WHY DO MOST PHYSICIANS NOW BELIEVE THAT TENDON AND LIGAMENT DAMAGE DO NOT CAUSE BODY PAIN?  A LITTLE HISTORY…

But, if you are not aware that connective tissue is a potential pain source (and the  notion that ‘ligaments’ are a potential pain source disappeared in the 1950’s, when physical examinations were abandoned in favor of ‘x-rays’, and ‘rheumatism’ became ‘arthritis’), to what will you attribute the patient’s symptoms?

The tenderness in ligaments that used to be noted on examination in conjunction with joint pain, and which used to be termed ‘rheumatism’, or ‘damage to connective tissue structures around the joint causing joint pain’, was supplanted by the notion of ‘arthritis’, or ‘joint inflammation’, based solely on the fact that the first anti-inflammatory medication, Cortisone, made many people with joint, neck, and back pain ‘feel better’.  This clinical observation suggested that the cause of these pains ‘must’ therefore be ‘inflammation, since an ‘anti-inflammatory’ medication (Cortisone) made them  feel better.  Unfortunately, those who proposed this ‘new’ theory in the 1950’s did not get tissue and look at it under a microscope to see if there was actually inflammation present in these structures.  It took 40 more years for someone to finally examine structures thought to have ‘tendonitis’ with a microscope.  When this was done, in more than 15 separate studies between 1995 and 2005, guess what was found?  No inflammation at all.  ‘Tendonitis’ does not exist.

But by that point, at least in the minds of practitioners, neither did ‘pain coming from ligaments’.  Ligaments, in the interim, literally ‘disappeared’ as a possible source of body pain.  In the current 5000 plus page text series that Orthopedic residents master during their training process (Campbell’s Operative Orthopedics), I do not believe the word ‘pain’ and the word ‘ligament’ occur in the same paragraph…and I looked.) then you will of necessity attribute symptoms reported to you by a person who HAS this pain source to a cause that you HAVE heard of…again usually something you ‘see’ on imaging, or ‘infer’, like a nerve pinch or an inflammation.  Or a Morton’s Neuroma, or a bone spur, or scar tissue, or occipital neuralgia, or spinal stenosis, or dozens of other purported ‘reasons’ for pain.