Prolotherapy permanently strengthens tissue. Strengthening weakened structures produces permanent pain relief. Prolotherapy effectively eliminates pain because it attacks the source of the pain: the fibro-osseous junction, an area rich in sensory nerves. When a weakened ligament or tendon is stretched, the sensory nerves become irritated, causing local and referred pain throughout the body. These referred pain patterns of ligaments were outlined in Dr Hackett’s observations after he performed more than 18,000 intraligamentous injections to 1,656 patients over a period of 19 years.

A referred pain occurs when a local ligament injury send a pain to another area of the body. Dr Hackett described the referral patterns of the ligaments involving the hip, pelvic, lower back, and neck. (see referred pain pictures). Physical therapists, chiropractors, family physicians and orthopedists are usually unaware of ligament referral pain patterns. From the illustration, note that the hip ligaments refer pain to the big toe. The sacroiliac ligaments refer pain to the lateral foot, which causes the symptoms resulting in a common misdiagnosis of “sciatica”. Pain traveling down the back into the leg and foot is usually from ligament weakness in the sacroiliac joint, not pinching of the sciatic nerve. Patient who are misdiagnosed with ‘sciatica’ are often subjected to numerous test, anti-inflammatory medicines, and surgical procedures with unsatisfactory results. Prolotherapy eliminates the local ligament pain, as well as the referred pain, and is curative in most cases of sciatica.

Ligament injuries may cause crushing severe pain because the ligaments are full of nerves, some of the nerves tissue being free nerve ending. Movement may aggravate the damage nerve in the ligament and produces a shock-like sensation, giving the impression that a nerve is being pinched. It is a nerve-type pain that is due to a ligament stretching, not a nerve pinching. When a weak ligament is stretched, the nerves inside the ligament often send shock-like pain to distant sites, as in sciatica pain. If the ligament is strengthened with Prolotherapy, the nerves in the ligaments do not fire, thereby relieving the pain.

It is well-known that an injury in one segment of the body can effect other distant body parts, especially in regard to ligament injury. For example, when dye is injected into the nerves of the ligaments of the lower neck, the dye will travel four segments above and four segments below the initial injection site. The dye may be seen in the autonomic (sympathetic) nerves in these areas. This implies that ligament laxity at one vertebral level could manifest pain, muscle tension, adrenal , or automatic disfunction four segments above or below the actual injury site. This is one of the explanations as to why ligament pain is often diffuse and can take on a burning quality.

Knowledge of referral pain patterns, along with a complete patient medical history, allows physicians who practice Prolotherapy to make accurate diagnoses of specific weak ligaments, even before performing an examination. A prolotherapist, for example, may examine a back pain patient with pain radiating down the leg to the knee. This reveals that the source of the pain is likely ‘A’ and ‘B’ areas of the sacroiliac ligaments(see referred pain figure). Pain continuing to the lateral foot indicates weak ‘D’ area sacroiliac ligaments. Pain radiating to the big toe reveals the source is in the hip area.

The physician examines the appropriate area utilizing his most important diagnostic tool – the thumb. We call it our personal MRI scanner: My Reproducibility Instrument. A diagnosis is made when a positive “jump sign” is observed. This occurs when the injured ligament is palpated, causing the patient to jump off the examination table due to the severe tenderness of the ligament. The pain is caused by something between the pressing thumb and the bone. The something between these two areas is the ligament. The positive ‘jump sign’ gives both patient and physician confidence that the pain-producing structure has been identified. Ligament injuries are often not detected with CAT or MRI scan because ligaments are such small structures. If positive ‘jump sign’ can be elicited, the permanent pain relief with Prolotherapy is likely.

Prolotherapy is so successful because it attacks the root cause of chronic pain which is most commonly ligament laxity( weakness). Signs of ligament laxity or injury are the following:

1. Chronic pain
2. Referral pain patterns
3. Tender areas
4. Positive ‘jump signs’
5. Pain aggravated by movement
6. Cracking sensation in the joint when moved
7. Chronic subluxation
8. Temporary help from physical therapy, massage, or chiropractic manipulation.

Prolotherapy helps strengthen chronically weak ligaments and relieves all of the above.

In summary, Prolotherapy works by permanently strengthening the ligament, muscle, and tendon attachments to the bone, the fibro-osseous junction. Because the cause of pain is addressed. Prolotherapy is often curative.