So, how can one ‘know’ whether or not they have a ‘connective tissue’ pain source?  The answer is simple:  if a person draws a map of the location of their symptoms, and if tender connective tissue structures can be located which correspond to, or ‘make sense’, in light of the location and nature of the patient’s symptoms (keeping in mind the large array of possible symptoms which connective tissue can produce, and the capacity of connective tissue to ‘refer’ symptoms, or for symptoms from a structure to be perceived inches, or feet, from the structure actually producing the pain or symptom, in known patterns of distribution), then a reasonable assumption is that these symptoms might be related to the connective tissue structures.   I am highly skilled at performing, and interpreting, such an examination, and i really cannot determine the answer to this question unless I have the opportunity to examine an individual.  But a patient can get some sense of this on their own:  in the area of their symptoms, if there are ‘sore spots’ noted when the area is pressed upon, or massaged, this likely represents symptomatic connective tissue damage.  This is true whether there is ‘one’ spot, like a sports injury, or body-wide tenderness and pain, as is seen in ‘fibromyalgia’.   It is also true that if a patient cannot ‘find’ such tender structures on their own, I often can.

But, how can we be sure that the located tender structures are actually related to what the patient is complaining of?  Again, the answer is very straightforward.  The ‘healing trigger’ solutions that are employed in a Prolotherapy treatment all contain Lidocaine, a ‘numbing medication’.  While triggering healing, I am also ‘numbing’ each treated structure.  If these structures have this theorized small fiber nerve damage, and if this damage is in fact causing the patient’s symptoms, what should happen if these nerve fibers are ‘numbed’?  The symptoms will all go away immediately, and for the hour or so that the Lidocaine is producing numbness.  Then they will return.  If you see this pattern, what would it tell you about where the pain and referred symptoms are ACTUALLY coming from?  This gets really amusing when patients have numbness and tingling in a leg that they have been told is ‘sciatica’.  While ‘actual’ sciatica exists, most patients who have been told that they ‘have it’ actually have referred symptoms from pelvic and hip ligaments.  It is fun to see patient’s reactions when I make ‘numbness and tingling go away…using a ‘numbing medication’.  An occasional patient asks me if I simply made their symptoms go away by ‘numbing the sciatic nerve’.  What do you think would happen if I ‘numbed’ the sciatic nerve?   The whole leg would go numb and the patient would be unable to walk for an hour or so.  But if I am numbing the small, damaged nerve fibers in the sacroiliac ligament that are producing this ‘referred symptom’, then it would make perfect sense that such numbness and tingling would go away for an hour or so.  In other words, this theory corresponds precisely to phenomena we observe in the office on a daily basis.

And the ‘character’ of numbness and tingling is different depending on whether the cause is actually a pinched nerve, or small fiber nerve damage in connective tissue structures.  In a true nerve pinch, there is loss of the sensation of light touch and pinprick.  The skin is so numb that patients do not ‘feel’ light touch at all, and barely feel a pin pricking the skin.  In referred connective tissue symptoms, the sensation of light touch is maintained, and a pinprick feels ‘normal’…the skin just has weird prickly sensation, and ‘feels’ like it is numb, even though, when tested, it is not actually numb. Then there is the distribution.  The sacroiliac ligament refers symptoms down the lateral thigh and calf.  True sciatica is not felt there.  Each ligament has a defined ‘referral pattern’.  When someone draws a symptom in the distribution of one or more ligaments, you simply check the appropriate possibilities for tenderness.  If one or more are tender, you inject the tender structures.  If the referred symptom ‘goes away’ immediately, you have built a strong case for the actual cause of this symptom.

Unfortunately, on a daily basis we have patients come in who have been informed that the cause of their symptoms is anything but their connective tissue, when it proves to be precisely and only from that source.  We have been, literally, amazed at the percentage of patients in whom this is the case.  This ‘missed diagnosis’, in my opinion, is THE reason that explains the failure of the medical community to do anything other than mask the symptoms of most body pain, and it explains the high incidence of persistent pain after most interventions, including ’curative’ operative therapy.  We emphasize correct understanding of the symptom source in a patient for a very good reason:  correct understanding of the cause is the only way to reliably find an actual solution to the problem.