Ligaments connect bones together and serve to stabilize joints. Tendons connect muscle to bone and transmit muscle generated forces to the skeletal system to permit movement.
Ligaments and tendons are primarily composed of collagen. Collagen is a tough protein and, pound for pound, stronger than steel. This collagen is bundled together and functions similar to a steel cable.
Additionally, there is a high density of c-fibers which are nerves that transmit pain signals. In fact, the density of nerves in ligaments & tendons is near the density of nerves in the skin. These nerves do not like to stretch.
The body heals itself through a complex inflammatory process. There are 3 phases to this process:
- Inflammatory – occurs over the first 36 hours or so following an injury
- Proliferative – 36 hours to 6 weeks (approximately)
- Remodeling – 6 weeks to 18 months (approximately)
This process tends to be fairly effective but is certainly not 100%. Additionally, when an injured person takes medications (motrin, advil, naprosyn, other NSAIDs, steroids, etc) or uses ice, the repair process can be slowed if not stopped all together.
Normally, the ligament/tendon is strong enough for the load it is expected to handle. However, an injury can damage the collagen which is like breaking the strands of the steel cable. When you break these strands, the cable is no longer able to hold the same weight and begins to stretch under the load. When ligaments & tendons are damaged (or stretch) it irritates the c-fibers in the ligament and causes pain.
Prolotherapy stimulates proliferation of new collagen fibers by inflammation. This process has been well studied over the past 70 years and it results it the addition of normal collagen and not scar tissue.
New collagen is laid down and begins to shrink. The shrinking shortens the ligament and tightens the joint.
It has been shown that prolotherapy can increase the diameter of the ligament by up to 40% over the normal size and increase strength by 50%!
This improved strength means that the ligament is able to handle its load and is no longer stretching. Since there is no more stretching of the c-fibers the pain goes away!
Once the ligament heals the pain goes away. No more treatment is necessary at this point. Re-injury is the only thing that can cause the pain to come back. However, the ligament is now stronger than before which decreases the risk of re-injury.
Most patients will require between 3 and 6 procedures (average) scheduled about 3-4 weeks apart. Many patients experience significant improvements in pain after a single injection but there are some that will require more than 6 to achieve adequate results.