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15 Important Things to Understand
About Your Pain |
- If the actual cause of pain is accurately diagnosed, you have a good chance of applying a useful therapy. If the cause of pain is inaccurately diagnosed, you may get lucky and choose a therapy that is helpful. More likely, you will employ a therapy that is expensively unhelpful, or even harmful.
- The vast majority of people who see me have been told that their pain is coming from a structure or a mechanism that proves to be incorrect. Often people who come to see me have been seen by a variety of healthcare professionals, have a whole collection of ‘diagnoses’, and not uncommonly have a stack of imaging studies, a collection of medical bills and a surgical scar or two.
- Significant, ongoing body pain in the vast majority of patients IS due to connective tissue damage. When people have significant pain, it usually IS NOT due to inflammation, pinched nerves, inflamed nerves, scar tissue, arthritis (inflamed joint), bursitis (inflamed bursa), cartilage loss, sciatica (sciatic nerve pressure), bulging discs, bone spurs, Morton’s neuroma, spinal stenosis (even if some stenosis is seen on an MRI), degenerative disc disease, myofascial syndrome, etc.
- How does connective tissue damage cause pain? Envision a steel cable with half of the wires that form the cable broken. Put the weight on the cable that it is designed to bear - can you see the remaining cable beginning to stretch and give under the weight? Collagen molecules in a ligament or tendon are just like wires in a cable. If you break a certain number of collagen molecules and don’t replace them, can you see the ligament or tendon beginning to stretch and give during weight-bearing? The problem then becomes the nerve supply in the ligament or tendon - these structures have more nerve supply than virtually any other body tissue, and these microscopic nerve fibers in these structures do not stretch. Can you envision these nerve fibers now beginning to tear and shear? This is the mechanism of pain in damaged connective tissue - ongoing damage to microscopic nerve fibers within weakened ligaments and tendons. To stop the pain, the structure must be returned to normal tensile strength by using the healing system to build new collagen molecules.
- It is exceedingly easy to diagnose pain of connective tissue origin. There will be tenderness over one or more ligament and/or tendon structures in a location that corresponds to the patient’s symptoms. That tenderness is very specific (it is noted directly over the structure), and is very consistent (symptoms arising from structure damage vary in location, character, and intensity - tenderness is always, always, always present unless the structure heals).
- It is impossible to correctly diagnose pain of connective tissue origin from imaging studies (including MRI), in the vast majority of cases. At least 90% of the seriously symptomatic connective tissue damage that I treat does not show up on ANY imaging study. For instance, in a shoulder that has a couple of visibly damaged structures on MRI, I will commonly find five, or ten, or fifteen damaged, symptomatic structures. If you simply repair the two that you see on MRI, what is the chance that the shoulder will be pain-free?
- It is IMPOSSIBLE to correctly diagnose connective tissue damage from a physical examination IF you believe that tenderness is due to INFLAMMATION - instead of understanding that tenderness is due to STRUCTURE DAMAGE. If someone tries to treat connective tissue damage with NonSteroidal Anti-Inflammatory Drugs (NSAID’s - like Advil, Aleve, Motrin, Mobic, Celebrex, etc.), or with Cortisone or Medrol, it is likely that they do not understand this distinction.
- Your body wants to heal your damage, and is generally capable of doing so when properly stimulated. A successful treatment strategy consists of first ceasing things that impair healing - ice, NSAID’s, corticosteroids. Secondly, trigger the body’s strongest healing system as many times as needed to repair the damage. On occasion, trouble-shooting is required for the healing system, which may be impaired due to other medical reasons.
- If you have pain ‘all over’, in multiple joints, which cannot be explained by trauma (you were not thrown off a three story building or hit by a bus, but feel like you were), you likely have a problem with your maintenance healing system. If your body stops doing daily maintenance connective tissue healing, you will slowly accumulate damage that will eventually result in pain in an increasing number of structures. The endpoint of this process is commonly called ‘Fibromyalgia’. Common causes of healing system failure include: low or low-normal testosterone level (particularly in females), significant allergies, and long-term anti-inflammatory medications.
- What do loss of cartilage, degenerative disc disease, disc rupture, and a torn meniscus have in common? ALL OF THESE CONDITIONS ARE CAUSED BY LOOSE LIGAMENTS. How much does your front tire need to be out of alignment before you notice abnormal rubber wear? If the ligaments in your knee, or hip, or shoulder, or spine are longer than they are supposed to be, will your cartilage or your disc wear abnormally? Probably. I have yet to see a joint with significant cartilage loss, or a torn meniscus, or a deteriorated or ruptured disc, without demonstrable ligament damage (tenderness). Most, or all, of the pain in these situations is coming from the ligaments, not the disc, or the cartilage surfaces, or the meniscus.
- Cartilage and Fibrocartilage (meniscus and labrum) can heal if properly stimulated. The more structure you remove (e.g. a torn meniscus), the more unstable your joint is going to be, and the more likely that deterioration of cartilage will accelerate. But the thing that puts your cartilage and meniscus at greatest risk in the future isn’t removing part of the meniscus - it is the ligament laxity that is causing this whole picture to begin with. Does it make more sense to heal the meniscus, refurbish the cartilage surface, and, most of all, tighten and toughen the loose ligament(s) that is the ultimate cause of the problem?
- Muscle Malfunction: tightness, spasm, trigger points, and weakness. Virtually all ongoing muscle malfunctions are CAUSED BY connective tissue damage. The nerve impulses coming from damaged nerve fibers (see # 4) disrupt normal function in surrounding muscles. You can massage, or adjust, or stretch, or strengthen these muscles indefinitely, but this muscle malfunction will reoccur unless you heal the connective tissue damage. If you do heal this damage, the muscle malfunctions disappear.
- Sciatica is usually not sciatica. I have seen literally hundreds of patients who have told me that they have pain, numbness, tingling, aching, or some other symptom down a leg (or arm), often extending to a foot (or hand). Less than a dozen patients among these have actually had nerve root compression (true ‘sciatica’). The remainder have ALL had referred symptoms from ligament damage. More properly, they have referred symptoms due to the damaged microscopic nerves within non-loadbearing ligaments or tendons. Dr. George Hackett, a trauma surgeon who did extensive clinical and laboratory research leading to the development of Prolotherapy, published very detailed maps of ‘ligament referral patterns’. These are extremely accurate, and almost unknown among the current medical community. Making the correct distinction between ligament referral symptoms and nerve root compression could prevent many disc surgeries and spinal fusions. Prolotherapy is very effective in treating ligament referral symptoms.
- Mistreatment of connective tissue injuries, particularly sports injuries, leads to serious complications. How can you mistreat an injury? Use Ice, then take a few days of an NSAID (motrin, advil, aleve, etc.). YOU WILL FEEL BETTER IN THE NEXT FEW DAYS, but YOU WILL NOT HEAL YOUR INJURED CONNECTIVE TISSUE COMPLETELY. You will be left with a more vulnerable structure, which is more subject to injury. If you are an athlete, and you repeat this process three or four times in a knee or ankle or shoulder, you will begin to have recurring pain, then chronic pain in this now-significantly-weakened structure. Complication Number One: your sport, that you put so much heart and time and effort into, is at risk because you are having ongoing pain. Complication Number Two: depending on what structure(s) is weak, you may well develop cartilage loss, torn meniscus or labrum, or expose yourself to a major operation when you finish tearing your ACL, etc. Complication Number Three: arthritis (see #15)
- What is ‘arthritis’? The word means ‘joint inflammation’. Are the characteristic findings of osteoarthritis (cartilage loss and new bone growth) due to some inflammatory process ‘eating’ your joint? Let’s look at another possibility. Loose ligaments cause abnormal wearing of cartilage. Abnormal impact on a bone prompts new bone growth - the bone tries to armor-plate itself. If your ligaments are loose, and you have more ‘play’ in your joint, are you likely to have ‘abnormal impact’ on the bone ends in, say, your knee? Would it surprise you, then, if you develop thickening of the bone, or bone spurs, or osteophytes, or some other form of bone growth around a loose joint? If you get an x-ray demonstrating these inevitable mechanical consequences of loose ligaments (cartilage loss and new bone growth) and show them to your family doctor, or Radiologist, or Orthopedic Surgeon, you will be told that you have---arthritis. The problem with using that word for a diagnosis is that it suggests that you need an anti-inflammatory medication, instead of ligament and cartilage healing. Interestingly, in almost every ‘arthritic’ joint that I have treated, when the ligaments are injected with proliferant/local anesthetic, the ‘arthritic’ pain immediately goes away. In other words, the pain in these joints appears to come, for the most part, from the LIGAMENTS.
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