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. 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.
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 ligament 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.
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.