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 Rebuilding Collagen: The Key to Prolotherapy
Marc Darrow, M.D.
What is Collagen?
Our bones and muscles are held together by the aptly named
connective tissue.
Connective tissues are
ligaments,
which connect bone to bone, and tendons, which connect the bones to muscles. It
is also the fascia covering muscles and the joint capsule tissue.
Ligaments and tendons are made of collagen. When the ligaments and tendons are
injured, the body produces collagen to heal them. The problem with ligaments and
tendons is that the body offers them a poor blood supply and, because of it, a
poor chance to completely heal.
The poor supply of blood to the ligaments and tendons is very apparent from
their white color. Muscles on the other hand are red because they have a very
good blood supply. Ligaments and tendons therefore are prone to not heal
completely from injury, because their limited blood supply does not offer, among
other things, the supplies necessary to rebuild collagen.
Collagen and Degenerative Disc Disease, Collagen and
Degenerative Joint Disease
Most are familiar with collagen because of its cosmetic benefits. Skin is held
together by collagen and young skin has plenty of it, making it smooth and
wrinkle-free. As we age, the quality and quantity of collagen diminishes and
breaks down. Years of sun exposure, facial movement, and gravity aggravate the
signs of age. Wrinkles and creases appear; the cheeks are not as full; and the
upper lip usually thins out.
Just as the collagen in our face deteriorates, so does the collagen in other
parts of our body. This includes the ligaments and tendons in, and around, our
joints. Where loss of collagen in our face is signified by wrinkles, in our
joints it is signified by pain and a diagnosis of degenerative joint disease or
degenerative disc disease.
The key to
Prolotherapy is its ability to
stimulate the growth of collagen and therefore, the growth of new ligament and
tendon tissue. Grow stronger ligaments and tendons and you repair the injury and
reverse the degenerative cycle of arthritis and wear and tear disorders.
A Profile of Collagen
Collagen makes up 70-90% of the stuff that holds our bones and joints together
and in their proper place. Some older readers may remember that old horses were
often sent to the "glue factory." The reason is that boiled collagen is used as
glue.
In degenerative disease and aging, collagen, like glue, dries out and loses its
ability to stretch. Why this happens more in some individuals than others is
speculation at this time. There are many theories including, but not limited to,
poor genetic makeup, blood type with its specific dietary requirements, viral or
bacterial load, pathological conditions, acidity in the body, and food
allergies, to name a few.
But just as collagen can rejuvenate damaged skin to make you look better,
collagen can rejuvenate your soft tissues to help eliminate your pain.
Collagen and Joint Injuries
In non-injured ligaments or tendons, collagen fibers are flexible and have some
elasticity. Elastic as they are, they are not supposed to stretch very far.
Injuries occur when we stretch these fibers beyond their designed lengths.
Injuries also occur when wear and tear through repetitive motion fray and tear
at these fibers.
When these tissues are stretched beyond their normal limits, wear out, or tear,
pain is perceived.
Inflammation produces pain, which is a sign the body's healing process is
occurring. So initially,
inflammation
occurs as the body tries to heal the damage. Since the tendons and ligaments
have a poor and limited blood supply, it is important not to shut down the
initial inflammatory response (as you will read in the following chapter on
painkillers and anti-inflammatories.) Shutting down the inflammation is
equivalent to shutting down the healing cycle and YOU prevent yourself from
healing correctly In all cases that require
Prolotherapy, the ligaments and tendons, whether through the use
of anti-inflammatories, or because of a weakened immune system, or because of
the severity of the injury, did not heal sufficiently.
When things do not heal correctly, not only is there chronic pain, but now
inflammation, initially our friend, also becomes chronic and bothersome.
Injured, loose, or stretched out ligaments are often referred to as ligament
relaxation, or
Ligament
laxity. This is what produces the pain and discomfort,
especially with movement. Because of the laxity, the joint may move beyond its
normal range of motion.
Referred Pain
Pain will not only occur at the site of the injury and loose ligaments, but may
also be referred to other parts of the body.
Referred pain is created by ligament laxity around a joint, but is felt at some
distance from the injury. These painful points that refer pain elsewhere are
called
trigger points, and will be dealt
with later. Abnormal joint movement also creates many "protective actions" by
adjacent tissues. Muscles will contract in spasm in an attempt to pull the joint
back to the correct location or stabilize it to protect it from further damage.
When this occurs in the back, orthopedic surgeons will often try to reduce
vertebral instability by fusing the vertebrae with bone and/or metal fixation.
But there is often an easier and more conservative way to achieve the same
stabilization. And this is the outcome of
Prolotherapy.
Unfortunately, this is where chronic problems begin, because the conventional
medical practice with its emphasis on pain relief, treats the symptom—pain, and
not the problem—laxity. A patient will likely be told to take anti-inflammatory
drugs, which is often precisely the wrong thing to do because inflammation is
the first part in the body's healing process.
Nonsteroidal anti-inflammatories (NSAIDS)
and
cortisone (an anti-inflammatory steroid) can give immediate relief, but with
a risk of creating a long-term injury with chronic pain.
By blocking inflammation, anti-inflammatories never allow complete healing, and
instead, aggravate the situation.
Inflammation and the Healing Process
If we allow the inflammation process to run its cycle without interference, we
see that inflammation leads to granular tissue formation that results in new
collagen tissue being created. The new collagen forms new threads, which attach
themselves to the damaged tissue.
New collagen fibers are short, they lose water and shrink, and as they attach
themselves to the old ligament, muscle, joint capsule, or tendon, these tissues
become more dense. Denser tissue is stronger tissue. This process is much like
the scab on a wound or scar that tightens up and shrinks once healing occurs.
The difference is that with
Prolotherapy, biopsies have shown brand new, beautiful tissue
without evidence of scarring. In essence, the tissue is healed, rejuvenated and
made stronger than before.
The Science Behind the Regrowth of Collagen with
Prolotherapy
As we have noted, the collagen in our bodies, especially in the tissue around
and near our joints, is prone to breakdown. We subject our joints to wear and
tear through repetitive movement, injury, accident or any other number of
reasons. Because the connective tissue around our joints and
cartilage
have poor blood circulation, conventional treatment maintained that any injury
to connective tissue was often irreparable. This was before a study conducted by
Y. King Liu.
In a 1983 study of Prolotherapy's effectiveness,
Y. King Liu injected five percent
sodium morrhuate
solution into the medial collateral ligaments of rabbits. He
found that after five
injections,
the ligament mass increased by 44 percent, the thickness by 27 percent, and the
strength of the ligament bone junction increased by 28 percent(1).
Liu's study (1)confirmed the results of an earlier study done by George Hackett
(2), M.D. In 1955, Dr. Hackett and his colleague Dr. D.G. Henderson, reported on
two years experimentation on the effects of the proliferant Sylnasol when
injected into rabbit tendons.
In 48 hours, histological tissue examinations revealed an early inflammatory
reaction surrounding the nerves and blood vessels with lymphocytic (immune
system cells that remove damaged tissue) infiltration throughout the area
between the two tendons and between the tendons and its sheath.
Two weeks after the
injection,
fibrous tissue was present; lymphocytic infiltration had diminished, although
some was still present, which showed that the proliferation of new white fibrous
tissue was still being stimulated.
One month after injection, fibrous tissue was present, and lymphocytic and
fibroblastic (immune system rebuilding cells) activity was greatly diminished.
In other words, they finished their jobs and moved on.
One year after three injections of the proliferant solution, the diameter of the
tendons increased dramatically, which was estimated to double the strength of
the tendon.
References
1.
Liu Y, Tipton C, Matthes R, Bedford T, Maynard J, Walmer H. An in
situ study of the influence of a sclerosing solution in rabbit medial collateral
ligaments and its junction strength. Connect Tissue Res 1983;11:95-102.
2. Hackett GS, Henderson DG. Joint Stabilization: An experimental, histologic
study with comments on the clinical application in ligament proliferation. Amer
J Surg 1955;89:968-1973. |
