Prolotherapy & Connective Tissue Damage Syndrome

Many joint and connective tissue pains defy clear and precise diagnosis. Often patients with various diagnoses for joint, back and neck pain are not cured by traditional treatment regimes appropriate for their “diagnosis”. Based on observations gleaned from treatment responses to Prolotherapy, the author describes and characterizes the Connective Tissue Damage Syndrome. When properly understood, the CTDS explains not only many body pains, undiagnosed conditions, and treatment failures, but also many muscular malfunctions (spasms, weakness, trigger points, etc.), and referred symptoms such as pain, numbness, tingling, and headaches. The results of Prolotherapy treatment in patients with these disorders suggest that pathological change in ligaments (CTDS) is the underlying cause of these disorders. Prolotherapy is the most rational and effective treatment for both the underlying cause (ligament damage), and secondary degenerative effects. The body is capable of healing damaged connective tissue structures, but certain hormone deficiencies and medical treatments such as anti-inflammatories prevent this. Once connective tissue damage syndrome is correctly diagnosed, then treatment is rightly focused on initiating and optimizing connective tissue healing. Since incomplete connective tissue healing can be principally due to either a trauma mechanism, or due to impairment of the body’s connective tissue healing system, the integrity of the healing system must be evaluated, and factors that impair connective tissue healing must be identified and addressed. These factors explain why many people with CTDS see their disease worsen over time, while under medical care. Patients who present with significant impairment of the connective tissue healing system are described, varying from “multisite connective tissue pain without trauma history” to full-blown fibromyalgia. Principles for successful treatment for the CTDS are described. Journal of Prolotherapy. 2009;1:45-53. keYWORds: connective tissue damage syndrome, ligament injury, Prolotherapy. Prolotherapy & Connective Tissue Damage Syndrome Why am I hurting, and no one seems to know what is wrong? Mark L. Johnson, MD, FACS W O N D E R W H Y ? P rolotherapy is certainly an important clinical tool to treat damaged connective tissue—ligaments, tendons, cartilage, meniscus, labrum, fascia, etc. But perhaps a greater contribution made by Prolotherapy is that it sheds light on an important medical mystery. That is, when someone has pain in a joint, or in the neck, or back, or when someone has symptoms going down an arm or leg, or various other distressing symptoms, what disease process is actually causing their symptoms? I see patients on a daily basis who have had the origin of their symptoms misdiagnosed. I hear patients on a daily basis give accounts of lengthy odysseys through the health care system, often involving multiple attempted treatments, including operations, who are not better, and perhaps worse, after all the medical attention they have received. Or I see patients with significant symptoms who have been told that “nothing” is wrong—because all their tests are “negative.” One can read the medical literature and see many purported mechanisms for back, neck, and joint pain. Then read the results of patient treatment based on these proposed mechanisms, and see failure rates that are remarkably high. One can also see in the literature a large group of patients who, at the outset, do not fit into any known “diagnostic category.” Practitioners cannot be exposed to diagnosing and treating patients with musculoskeletal pain for long before a question becomes glaringly obvious. “Are we missing something here—is there a disease process that is right under our noses every day that is poorly understood, or totally misunderstood, by the medical community at large?” I believe that the answer is “Yes.” Thanks to observations gleaned from successfully treating thousands of painful joints with Prolotherapy, I think I have developed a fairly clear understanding of this disease process. Many of these observations have been made by others in the Prolotherapy community for decades. What has been lacking thus far is assembling these observations into a description of a