Non-Surgical Tendon, Ligament and Joint Reconstruction

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Non-Surgical Tendon, Ligament and Joint Reconstruction

by J. Faber, D.O.

_http://www.prolotherapy.com/articles/fabernstljr.htm_

(http://www.prolotherapy.com/articles/fabernstljr.htm)

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. 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 Klein, M.D., a rheumatologist, and 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 town, 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.

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 sdale, 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

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.**

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

af

ter 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.

Originally published in the Townsend Letter for Doctors, May 1993