 Ligament Injury and Referred Pain
Patterns
Ross Hauser,
M.D.
The chief
principle of
Prolotherapy
is that it treats the root cause of
chronic pain
and sports injuries—ligament
and tendon weakness. The chief symptom of ligament and/or tendon injury is
pain. The pain is aggravated by activity when tension is placed upon the
ligament or tendon and usually subsides when the tension is relieved with
inactivity. Often the general activity of the athlete is curtailed because of
the pain.
Severe pain from muscle spasm can occur from ligament and tendon weakness
because the muscle is trying to stabilize the area. Chronic muscle spasms are
almost always an indication of underlying ligament weakness. If the
ligaments
cannot stabilize the joint, the muscles contract to do it.
This is why treatments such as
physical
therapy, electrical
stimulation, and
massage, often help to some degree, by relaxing the muscles,
but do not cure the problem because the ligament laxity or weakness continues. Prolotherapy to strengthen the underlying joint and ligament permanently
eliminates the pain.
The odd thing is that sometimes the pain will totally dissipate
between attacks. During this period a physician can still palpate the region and
find the tender areas. When the tender areas are palpated, a female will squirm,
but a male will jump because of his lower pain threshold. This is called a
positive squirm and jump sign, respectively.
What most athletic trainers, orthopedic surgeons, and physical therapists do not
know is that ligaments can refer pain to a distant site. The more severe the
injury, the more likely a referral pain pattern will exist.
Dr.
Hackett determined the referral patterns of the ligaments of the lower back,
which refer to the legs, after giving 18,000 intraligamentous injections to 1656
patients over a period of 19 years. (Hackett, G. Ligament and Tendon Relaxation
Treated by Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas,
Publisher, 1958.)
He determined that often sacroiliac ligament injury refers pain down the leg
into the
foot and is the reason for so-called "sciatica." Hip joint ligament
injury refers pain down the leg into the big toe. Thus if a person has the
respective ligament referral pattern, it helps the
Prolotherapy doctor determine
which ligaments should be examined. The tender areas, as determined by a
positive squirm or jump sign, are then injected. Ligament and/or tendon laxity
(weakness) is one of the only conditions in which the diagnosis is confirmed
before treatment and verified after each treatment. This one fact may be the
reason for Prolotherapy's tremendously high success rate.
The treatment involves a physician palpating the exact site of the injury,
reproducing the pain, and then confirming the diagnosis with the actual
injections, because an anesthetic is contained in the
Prolotherapy solutions. The pain is then usually eliminated immediately after
the treatment due to the effect of the anesthetic being injected right into the
source of the pain-the
fibro-osseous
junction.
Prolotherapy injections into all
the tender areas will immediately eliminate all of the sharp pain and tenderness
if enough solution of sufficient anesthetic strength is injected. Some people
get so many injections that each injection can only contain a small amount of
anesthetic solution (higher levels would be toxic). In such an instance, most of
the pain will be immediately eliminated, but not all of it. Relieving the pain
immediately after the Prolotherapy gives the athlete and the physician
confidence that the injured structures have been treated.
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