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Non-Surgical
Tendon, Ligament and Joint Reconstruction
William
J. Faber, D.O.
In acute injuries,
the ligaments and tendons become torn. Ligaments function to limit the range
of motion that bones can move between each other, and function to stabilize
joints and hold the joint together. Tendons function to attach a muscle to
bone in order to provide motion. Discs and cartilage serve to absorb shock and
keep the bones from rubbing against one another. If the ligaments become torn
or over-stretched the joint becomes unstable and resultant friction causes the
discs or cartilage to become worn down causing a loss of height. The disc and
cartilage may also become worn away by repeated motion. This loss of height
causes further ligament laxity and thus more instability. The friction of the
joint is a stress. Bones respond to stress by making more bone. This
results in bone spurring which is the body's attempt to splint or stabilize
the unstable joint. Degenerative disease is merely the body's attempt to
stabilize joints as the tendons and ligaments have not been able to heal
because of lack of blood supply. If a patient has considerable degenerative
arthritis, the loss of disc or cartilage height causes a laxity of the
supporting ligaments. This causes joint instability. Reconstruction has been
shown to be effective in these conditions, causing the lax ligaments to become
strengthened, thus stabilizing the joint and allowing for increased function
and endurance.
Reconstruction
therapy (also known as sclerotherapy and proliferative) is given by a slender
needle similar to the hairline needles of the acupuncturist, into the
fibro-osseous junction. This is the area where the tendon or ligament attaches
to the bone. The substance used is sodium morrhuate which comes from cod liver
fish oil and a local anesthetic. Repeated studies at the University of Iowa
have shown that areas injected have increased in size by 35% to 40%, thus
causing permanent strengthening.
Therapy Benefits
Each treatment
session results in more and more tissue being laid down in the needed areas.
As a result, the joints continue to become stronger. The patient notes more
endurance, they can do more activities, as well as activities they couldn't do
before. The main side effect of the treatment is less pain as a result of the
joint being stabilized. Also, snapping, clicking, and popping sounds go away
or decrease. The patients can usually feel the joint becoming stronger with
each treatment they receive.
In Dr. George S.
Hackett's monograph Ligament and Tendon Relation Treated by Prolotherapy,
illustrations #5 and #6 show normal rabbit tendons which have been injected
three times each. The tendon on the right has been given a proliferative
solution. The left tendons have been given placebo injections. Hackett found
that the tendons injected with the proliferative solutions were 35% to 40%
larger in diameter and weight compared to the control injected left tendon. In
his monograph and article in the Journal of the American Medical
Association, Hackett states that 1600 patients with severe sacroiliac
sprain were treated with reconstructive injections. They were examined by
independent physicians 2 to 12 years after treatment was completed and 82%
remained free of pain or recurrences.
Double-blind Study
Demonstrates Reconstruction Success
In a study at the
Sansum Medical Clinic of Santa Barbara, California led by Robert Klein, M.D.,
a rheumatologist, and Thomas Dorman, M.D., an internist, they conducted the
most difficult task of a double-blind study in the most difficult cases of
continuous low back pain patients who suffered for ten years or longer. They
divided 81 patients who had surgery, medications, manipulations adjustments,
exercise, physical therapy and other treatments which failed to provide
adequate relief for 10 or more years.
One group was given
manipulation and a reconstructive solution of dextrose, glycerine and phenol.
The other group was given sham manipulations and normal saline injections.
Great care was taken to insure that neither the patient nor the physicians
knew which solution was injected. Both groups were given a total of six
treatments. It was found that 88% of the group injected with the
reconstructive solution had moderate to marked improvement. They reported
their findings in the prestigious British medical journal, The Lancet on
July 18, 1987.
40% More Strength and
Endurance Proven Possible
Harold Walmer, D.O.
of Elizabethtown, Pennsylvania has performed reconstructive therapy since
1952. He became interested in the marked increase of the white areas of the
X-rayed tendons of Dr. Hackett. He spearheaded the research which further
explored the question of increased strength caused by reconstruction therapy.
At the University of Iowa Department of Orthopedic Research, medial rabbit
knee ligaments were injected with sodium morrhuate 5% three times. Sodium
morrhuate is an FDA approved substance purified from distilled cod liver fish
oil. The control ligaments were injected three times with normal saline
solution. The ligaments were then mechanically pulled from the bone and the
force required was recorded. It was found that mechanical strength of the
morrhuate injected ligaments was some 25% to 40% over the normal ligament. Dr.
Walmer states that this is consistent with the clinical results he and other
skilled reconstruction therapists have noted for many years. Dr. Walmer feels
that it is this 35% to 40% increased structure as well as mechanical strength
over normal, that makes the therapy so exciting and dramatic in the results
frequently obtained. He postulates that the above observations may explain the
fact that numerous patients with severe conditions of long-term advanced
degeneration of bones, discs, cartilage, joints, tendons, ligaments, failed
surgery, compression fractures, polio, muscular dystrophy and other advanced
musculoskeletal problems have been seen to have dramatically improved strength
and endurance, allowing them to literally throw away wheelchairs, walkers,
crutches, braces and other aids. Dr. Walmer is pursuing grant money for
another university study to measure before and after strength of severely
degenerated joints. He feels that people in wheelchairs and other severely
weakened joint conditions may leave the patient with only 20% of the normal
strength. Since reconstruction therapy has been shown to increase size and
strength by 35 to 40% over normal, he speculates that increases of over 100%
may be possible. Dr. Walmer feels that grant research funds would be
well-spent in these times of increased medical and surgical costs, for more
studies on this life-restoring biological therapy. The therapy is estimated to
be 3 to ten times more cost effective than joint surgery, joint replacement or
spinal surgery. Studies need to be done so that costs and rewards of the
treatment can be evaluated. James Carlson, D.O., Knoxville, Tennessee,
orthopedic medicine and sports medicine specialist and past president of the
American Association of Orthopaedic Medicine, states that any pain or
discomfort associated with receiving multiple injections is made up for
ten-fold in benefits received from the therapy.
Kent Pomeroy, M.D. of
Scottsdale, Arizona, a rehabilitation specialist and president of the American
Association of Orthopaedic Medicine, says dramatic results should be noted by
the patient within the first week after the injections, provided no severe
swelling is present. If swelling occurs after the treatment, the patient needs
to wait until the swelling subsides before they can note improved strength and
endurance. If marked improvement is not obtained after the first few
treatments, then further laboratory examination is recommended to find why the
patient cannot reconstruct tissue.
How New Tissue is
Made
Biology has very few
laws but one is the Arndt-Schultz Law. It states that small stimuli are
stimulating; Large stimuli tend to inhibit. For example, a little electrical
current stimulates circulation and healing. A large electrical stimulation
causes decreased circulation and cell death. Mild irritating reconstructive
solutions cause dilation of blood vessels and a migration of fibroblasts
(healing cells) to the injured areas.
The fibroblasts then
lay down collagen which is structural protein to repair the area. The
University of Iowa and Dr. Hackett's research substantiate this re-growth.
The Results of
Reconstructive Therapy are Permanent
Rodney Chase, D.O. of
Bethlehem, Pennsylvania, a joint reconstruction therapist for over 30 years,
has stated that because new tissue is created, the results must be considered
permanent. He further advises that patients with loss of disc, cartilage, bone
anatomy from surgery, fractures or degenerative disease, and those with severe
scoliosis receive periodic treatments after they reach their maximum level of
improvement. Dr. Chase explains that with loss of structures, structural
height or deformities, these patients have been helped significantly but need
periodic treatment to maintain their optimal level of strength and function.
Contraindications and
Side Effects
John Sessions, D.O.,
a reconstruction therapist and biological practitioner from Kirbyville, Texas,
finds that the main side effect is less pain. This sometimes makes people
think that they are cured and they overuse the treated body part. Dr. Sessions
reminds them that reconstruction therapy is a natural process like growing
grass from seed. "You don't play baseball on new grass. You let it grow
up to its maximum growth, then you can play ball on it."
William Kubitschek, D.O. of San Marcos, California states that a contraindication to the therapy
is getting the therapy from a physician who has not specifically trained in
reconstructive therapy. Further, Dr. Kubitschek, in speaking as Director of
the Board and founding Director of the American Association of Orthopaedic
Medicine, states that "reconstructive therapists should know how to use
various solutions in all the anatomical areas of the body if they are D.O.'s
or M.D.'s. Dentists and podiatrists who use the therapy have been specifically
trained in reconstruction therapy. Those not specifically trained in
performing reconstruction therapy are simply not qualified to comment on its
indications and use of this specialized therapy." The main side-effect of
the therapy is less pain. The main effects are reconstruction and increased
strength. It is not uncommon for joints to swell after injection. This may
last a few days to a week or longer. The treating reconstructive therapists
should be contacted for any problems and follow-up. Refer to chapter 5 and
other pages of Pain, Pain Go
Away for further
discussion.
Introduction to Prolotherapy
Why Get Prolotherapy? Donna Alderman, D.O.
What is Prolotherapy?
Alvin
Stein, M.D.
Introduction to Prolotherapy
Ross
Hauser, M.D.
How
Safe Is Prolotherapy? Ross
Hauser, M.D.
The
Importance of an Experienced Prolotherapist Ross
Hauser, M.D.
Non-Surgical
Tendon, Ligament and Joint Reconstruction William J. Faber, D.O.
How Does Prolotherapy Work? Marc
Darrow, M.D.
When Prolotherapy May Not Work David Harris, M.D.
Twenty
Common Questions About Prolotherapy
David
Harris, M.D.
The History of Prolotherapy Ross
Hauser, M.D.
Curing Chronic Pain with Prolotherapy Scott
Greenberg, M.D.
Why So Many Turn To Prolotherapy
David Harris, M.D.
Prolotherapy
and Chronic Pain Ross Hauser, M.D.
Peripheral Joints
& Prolotherapy
Jay W. Nielsen, M.D.
Orthopedic Medicine: A
Non-Surgical Approach to Chronic Pain Lawrence
Cohen, M.D.
The Difference
Between Prolotherapy, Trigger Points, and Acupuncture Marc Darrow,
M.D.J.D.
Prolotherapy: Creating
Inflammation in an Area that is Already Inflamed Marc Darrow,
M.D.J.D.
Growth Factor Basis of
Prolotherapy
David Harris, M.D.
What
Does It Take To Heal Connective Tissue?
Dave
Harris, M.D.
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