Joints and Areas

Head and occiput, TMJ, many facial pains and headaches, cervical pain and spasm, pain across the top of the shoulders, shoulder blades, and between the shoulder blades, (often incorrectly called ‘trigger points’), thoracic spine and costa-transverse joint (where ribs and vertebrae join), shoulder pain, including rotator cuff tears and labrum tears, symptoms radiating into shoulders, arms, and hands diagnosed as due to nerve pinch in the neck or disc problem in the neck (most of these symptoms are actually arising from the ligament structure, though an actual ruptured disc with visible nerve root compression, resulting in profound symptoms in the upper extremity, IS a surgical problem), elbow pain, including ‘golfer’s’ and ‘tennis’ elbow, ligament injuries for which ‘Tommy John’ operations are recommended, forearm, wrist, thumb (including ‘arthritis), hand, and finger symptoms (if you have been told that you have ‘carpal tunnel’, but have a ‘negative’ nerve conduction velocity test, you may well have symptoms arising from connective tissue), lumbar spine (including many situations where various disc problems, spinal stenosis, spondylolisthesis, sciatica, and arthritis are diagnosed), sacroiliac joint/ligament, and ligaments of the posterior and anterior pelvis (all of which are commonly associated with muscle malfunction—‘back locking up’, ‘pelvic tilt’, spasm, weakness, or limp), hip pain (with or without imaging evidence of cartilage loss or labrum tear, particularly when a ‘nerve pinch in the spine’ has been proposed as a cause, and an epidural steroid injection has been proposed as treatment), thigh and ilieotibial tract pain, hamstring and ‘groin muscle’ ‘pulls and tears’ that produce ongoing or recurrent symptoms, knee pain, with or without an ‘x-ray’ diagnosis (including cartilage loss, meniscal tears, ligament and tendon injuries),  ‘Baker’s Cyst’, ’jumper’s knee’, foot and ankle pain (including that proposed to be due to ‘bone on bone’, ‘scar tissue’, ‘bone spurs’ plantar fasciitis, or ‘Morton’s Neuroma’,achilles tendon pain, and pain associated with bunions.  This is a partial list of conditions and previous ‘diagnoses’ in patients who had symptoms successfully treated in our office.  A complete list would be longer than you want to take the time to read.  Bottom line:  connective tissue damage is a common, and commonly mis-diagnosed, cause of moderate to severe body pain and dysfunction.   Ruling this cause out before major Orthopedic and spine operations might be a good idea.


Ligaments:  a partial tear noted on films, or tenderness and pain not associated with imaging findings.  Prolotherapy cannot treat a completely severed ligament or one that is completely torn from its attachment to the bone.  One ‘asterisk’ is that ACL damage may be misdiagnosed as a ‘complete transsection’ on film when it is in fact only a partial tear.  The ACL has a complex shape and it is often not seen in its entirety even when it is completely normal on MRI.  We have seen several patients who had a ‘complete ACL tear’ read on film who had successful treatment with Prolotherapy.  Ligament damage in the low back and neck often produces muscle malfunctions which may be interpreted as the ‘primary pathology’ and treated with massage and Chiropractic treatment for long periods, with transient improvement, but eventual recurrence, of symptoms.  Any ‘ongoing’ muscle malfunction generally represents ligament and/or tendon damage.  And what about the allegation made by some healthcare professionals that ‘ligaments do not heal’ due to a poor blood supply.  This assertion is made by people who do not watch such healing occur on a daily basis in large numbers of people based on their misconception of how the healing system ‘works’.

Tendons:  a partial tear noted on films, or tenderness and pain not associated with imaging findings.  These injuries are often associated with spasm of the muscle served by the tendon, or with laxness of weakness of this muscle.  A tendon that is completely severed or torn from its attachment to bone cannot be successfully treated with Prolotherapy.

Meniscus and Labrum (shoulder and hip):  These are ‘fibro-cartilage’ structures, made of both collagen and cartilage.  A tear can be ‘healed’ with a collagen bond, just like a cut in the skin, if the healing system is properly stimulated.  Pain due to tearing of any of these structures can be eliminated with a high success rate by Prolotherapy, but there is one other element that is important to understand:  these structures tore in the first place because there was abnormal movement of the bones in the joint.  This means that the ligaments were stretchable and loose, which virtually always means that those ligaments are also a significant source of symptoms, and one that does not often ‘show up’ on films.  This is why people often have pain following arthroscopy to ‘repair’ a damaged meniscus or labrum, and it is also why there is a high risk of ‘recurrent tearing’ of these structures—because the underlying situation that caused the tear to begin with has not been identified and successfully treated.  I have treated dozens of patients with meniscal and labral tears over the last ten years.  I am not aware of a single patient who has had a ‘new’ tear following treatment, nor has a patient, to my knowledge, required surgical treatment following Prolotherapy.  This certainly could happen, but that it appears not to have happened suggests that Prolotherapy is an excellent treatment choice for these problems.  In virtually all of these patients, there were multiple connective tissue structures, in addition to the ‘film-identified’ meniscal or labral tear, that required treatment.

TMJ:  One of the first uses of Prolotherapy was in tempromandibular joint malfunction.  Dr. George Schultz published a paper in the 1930’s after successfully treating a large group of such patients.  The TMJ is also a ‘fibrocartilage’ structure, but it is usually the sole culprit causing symptoms in contrast to the situation detailed above for the meniscus and labrum, when other structures are almost always causing a portion of the symptoms.

Cartilage:  Both Dextrose Prolotherapy and PRP have been shown to regrow cartilage in scientific studies.  While this is the ‘main’ reason that a stem cell treatment is done, to address ‘bone on bone’, as mentioned above, the loss of cartilage is usually not the main source of symptoms—it is the ligament structure which allowed abnormal movement within the joint, ‘rubbing off’ the cartilage.  If you make a shiny, and very expensive, new layer of cartilage, but do not address the issue that caused the cartilage to disappear in the first place (and no, this was not caused by ‘arthritis’, it was caused by mechanical forces), what do you think will happen in the next few years to your ‘new’ cartilage?  We have looked out four years following treatment at some of our knees (in which knee replacement was recommended, so these were ‘severe arthritic’ knees when we started treatment).  Absent a re-injury, this group of knees had fewer symptoms reported at four years than at one year following treatment.  Meaning, our ‘different approach’ did address the dynamic that tore up these knees to begin with, which is the loose ligaments.  Would this ‘different approach’ make a difference for you?  Stem cells are an option to treat knees, hips, and other joints, to be sure.  I am trained to offer this treatment.  But I rarely do, because I do not need to do so to get the results that my patients desire—and receive, much more economically.

Muscle tears:  the muscle cells are supported by a collagen meshwork. When a muscle is ‘torn’, this meshwork is also torn, and it must heal before the muscle can undergo heavy use.  Prolotherapy can accelerate the healing process in current tears (in the case of sports injuries), and can generally address pain and dysfunction arising from prior tears.  These ongoing ‘muscle tear’ symptoms are often also associated with undiagnosed tendon damage.

Fascia and periosteum:  this covers a wide array of conditions, from fibromyalgia to shin splints to postpartum abdominal muscle laxity.  These structures are also almost entirely made of collagen, and respond just like the ligaments and tendons.  In essence, any situation where a combination of tenderness in connective tissue, and pain or muscle malfunction is seen, represents small fiber nerve damage within the connective tissue structure that is tender, and this can generally be rectified by triggering connective tissue healing (Prolotherapy).

Other Symptoms and Conditions:

One of the fascinating things about connective tissue damage that begs for explanation is its ability to produce ‘distant symptoms’.  There is no explanation in the medical literature that explains how this might possible happen, except my paper on the Connective Tissue Damage Syndrome (Journal of Prolotherapy, Feb. 2009).  It does make sense that damaged nerve fibers, firing impulses into the nervous system, might produce symptoms at a distance.  These ‘distant symptoms’ include muscle malfunction (spasm, weakness, trigger point formation, abnormal tension, limping, and limited range of motion); somatic referred symptoms (burning, aching, throbbing, numbness, tingling) down legs and arms, on occasion to hands and feet; and autonomic referred symptoms, like migraine headaches, the Barre Lieou syndrome, voiding dysfunction, etc.

Barre-Lieou, headaches, ‘fibromyalgia’, ‘sciatica’, often cause has been previously misdiagnosed, or undiagnosed.