Read the book that finally explains the cause of your unexplained symptoms!
Ligamentous
Joint Instability:
The Missing Diagnosis
by Ross Hauser, MD
We are thrilled to begin releasing chapters from this long-awaited book! The chapters are not being released consecutively, so you will notice jumps in the numbers.
Primary author: Ross A. Hauser, MD
Editor: Benjamin R. Rawlings, BA, BS
Illustrators: Travis Mitchell, Xavier Williams, Kerstyn Gay
Chapter 1. Ligamentous Joint Instability: The Missing Diagnosis
About this chapter
This chapter lays the foundation of understanding how ligamentous joint instability is the missing diagnosis and the root of most chronic pain conditions. Chronic pain is basically the body saying that a structure is under too much tension and pressure for the activity desired. No matter how common or unusual the pain syndrome is, if resting makes the pain subside and certain activities or motions make it worse, then joint instability is playing a role. Joint instability is caused by injuries to the white structures of the body which have limited blood supply and struggle to heal completely on their own (ligaments, tendons, cartilage, discs, etc.). This starts the degenerative cascade and leads to painful symptoms of muscle spasms, joint swelling, and bone spur formation. Muscles, on the other hand, are red structures with ample blood flow, and can heal quickly and completely.
When there are signs that the pain is caused by a structural issue causing joint instability and degeneration, Prolotherapy is the ideal solution. The treatment aims to provide a long-term cure by promoting healing in ligaments and tendons, ultimately resolving joint instability and alleviating chronic pain. In patient studies, Hackett-Hemwall Comprehensive Prolotherapy demonstrates that it offers curative results, even when patients were told by other providers that no other treatment existed for their condition.
Chapter 2. Basic Ligament Physiology
About this chapter
This chapter explores ligament injury and healing, shedding light on the clinical diagnosis and treatment options. Ligaments can sustain damage not only from sudden, high-impact events like car accidents, but also from repetitive stresses over time, such as poor posture or prolonged periods of specific activities. This chronic stress can lead to ligament deformation known as creep, contributing to joint instability in various parts of the body.
The severity of ligament injuries is classified into 3 grades: Grade 1 for mild injuries, Grade 2 for moderate injuries involving partial tears, and Grade 3 for complete tears. Understanding the extent of the injury and the types of forces the joint is subjected to is essential in determining a curative treatment.
Treating ligament injuries is vital because ligaments do not heal well on their own due to their limited blood supply, giving them a disadvantage to repair efficiently. Prolotherapy is the ligament treatment of choice because it directly stimulates cellular repair at the injection sites. As ligament integrity is renewed and stability is restored, joint swelling and other coping mechanisms resolve, breaking the degenerative cycle.
Chapter 3. Understanding Joint Biomechanics & Kinematics
About this chapter
The human body is built to move upright, and regular movement and exercise enable us to stay built the way we were intended—with strong, healthy ligaments that stabilize our joints. Without motion, the body, and especially the joints, quickly weaken and degenerate. To understand joint instability and how and why ligament damage occurs, it is necessary to have a fundamental knowledge of joint biomechanics and kinematics. The focus of this chapter is to help the reader gain a deeper understanding of the various types of synovial joints and how they move through space normally, as well as appropriate loading and forces on the joints.
This chapter also touches on joint biomechanics as they relate to microinstability. Forces that are too great, quick, or are shear or torsional in direction are more likely to injure the ligaments and joint. Stretched and torn ligaments that have been damaged over time and that lead to microinstability have multiple etiologies, with the wear and tear of normal repetitive motion being the most common. Once a ligament is injured, forces within the joint become concentrated on one side of the joint, which makes the structures on that side of the joint, including the articular cartilage, more prone to injury. If the process is not stopped, adjacent joints are also at risk for injury. Prolotherapy can stop the process of joint degeneration and can repair microinstability by restoring ligament strength and integrity.
Chapter 4. The Loose Hinge-Joint Instability Analogy
About this chapter
This chapter delves into the intricacies of joint instability and the degenerative effects within the body and draws a parallel to a loose hinge on a cabinet door, highlighting the best and worst tools to fix both the cabinet door hinge and the joints of the human body. The analogy underscores the importance of treating joint issues at their core rather than opting for superficial, temporary, or over-the-top remedies.
Traditional medical interventions often fail to address the root cause of joint instability, which is like using the wrong tool from the toolbox to try and fix a loose hinge. Fusion surgery, for instance, results in restricted natural joint movement, placing abnormal stresses on adjacent joints and accelerating degeneration of those joints. Instead, normal joint motion should be the goal, which means addressing the loose ligaments by tightening them with Comprehensive Prolotherapy. For a loose hinge, using a Phillips-head screwdriver to tighten the screws makes the most sense vs. some of the other tools discussed in this chapter. By comprehensively tightening the ligaments akin to screws in a hinge, this treatment can effectively restore joint stability and alleviate pain.
Chapter 5. Locating the Instability
About this chapter
This chapter details many clues that can be used to identify the exact location of joint instability through symptom analysis and physical examination. Common signs and symptoms that occur with joint instability include cracking of the joint, pain that increases with activity and decreases with rest, pain on the side of the joint, and loss of muscular power. Matching signs and symptoms with a physical examination is an important part of helping a patient get on the right road to healing.
Static MRIs and x-rays are often misleading in chronic pain cases, especially pain due to ligamentous joint instability. Ignoring joint instability can have detrimental long-term consequences for the original problem joint, as well as the surrounding joints. When the instability is properly addressed, there is a higher likelihood of resolving the problem and seeing the person return to full activity.
Chapter 7. Osteoarthritis: Whole Joint Organ Gangrene
About this chapter
This section delves into the pathophysiology of osteoarthritis, emphasizing the crucial role of ligament laxity and injury as root causes of the degenerative process in the joints. Osteoarthritis is not just a condition related to “wear and tear,” but is caused by ligamentous joint instability, leading to destructive joint motions/forces and subsequent cell death of many structures in the joint, hence the term “whole joint gangrene.” If one wants to prevent or stop joint degeneration, the ligamentous joint instability must be treated. This chapter provides a different way of thinking about osteoarthritis by understanding it as a whole joint organ disease, as well as knowing how the joint structures, biomechanics, and healing processes can achieve long-term pain relief and functional improvement through the use of regenerative treatments such as Prolotherapy, which mitigates joint degeneration and improves outcomes in patients who suffer with osteoarthritis.
Chapter 8. Prolotherapy, Inflammation, & Healing: What is the Connection?
About this chapter
This chapter discusses the importance of inflammation to heal musculoskeletal injuries, particularly ligament and tendon injuries. Unfortunately, modern medicine's approach of using rest, ice, compression, and elevation (the RICE protocol) is counterproductive and actually hinders the natural healing process. The traditional approach of immobilization, for instance, leads to atrophy, weakening, and degeneration of ligaments, tendons, and cartilage. Instead, the MEAT protocol (movement, exercise, analgesics, and therapy) allows the body's natural healing process to occur, such as using moderate movement and exercise after an injury (instead of immobilization) to trigger the influx of reparative cells and the production of collagen to strengthen the injured tissue. The temporary inflammation caused by Prolotherapy as part of the MEAT protocol is also reviewed in this chapter. These targeted injections of concentrated dextrose and other proliferants, which can include a patient's own blood/platelets, stimulate an inflammatory response and promote tissue repair. After a ligament or tendon injury, it is preferable to use treatment modalities that bring reparative blood flow to an injury vs. ones that decrease the presence of reparative cells.
Chapter 9. The Pioneers of Prolotherapy
About this chapter
This chapter honors the history of Prolotherapy and its pioneers, Dr. George S. Hackett and Dr. Gustav A. Hemwall. Dr. Hackett’s revolutionary discovery involved injecting specialized solutions into ligaments to trigger the growth of new fibrous tissue, effectively strengthening the ligaments. Dr. Hackett was originally trained as a trauma surgeon but found that the results of spinal fusions were not the answer to chronic low back pain. Rather, low back pain and disability were due to the relaxation of articular ligaments, so he set about finding solutions that would trigger their strengthening and repair.
Chapter 11. Types of Prolotherapy
About this chapter
This chapter focuses on different types of Prolotherapy solutions and techniques and how each activates the body’s natural inflammatory healing cascade. Dextrose-based Prolotherapy solutions are used in Comprehensive Prolotherapy, also known as H3 (Hackett-Hemwall-Hauser) Prolotherapy, and Perineural Injection Therapy. Dextrose has been shown to increase the level of various growth factors involved in healing, including platelet-derived growth factor, transforming growth factor-β, vascular endothelial growth factor, and fibroblastic growth factor. This chapter also dives into the applications of various autologous cellular solutions that have well-documented results. Using blood from the patient as whole blood or concentrated platelets from a simple blood draw has become a widely popular form of Prolotherapy, particularly in challenging cases of tendinopathy and meniscal tears in patients who wish to avoid surgery. When an even stronger solution is needed, stem cell therapy may be appropriate. Stem cells possess self-replicating and differentiating capabilities, making them valuable in regenerative medicine. Using the patient’s own mesenchymal stem cells from a bone marrow and/or fat tissue aspiration has become increasingly used with more advanced cases of osteoarthritis and osteochondral defects.
NEWEST CHAPTER RELEASE!
Chapter 20. Generalized Joint Hypermobility, The Ehlers-Danols Syndromes, and Instability
About this chapter
This chapter examines collagen disorders that cause systemic joint hypermobility, primarily Hypermobility Spectrum Disorder (HSD) and Ehlers-Danlos Syndrome (EDS). Hypermobility occurs when joints move beyond their normal range due to lax or weakened connective tissues. Case studies in this chapter illustrate the challenges faced by individuals with EDS, including severe joint instability, mobility limitations, chronic pain, and the emotional burden of living with an often-misunderstood condition. Common associated conditions include postural orthostatic tachycardia syndrome (POTS), dysautonomia, and mast cell activation syndrome (MCAS), all of which can significantly worsen symptoms and daily functioning. Prolotherapy provides an excellent treatment option for ligamentous joint instability in people with hypermobility disorders to improve stability, reduce pain, and enhance long-term function.
Chapter 21. Nerve Entrapments (Compression) and Unusual Nerve Syndromes
About this chapter
This chapter discusses the profound implications of joint instability
on nerve entrapments and unusual nerve syndromes. In the human
body, nerves are typically encased in bone or run close to bones for
their own protection, which allows them minimal space to maneuver as they are constantly near bones or bony structures while they navigate through the body. If joints become unstable, this destructive joint motion can lead to conditions such as radiculopathy and nerve entrapments. Even minor joint instabilities can impact distant nerves due to the interconnectedness of the nervous system. Additionally, this chapter examines how ligamentous cervical instability can affect the autonomic nervous system and vagus nerve, and lead to systemic conditions like fibromyalgia and small fiber neuropathy.
Chapter 23. Prolotherapy as an Alternative to Joint Replacement
About this chapter
This chapter highlights how Prolotherapy is a safer alternative to joint replacement surgery for treating osteoarthritis. Joint replacement and revision surgeries are increasing exponentially, yet they have significant risks, including not resolving the original pain for which they were performed. This scenario is not uncommon in a Prolotherapy clinic, and indicates an underlying joint instability issue that was not addressed by the joint replacement. Most people who sign up for joint replacement surgery have not tried Prolotherapy, which stimulates healing rather than inhibiting it like conventional treatments that typically lead to the need for a joint replacement (NSAIDs, cortisone shots). This chapter discusses who is an ideal Prolotherapy candidate based on joint architecture and range of motion, and when severely altered bone structures require replacement.