PROLOTHERAPY AND JOINT HYPERMOBILITY

BY FRED G. ARNOLD, NMD

Hypermobile joints are sometimes referred to as "loose joints," and those affected are referred to as being "double jointed." Hypermobility of a joint can be entertaining when we watch a contestant on America’s Got Talent, or an entertainer at Cirque Du Soleil contort their bodies in strange and awkward ways. However, to some individuals who have these loose joints, hypermobility can be a very painful and serious condition.

Joint Hypermobility: While joint hypermobility is very common, occurring in 10-20% of populations of Western countries, and higher still in those in Indian, Chinese, and Middle Eastern groups, it is important to distinguish between joint hypermobility and Joint Hypermobility Syndrome. People who are hypermobile without symptoms are merely people with hypermobility. Those with symptoms attributable to their hypermobility may have Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) which are genetic disorders of connective tissue characterized by joint laxity and hypermobility. Both of these conditions affect collagen synthesis involving the joints and almost every bodily system.1 Collagen is the tissue that helps to form strong tendons, ligaments, muscle, bone, cartilage, menisci, blood vessels and even the skin. Many JHS patients have signs and symptoms suggestive of fibromyalgia and are frequently misdiagnosed.2 Hypermobility can be documented by the Brighton criteria which involves objective measurement of the hyperextensibility of various joints.3

Joint pain is the major presenting complaint of JHS and EDS and if the hypermobility is left unchecked, joint dislocations and degeneration of the joint, degenerative joint disease (DJD), can occur. Other common conditions associated with hypermobile joints include rotator cuff injuries, recurrent sprains and strains, scoliosis, neck and back injuries due to soft tissue injury, disc herniations, TMJ syndrome and flat feet. Many hypermobile patients also experience muscle pain, which may be explained by the extra stress placed on muscles to compensate for lax joints as the muscles attempt to stabilize the joints. The traditional treatments for joint hypermobility includes education and lifestyle advice, behavior modification, physical therapy, taping and bracing, and pain medication. While these treatments may offer some reduction in pain symptoms, they do not address the cause of the problem and do little to curb the progressive debilitation of the disease. When the excessive joint mobility with its subsequent joint degeneration becomes bad enough some individuals seek surgical intervention. Studies have shown suboptimal results in the hypermobile patients compared to the normal population.4,5 In general, traditional medical treatments are limited to temporary symptom relief.

Prolotherapy and Joint Hypermobility: As a form of regenerative medicine, Prolotherapy offers great hope for symptoms from generalized hypermobility because it is designed to treat and strengthen joint laxity that accompanies JHS and EDS. Prolotherapy causes a brief, localized inflammatory response to the weakened joint and the generation of new collagen. This process gives the collagen tissues improved strength and the ability to handle strain and forces to the joint. Prolotherapy has a long history of success treating joint injuries, including patients with joint hypermobility. High resolution ultrasounds and MRI’s have been used to confirm that prolotherapy does indeed stimulate tissue growth.6,7

Prolotherapy has shown it to be a safe and effective procedure that treats chronic pain, including joint hypermobility.8,9 Many studies have shown that prolotherapy eliminates chronic pain even in those patients who have been told by their medical doctor(s) that surgery was the only treatment option for their pain.10-13

Summary: Logically, the best approach for weakened, hypermobile joints is one that directly addresses the root of the disability, weakened connective tissues, such as ligaments and joint capsules, by stimulating their repair and stabilizes the affected joints. Prolotherapy is a safe and proven orthopedic procedure that has provides significant relief to patients for hypermobility disorders. Prolotherapy provides relief when other treatments have failed for it strengthens weakened ligaments and helps to slow down the degenerative changes associated with hypermobile joints. Prolotherapy helps to prevent joint surgeries and treat painful hypermobile joints without the negative effects of pain medications. Prolotherapy should always be considered when other treatments have failed and especially when surgery has been recommended.

References:

1. Bravo JF, et al. Clinical study of hereditary disorders of connective tissues in a Chilean population: joint hypermobility syndrome and vascular Ehlers-Danlos syndrome. Arthritis and Rheumatism. 2006;54:515-523.
2. Bravo JF. Ehlers-Danlos syndrome, with special emphasis in the joint hypermobility syndrome. Rev Med Chil. 2009;137:1488-1497.
3. Grahame R. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome. Journal of Rheumatology. 2000;27:1777-1779.
4. Aldrige JM, et al. Thermal capsulorraphy of bilateral glenohumeral joints in a pediatric patient with Ehlers-Danlos syndrome. Arthroscopy. 2003;19:E41. (Pubmed 12724665)
5. Rose PS, et al. Total knee arthroplasty in Ehlers-Danlos syndrome. Journal of Arthroplasty. 2004;19:190-196.
6. Fullerton BD. High-resolution ultrasound and magnetic resonance imaging to document tissue repair after Prolotherapy. Archives of Physical Medicine and Rehabilitation. 2008;89:377-385.
7. Fullerton BD, et al. Ultrasonography in regenerative injection (Prolotherapy) using dextrose, platelet-rich plasma, and other irritants. Physical Medicine and Rehabilitation Clinics of North America. 2010;21:585-605.
8. Liu Y. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connective Tissue Research. 1983;2:94-102.
9. Centeno CJ, et al. Fluroroscopically guided cervical Prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005;8:67-72
10. Hauser RA, et al. A retrospective study on dextrose Prolotherapy for unresolved knee pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;2:76-88.
11. Hauser RA, et al. Prolotherapy: dextrose Prolotherapy for unresolved neck pain. Practical Pain Management. 2007;7:56-69.
12. Hauser RA, et al. Prolotherapy as an alternative to surgery – a prospective pilot study of 34 patients from a private medical practice. Journal of Prolotherapy. 2010;2:272-281.
13. Hauser RA, et al. Dextrose prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;3:145-155.

With over 20 years of clinical experience, Dr. Fred G. Arnold, N.M.D specializes in Prolotherapy/Pain Rehabilitation services. He is a Diplomat of the American Academy Health Care Providers, member of American Academy of Pain Management and he is one of the few physicians in the nation with both a Naturopathic Medical Degree and Chiropractic Degree. 602-292-2978. www.prolotherapyphoenix.com