Connective Tissue Damage
The Underlying Culprit of Chronic Pain
Ross Hauser, M.D.
 

There are many articles written on chronic pain though rarely is mention given to the main culprits for pain, the connective tissues of the spine and joints. Yet by addressing the deficiency of connect tissues, the lack of collagen and weakness in ligament, tendons, and muscle, even people with rheumatoid arthritis can be cured of their pain--even to test rheumatoid factor negative in the blood, previously thought irreversible.
 

What is connective tissue anyway?
Connective tissue is composed of water, fibroblasts and chondrocytes, and the substances made by these cells, collagen and proteoglycans.
 

Water
By weight, connective tissue is comprised of 60 to 80% water. It is water and proteoglycans that enables connective tissue structures such as ligaments to be strong and somewhat flexible.
 

Other than sports or acute injury, the major reason joints stiffen and cause pain is dehydration. This especially affects the articular cartilage and discs, and is a contributing factors to degenerated discs. One of the easiest ways to begin the reversal of connective tissue damage is to drink more filtered or distilled water.
 

Fibroblasts
Fibroblasts make the collagen which makes up skin, bone, tendons, ligaments, vessel walls and viscera, and proteoglycans which make up connective tissue. Fibroblasts are crucial for healing because they have the ability to proliferate and heal injury.
 

Chondrocytes
Chondrocytes are responsible for formation, maintenance, and repair of articular cartilage, though unlike Fibroblasts, their ability to proliferate and repair injury is greatly inhibited by a lack of a direct nutrient supply from the blood.
 

Recent research into Chondrocytes have shown that despite the limited nutrient supply, these cells can generate new cartilage tissue. These important findings have dispelled the long held notion that cartilage tissue could not be repaired and damaged cartilage should be removed by surgery.

Proteoglycans
The proteoglycans are highly viscous proteins that are very hydrophilic, meaning they are attracted to water. The shock-absorbing properties of articular cartilage is primarily due to the proteoglycans. For people with arthritis or athletes with cartilage damage oral chondroitin sulfate and glucosamine sulfate are recommended as these substances are components of the articular cartilage.
 

Collagen
Collagen is the most abundant protein in the human body, making up about thirty percent of all proteins. Collagen is the major component of connective tissue, providing tensile strength and structural rigidity to tissues.
 

The cousins of collagen are the elastins, proteins which give elastic, resilient properties to tissues which need to expand and contract. These tissues are found in the lungs, ligaments, skin, and large blood vessels. Wrinkles, sagging skin, bags under the eyes are all a result of collagen and elastin deficiency.
 

Soft tissues: muscles, tendons, and ligaments and connective tissue
whiplash injuries, back strains, ankle sprains, loose joints, fibromyalgia, all have as their root cause in weakness or deficiency in the soft tissues of the body.
 

In normal pain free function, muscle, tendon and bone move in unison to create joint motion. Ligaments which connect bone to bone give the entire joint stabilization. It is the strength of the ligaments around each joint that is the determining factor in the joint’s overall stability and ultimately the level of pain.
 

The chronic pain error: ligaments are not muscles and muscles are not ligaments
The main difference between muscles and ligaments is that muscles are massively strong structures with a tremendous blood supply. Ligaments, on the other hand, are small tissues that have a poor blood supply. Muscles, because of their good circulation, heal quickly and rarely cause long-term problems, ligaments on account of their poor blood supply, often heal incompletely and are the cause of most chronic pain. Ligaments are also more easily susceptible to injury and weakness due to immobility (lack of exercises) and the aging process.
 

Articular Cartilage
Articular cartilage acts as a pad between the surfaces of two bones, it prevents the bones from making contact and as such is the main line of defense against osteoarthritis.
 

As stated, articular cartilage have the ability to re-grow and heal, yet the long held notion of damaged cartilage having no regenerative properties led to many people being subjected to arthroscopies and subsequent joint replacements.
 

Beginning in the early 1960’s medical studies reported that healthy cartilage cells (chondrocytes) had very little or no ability to proliferate. Since it was then thought that cartilage could not be repaired, orthopedic surgeons developed techniques to address the problems of chronic pain in degenerative joints. The first total hip replacement surgery occurred at this. A short time later the arthroscope was invented.
 

Medical alternatives to surgery
A small number of physicians (presently less than 300) have turned to a non-surgical treatment first developed in the late 1930’s that has shown very promising results in the treatment of chronic pain. By using Prolotherapy, these doctors have accelerated the rate of cartilage growth and strengthened the complete joint structure in patients with "no cartilage." Using this therapy many hip and knee replacements surgeries have been avoided.

In Prolotherapy, a series of injections, consisting mostly of naturally derived substances such as cod liver oil, sugar, salt, or corn extract are given at the site of the chronic pain—usually where ligaments and tendons attach to the bone. These injections are designed to stimulate the immune system by tricking the body into thinking a new injury has occurred.
 

The injected substances, as foreign matter, mimic an injury by causing irritation and mild swelling in the painful area. The immune system responds to this "injury" by sending macrophages, cells that remove debris and irritants from the body. After the macrophages carry off the irritants for elimination, the immune system sends in fibroblasts, cells that rebuild connective tissue where damage has occurred. This rebuilding process results in new ligament growth which can be 40% stronger than the original ligament. It also results in the acceleration of re-growth of cartilage tissue! Consequently, the physical structure supported by this connective tissue becomes stronger and more stable, thereby eliminating or greatly diminishing the pain triggered by the corresponding nerves and muscles.
 

Harold Wilkinson, M.D. professor and former chairman of the Division of Neurosurgery at the University of Massachusetts Medical Center, performed a 16 year Prolotherapy study culminating in 1995. In his report, Dr. Wilkinson states that it was noteworthy that "a sizeable portion of people with unresolved chronic pain had more than a year’s pain relief with only one Prolotherapy injection." While these results were obtained with a single injection, most Prolotherapy sessions involve multiple injections given in each session.
 

Non-Steroidal Anti-inflammorty Drugs (NASIDs)

Cortisone injections and anti-inflammatory drugs have the following effects on connective tissue healing:

- They decrease blood flow which inhibits the ability of immune cells to get to the area where damage needs to be repaired.

- Inhibits fibroblast proliferation thus restricting the body’s ability to repair damage.

- Decrease collagen strength by decreasing protein synthesis and regeneration of collagen tissue

- Decrease tendon and ligament strength

- Accelerate cartilage breakdown

In addition many recent studies have shown that physician and patient alike are weary of the prescription of NSAIDS because of harmful and well-known side effects.

If someone exhibits evidence of systemic inflammation, such as being tender all over or having a diagnosis of fibromyalgia or a rheumatological disease, then high dose proteolytic enzymes like bromelain can be given. Omega-3 fatty acids, oils such as evening primrose oil, borage oil, and flax seed oil may also be used and are typically necessary when weaning someone off of anti-inflammatories. Initially, switching from anti-inflammatory medications to Ultram or Tylenol may be used because its anti-inflammatory effects are generally negligible.
 

Many factors affect connective tissue healing
There are many other factors that affect connective tissue healing, but the next most important factor is the nutritional and medical status of the person. People who consume very healthy diets and do not have systemic medical conditions, have an excellent chance to heal their chronic pain. If they experience positive jump signs where tendons or ligaments attach to the bones, then they have almost a one hundred percent chance of curing their chronic pain with Prolotherapy.
 

RELATED ARTICLES
Benign Congenital Hypermobility
Degenerative Joint Disease

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POWER OVER PAIN THE CARE OF THE PATIENT BEGINS WITH CARING © 1999-2009 Ten Years Online! Caring Medical and Rehabilitation Services, 715 Lake Street Suite 600 Oak Park, IL 60301 708-848-7789

The information on this website is presented as information only and not a self-help guide NOR AS SPECIFIC HEALTH RECOMMENDATIONS. Never alter or change your health management or begin any new health plans without first consulting your personal health care provider. Some statements on this site regarding the value of nutritional supplements have not been evaluated by the FDA.

As with any medical technique, Prolotherapy may not be effective for every individual and there are risks involved, these risks should be discussed with your physician. Results achieved with some may not be typical of all. Please consult a physician. Please read Prolotherapy Risks

There is no known cure for arthritis. Prolotherapy and nutritional supplements can help alleviate, reverse, or end arthritic pain by treating an underlying cause that contributes to degenerative disease, ligament laxity. Strengthening ligaments and other connective tissue can help prevent bone on bone arthritis from developing.

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