an anti-inflammatory, steroid, physical therapy, muscle relaxer, narcotic, and a six month return appointment.
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The second problem with imaging studies is that they may show an ‘abnormality’ that is not the source of the pain. But, in the absence of any other identified source, the doctor may attribute your pain to the ‘abnormality’. That ‘abnormality’ may not be causing any symptoms. But these findings may prompt surgery, which will leave the patient with not only their original pain, but perhaps new pains as well.
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Or, the diagnosis may be correct, but the therapies may not work. People are still in pain, after ‘trying everything’. It is not uncommon for me to see patients who have had years of treatments—chiropractic, physical therapy, anti-inflammatory and steroid medications, supplements, massage, perhaps one or more operations, and they still have the exact pain they started with. Often more than one practitioner has told them things like, ‘There is nothing more that can be done. Learn to live with it. Take pain medication. Buy a cane. Stop doing all those things you really want to do.’ The basic approach of the ‘mainstream’ medical community is to:
- Make the pain stop by attacking your inflammatory process with medication. (Keep in mind that this pain is your body’s way of telling you that you have damaged, unhealed connective tissue, and that heavy use of this structure risks damaging it further. This pain is a sign that you have damage that needs to heal. It is not an ibuprofen or steroid deficiency.)
- Assume that any imaging study abnormality is the source of your pain.
- Medicate you to help you ‘live with’ your symptoms.
- Assure you that since ‘all the tests are negative’, your pain must not really be that severe after all.
Why have some patients seen multiple practitioners, yet not had a proper diagnosis or a treatment that will work for ligament and tendon problems, when a treatment exists? Because, for reasons that still puzzle me, the mainstream medical community is not familiar with Prolotherapy. These patients just need to heal their own tissues. Prolotherapy can accomplish that.
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It is essential to correctly identify, and to properly treat, the cause of pain. In order to do this several things are important. First is a correct diagnosis. In order to arrive at a correct diagnosis, I do one thing that is often omitted by other practitioners: a careful physical examination. That is all that is necessary to diagnose the presence or absence of damaged ligaments or tendons as the source of pain. Secondly, understanding the realities related to this damaged tissue is vital:
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- If a structure is damaged enough to produce significant intermittent or chronic pain for more than a few months, IT WILL NOT HEAL ON ITS OWN. Additional physical therapy, anti-inflammatories, steroids, exercise, supplements, and manipulation will not prompt healing.
- Pain and disability will continue, and likely increase, over time unless healing occurs.
- This pain is your body’s way of telling you that you have a damaged structure, that is not fully weight bearing, and if you overuse this structure in its compromised state you will damage it even more.
- The goal of treatment should NOT be to mask this pain (steroids and anti-inflammatory medication). The goal of treatment should be to heal the damaged structure.
- ‘Mainstream’ medical practice, including Orthopedics, does not recognize or utilize any treatment specifically directed at healing damaged ligaments and tendons.
- Anti-inflammatory medication and steroid injections can directly weaken already-damaged structures, and can impair your ‘wear and tear’ repair system so that other joints may become compromised in the future.
- Prolotherapy has been shown, by scientific research and over 60 years of clinical practice, to be capable of healing damaged tendons and ligaments so that pain and disability are cured. The cure rate using Prolotherapy is around 80% for most applications.
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A Prolotherapy physician will take a careful history to understand the origin and location of the pain. Since a person’s ability to heal is crucial in this therapy, an extensive history is also obtained for factors which effect healing. Using a careful physical examination, and an understanding of pain referral patterns, the structure that is actually damaged, the actual source of the pain, is located. Often there is more than one damaged structure. These structures are treated with proliferant solution.
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This proliferant solution prompts a ‘healing cycle’ which lasts six weeks. Ligaments and tendons are damaged to different degrees, and people heal at different rates. It may require multiple treatments to create enough healing to return the structure to full load-bearing status. The range of treatments is usually two to eight, with the average around four, to completely heal a damaged structure. Unlike many treatments which either mask the pain, or temporarily relieve the pain, Prolotherapy stops pain by returning the structure to normal. Unless that structure is damaged later, pain relief will be permanent. Changes may be recommended in medications, nutrition, and supplements that will promote healing and health.
Major injuries involve many structures. So do ‘wear and tear’ injuries. Very often, as noted by Dr. Hackett (see ‘History of Prolotherapy’), the greatest cause of pain is unhealed ligament and tendon damage. However, healing often involves many kinds of care, and many practitioners, to be complete. There is definitely a role for Orthopedic surgery, Chiropractic, Physical Therapy, Massage, Acupuncture, Nutritional and Supplement therapy, and other healing arts in the care of these people. But none of these therapies can accomplish what Prolotherapy can accomplish. Prolotherapy can play a role, sometimes a key role, in curing pain and disability. It is important that people with chronic joint pain be aware of this option, and have access to this type of care.
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