Ligaments are tough bands of slightly elastic fibrous connective tissue that are attached to bone at either end. Their purpose is to stabilise joints within their normal range of motion, to optimize joint function.
Fascia are the sheets of woven fibres that wrap every structure in the body. Ligaments and fascia connect all the parts of the body to each other, so that injury in one region may affect the whole structure. The understanding of this concept lies in the science of tensegrity.
Ligaments are an extremely common source of pain, either directly because:
- the ligament is strained or torn; or
- because the ligament is stretched and causes the joint it bridges to be stressed or unstable; or
- the ligament/fascia is tethered and unable to support the movement of the joint.
Thus joints can be painful secondary to ligament/fascia pathology or directly because the ligament/fascia is causing pain itself.
Each joint in the spinal and peripheral joints have many ligaments and innumerable sheets of fascia which can be causing pain or imbalance in those joints.
The idea of prolotherapy is that by injecting the ligament/fascial tissue, one can improve the structural integrity of the connective tissue around a joint to allow better function.
The substances that are used to produce the tissue strengthening required in prolotherapy can be dextrose or PRP/PRF. These substances are injected into the ligaments and tendons that require healing to produce the end result.
Common ligament injuries are:
- ACL (anterior cruciate ligament) stretch, tear or rupture (link);
- MCL (medial collateral ligament) stretch, tear or rupture;
- Ankle ligament sprains causing unstable, painful or swollen ankle;
- Whiplash causing widespread micro and macro trauma to the ligaments and fascia of the neck, thoracic and lumbo-sacral spine;
- SIJ (sacroiliac joint) ligament laxity, which usually associated with multiple imbalances in the muscles of the pelvis (link to this subject);
- Wrist ligament strain or tear, causing wrist pain and dysfunction;
- Thumb-base ligament strain causing thumb-base osteoarthritis and pain;
- Big toe ligament strain.
Ligament stretch and strain are suitable to treat with orthobiologics and tears are referred to surgical repair.