Resolve Joint Pain Without Surgery

Reconstructive Therapy Prevents Injury And Increases Endurance

By Dr. William J. Faber

As a water ski enthusiast myself, I am well aware of the physical stress this sport exerts on the body's joints - particularly the shoulders, back, neck, wrists, knees and ankles. After treating a number of skiers at the Milwaukee Pain Clinic, I have realized that the relatively new, well-researched treatment known as reconstructive therapy has the potential to help many skiers enjoy their sport more and increase their competitive edge.

When one of these skiers, Scott Schultz, first came to see me, he complained of pain in the back, shoulder and neck - common complaints for a water skier. Additionally, Scott was a barefooter. The extreme torque from this technique, combined with occasional hard falls, was clearly responsible for his suffering. I had to admire his tenacity and his passion for the sport. However, Scott wasn't willing to quit skiing. As he said at our first meeting, "The pain impairs my ability to ski and have fun at the same time, so I wear a lot of extra ski equipment to hold my body together."

When I first examined Scott, he was suffering from a number of torn and stretched ligaments and tendons throughout his upper back, neck and one shoulder. He was not optimistic in the beginning. He had explored too many other avenues of therapy, including recommendations for surgery, without relief. But after our first treatment, there was a gleam of hope in his eyes. The day after the first treatment, he was barefoot water skiing and the pain was already reduced.

After we completed Scott's program, he sent the clinic a letter in which he stated, "The results were astounding. I am able to perform better on the water. The crashes no longer put me in a position where I cannot move my neck without the help of someone else. My shoulder and back became stronger and more sturdy, enabling me to concentrate more on the skiing and less on the pain. The treatments are quick and easy and never kept me down."

How The Therapy Works

Reconstructive therapy, also known as prolotherapy or sclerotherapy, is an injection technique which stimulates the body's own healing capability to regrow ligaments and tendons and thereby restore function to injured joints. The problem with joint injuries is that the supporting tissues-the ligaments, tendons, disc and cartilage - do not receive adequate blood flow. A deep cut to a finger, for example, heals quickly and naturally because it gets plentiful blood supply. This is not the case with the joints.

Ligaments are supporting tissues - fibrous bands, similar to Ace bandages but tougher - that connect articulating, or jointed, bones. The ligaments actually hold joints together -- cushioning them from direct contact, often in conjunction with cartilage or disc -- while limiting the joint's range of motion. Tendons connect muscles to bones, enabling movement of the joint. (See Illustration 1.)

Illustration 1 - Normal shoulder ligaments	Illustration 2 - Unstable and torn shoulder ligaments

If the ligaments become loose because of injury, repeated motion, or wear and tear, the individual develops a loose joint that does not function properly and slips out of place easily. (See Illustration 2.) Every time the joint moves, it is painful. This can eventually lead to more serious conditions, such as osteoarthritis, which results from bones rubbing directly against bones.

Stretched or torn ligaments and tendons generally do not heal on their own because they lack the influx of good blood supply present in other areas of the body, such as the skin. The body is capable of performing far beyond the parameters for which it was designed. However, routine "unnatural" activities such as repeatedly being towed across a water surface at high speeds, stress the ligaments and tendons to a degree that the body cannot always easily or completely repair these tissues.

With reconstructive therapy, a physician uses a very thin needle, similar to those used in acupuncture, to inject a solution into the damaged ligaments and tendons surrounding a joint. The solution is a combination of a natural proliferant (a substance that irritates the tissue) and local anesthetic, and provides a biochemical stimulus to the area. Inducing inflammation, it triggers the body's natural healing mechanism. The swelling causes more blood to flow to the area, which produces new collagen to rebuild the tissue within and around the joint. Light exercises - not barefooting, please - cause the new tissue to align correctly with the joint.

The result is that the treated joint is stronger than the original joint, providing more support and strength - as mentioned by Scott in his letter - and lowering the potential of future injury (see Illustration 3). Two studies performed by the Department of Orthopedic Surgery at the University of Iowa-one published in the Journal of Orthopedic Research and one published in Connective Tissue Research - show that both ligaments and tendons can increase up to 40 percent in strength and size with this therapy. Exercise alone cannot do this.

Illustration 3 - Stable shoulder ligaments after reconstructive therapy

Results of double-blind studies - in which neither the physician nor the patients knew which patients were getting the proliferant -were published in The Lancet, one of the most prestigious medical journals. These studies show that 88 percent of patients treated with reconstructive therapy improve. Typically, when a patient does not improve with the therapy, there are one or more existing conditions that inhibit the body's healing process, such as a hidden infection or the use of cortisone.

Reconstructive therapy normally requires between 12 and 30 treatments, although it can go more quickly depending on the individual and the severity of the damaged joint. Treatments are normally given once a week, with accelerated programs available for patients who have to travel to reach a therapist.

Who Does Reconstructive Therapy?

Reconstructive therapy is a relatively new treatment for chronic joint pain. Its development started in the 1920s. In 1956, Dr. George Stuart Hackett published a book on his successes from injecting a proliferating agent into torn vertebral ligaments for the treatment of lower back pain. Dr. Hackett's work was the turning point for the therapy.

The medical community is not noted for its rapid assimilation of therapies that require hands-on training, as this one does. Regardless of that, this therapy is becoming known and used at a relatively rapid pace. Presently, there are approximately 250 doctors who can administer reconstructive therapy across the country. This number is growing as more medical schools, like the University of California at San Diego, continue to research and publish the favorable results.

As an economical and less risky alternative to surgery, reconstructive therapy not only gives lasting relief from pain, it also aids in preventing future injury and increases energy and endurance. Its potential to improve the quality, safety and competitiveness of all active sports is profound. This is becoming recognized gradually as the results demonstrate this potential for athletes.

William J. Faber, D.O., is the medical director of the Milwaukee Pain Clinic. He is the author of two books, lectures broadly on reconstructive therapy at seminars for doctors and for consumers, and trains other physicians on the techniques. Faber recommends that chronic joint pain sufferers read the book on the therapy, "Pain, Pain Go Away." It costs $18 and can be ordered from the Milwaukee Pain Clinic, 6529 W. Fond du Lac Avenue, Milwaukee, Wisconsin 53218, (414) 464-7680.

Illustrations reprinted with permission Faber, W., Walker, M., Pain, Pain Go Away. Ishi Press International. San Jose, California, 1990.

Originally published in The Water Skier, November/December 1993