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Ligament and Tendon Laxities
Ross Hauser, M.D.
A tendon attaches a muscle to the bone and involves
movement of the joint. A ligament connects two bones and is involved in the
stability of the joint. A strain is defined as a stretched or injured tendon. A
sprain is a stretched or injured ligament. Once a body structure is injured, the
immune system is stimulated to repair the injured area. Because ligaments and
tendons generally have a poor blood supply, incomplete healing is common after
injury. (Browner, B. Skeletal Trauma. Philadelphia, PA: W.B. Saunders Company,
1992, 1:87-88.; Deese, J. Compressive neuropathies of the lower extremity. The
Journal of Musculoskeletal Medicine. November 1988, p. 68-91.)
This incomplete healing results in decreased strength of the area. The ligaments
and tendons are normally taut, strong bands of fibrous or
connective tissue but,
because of injury, become relaxed and weak. The injured ligament or tendon then
becomes the source of
chronic pain and weakness for the athlete.
Ligaments and tendons are also more prone to injury because of the natural aging
process. The water content in our joints and connective tissues (ligaments and
tendons) decreases with age, the articular
cartilage (which lines the joints)
gets brittle and shrinks.
Cartilage is so vital, especially in weight-bearing joints like the knee,
because it causes an even force to be generated at the underlying bone. It also
causes the force generated on the bone to be less. When cartilage is
degenerated, the force to the bone is greater and uneven and arthritis develops.
Since cartilage decreases the force inside the joint, it becomes obvious that as
cartilage deteriorates as we age, other structures are going to have to bear
this force. Since tendons move the joints and ligaments stabilize the joints, it
is primarily these soft tissue structures that are involved. Because ligaments
stabilize the joints, a weakening of these structures causes a further force to
the bones of the joints. This increased force hastens the arthritic process.
The greatest stresses to the ligaments and tendons are where they attach to the
bone, the
fibro-osseous
junction. The most sensitive structures that produce
pain, according to Daniel Kayfetz, M.D., are the periosteum (covering of the
bone) and the ligaments. It is important to note that in the scale of pain
sensitivity (which part of the body hurts more when injured), Dr. Kayfetz notes
that the periosteum ranks first, followed by ligaments, tendons, fascia (the
connective tissue that surrounds muscle), and finally muscle. (Kayfetz, D.
Occipital-cervical (whiplash) Injuries treated by
Prolotherapy. Medical Trial
Technique Quarterly, June, 1963, p. 9-29.)
articular cartilage contains no
sensory nerve endings. If you are told that your cartilage is the cause of your
pain, that is not possible and is, actually, quite ridiculous. The cartilage
cannot hurt because there are no sensory nerves to sense pain located in the
cartilage. If there is cartilage damage, what hurts? The ligaments are typically
the structures that hurt. Ligaments are weakest where they attach to bone. The periosteum is the most sensitive area to pain and the ligaments second. It is
now easy to understand why this area hurts so much. This is where the
Prolotherapy injections occur and thus eliminate the chronic pain of many
conditions including arthritis, mechanical
low back pain,
degenerative disc disease, cartilage injury, and, of course,
sports injuries.
Prolotherapy works by stimulating the body's healing system, a process called
inflammation. The technique involves the injection of various solutions that
cause a mild
inflammatory response that "turns on" the healing process. The
growth of new ligament and tendon tissue is then stimulated. These new ligaments
and tendons should not be confused with scar tissue, which is a chaotic matrix
of
collagen. The ligaments and tendons produced after Prolotherapy, appear much
the same as normal tissues, except that they are thicker, stronger, and contain
fibers of varying thickness, testifying to the new and ongoing creation of
collagen tissue.
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