As a medical doctor who specializes in musculoskeletal medicine I often encounter patients with auto-related injuries such as whiplash, low back and other joint injuries. The key to optimal healing of whiplash and many auto injuries is to recognize that connective tissue damage is often the major cause of persistent pain and loss of functioning. Unfortunately, connective tissue injuries are often missed and given much less consideration than bony problems such as fracture or pinched nerve problems in the spine. Yet they are much more common. Approximately 80% of persistent pain after auto injuries is due to connective tissue problems. If a person does not get better within six weeks of conservative management with physical therapy they should be evaluated by a connective tissue specialist.
Connective tissue injuries must be differentiated from so-called soft-tissue injuries which often refer to muscle tears. By connective tissue we refer to ligaments which join bones to bones and form joints or tendons that join muscles to bones. These “connective tissues” are white, fibro-elastic tissues that are very strong yet resist stretching. The problem with the healing of these tissues is that their blood supply is very poor, limiting the body’s capacity to heal them. Muscles on the other hand, have excellent blood supply (giving them their red color) and generally heal readily with simple treatments such as massage, ultrasound and electrical muscle stimulation. What is underappreciated in medicine is that connective tissue is very rich in nerve endings. These nerve endings give the brain the input it needs to determine joint position and modulate complex movements. When injured and stretched, these nerve endings become exquisitely painful, allowing the body to protect itself from further damage by recruiting surrounding muscles to tighten and go into spasm thereby “splinting” and protecting the injured connective tissue from further damage.
Connective tissue injuries generally do not show up on x-ray or MRTs (unless there is a complete tear) but are readily evaluated by a new type of x-ray study called dynamic motion x-ray. This impressive test can show the abnormal movement of vertebrae in a patient, documenting the severity of connective tissue injuries and validating the source of pain and debility that patients often feel. Connective tissue injuries can be every bit as painful and debilitating as bone fractures and disc herniations and are much more common.
Prolotherapy: a safe and effective treatment
The importance of properly diagnosing connective tissue injuries is that they can often be treated successfully by a medical technique called Prolotherapy or Non-surgical ligament reconstruction. Prolo is a technique that stimulates the body to rebuild and tighten loose connective tissue. It can be used in almost any joint in the body. Prolotherapy can successfully treat an amazing assortment of auto-related and other musculoskeletal injuries including whiplash, upper and lower backpain as well as injuries to the shoulder, elbow and knee. Most studies show about an 85% success rate of improving the symptoms 50% or more.
Prolotherapy involves the injection through very thin needles of natural proliferants such as dextrose, at the precise points of ligament and tendon injury. Through Osmosis and other natural phenomenon it sets up a healing proliferating response that will stimulate the body to heal and rebuild the damaged tissues areas over the following 6-8 weeks and beyond. It usually takes 5 or 6 sessions to heal any given area. The goal of Prolo is not the immediate relief of pain but to stimulate the body to rebuild connective tissue which will permanently solve the root cause of the problem.
Prolotherapy has been around for 50 or 60 years and was originally an Osteopathic medicine technique that has impressive support in the medical literature. C. Everett Koop, M.D., our former Surgeon General is a staunch supporter of prolotherapy since he used it to cure his own long-standing back pain. He was so impressed that prior to being called to the Surgeon General post, he considered doing Prolo as a career. The reason that it is relatively unknown and not standard practice is that there is no pharmaceutical company behind it. There are only about 250 M.D.’s and D.O. If nationwide who specialize in Prolotherapy. Prolo is only taught at the post-graduate level and many doctors have never even heard about it, let alone knowing about the important role it can play to treat and rehabilitate patients with connective tissue problems.
Prolo is very safe and easily done in an office setting. Patients can be evaluated for connective tissue injuries through a simple examination. It can often preclude the need for the prolonged use of anti-inflammatory or pain medicines. Since Prolo has virtually no adverse effects, it usually makes sense to try it before resorting to painful and invasive (as well as risky) surgical procedures. In my view, it should also be considered before the injection of steroids in epidurals or other injections, since steroids can weaken connective tissues and generally gives only temporary relief. Since we numb the skin prior to any injections most patients find Prolo only mildly uncomfortable. Patients usually find the shots much less uncomfortable than their persistent pain and well worth it if they can permanently be rid of pain and regain functionality. Prolotherapy also works well in conjunction with other healing modalities such as acupuncture, chiropractic, physical therapy and massage to help promote optimal results.
In short, Prolotherapy is a safe, effective and elegant treatment that can permanently treat and often completely heal many auto injuries and other types of injuries and musculoskeletal problems. When I first see a patient and if they do have significant connective tissue problem (which is quite common) the most important thing I tell them is that there is hope for a safe, simple and effective treatment that will help them get rid of their pain and back to a full and active life. Learn to Prolo your pain away!
- Dr. Mark V. Walter