Prolotherapy effectively eliminates pain because it addresses the source of the pain: the enthesis, an area rich in sensory nerves.14,15 When a weakened ligament or tendon is stretched, the sensory nerves become irritated, causing local and referred pain throughout the body. These referred pain patterns of ligaments were outlined in Dr. Hackett’s early observations after he performed more than 18,000 intraligamentous injections to 1,656 patients over a period of 19 years.16
A referred pain occurs when a local ligament injury sends pain to another area of the body. Dr. Hackett described the referral patterns of the ligaments involving the hip, pelvis, lower back, and neck. Many physical therapists, chiropractors, family physicians, and orthopedists may be unaware of ligament referral pain patterns.
From the illustrations, note that the hip ligaments refer pain to the big toe. The sacroiliac ligaments refer pain to the lateral foot, which causes the symptoms resulting in a common misdiagnosis of “sciatica.” Pain traveling down the back into the leg and foot is usually from ligament weakness in the sacroiliac joint, not pinching of the sciatic nerve. Patients who are misdiagnosed with “sciatica” are often subjected to numerous tests, anti-inflammatory medicines, and surgical procedures with unsatisfactory results. Prolotherapy eliminates the local ligament pain, as well as the referred pain, and is curative in most cases of sciatica.
Ligament injuries may cause crushing severe pain because the ligaments are full of nerves, some of the nerve tissue being free nerve endings.14,15 Movement may aggravate the damaged nerve in the ligament and produces a shock-like sensation, giving the impression that a nerve is being pinched. It is a nerve-type pain that is due to a ligament stretching, not a nerve pinching. When a weak ligament is stretched, the nerves inside the ligament often send shock-like pain to distant sites, as in sciatica pain. If the ligament is strengthened with Prolotherapy, the nerves in the ligaments do not fire, thereby relieving the pain.
Among Prolotherapists, it is well known that an injury in one segment of the body can affect other distant body parts, especially in regard to ligament injury. For example, when dye is injected into the nerves of the ligaments of the lower neck, the dye will travel four segments above and four segments below the initial injection site. The dye may be seen in the autonomic (sympathetic) nerves in these areas.17 This implies that ligament laxity at one vertebral level could manifest pain, muscle tension, adrenal, or automatic dysfunction four segments above or below the actual injury site. This is one of the explanations as to why ligament pain is often diffuse and can take on a burning quality.
Knowledge of referral pain patterns, along with a complete patient medical history, allows us to make accurate diagnoses of specific weak ligaments. We may examine a back pain patient with pain radiating down the leg to the knee. This reveals that the source of the pain is likely the sacroiliac ligaments, and pain radiating to the big toe reveals the source is in the hip area.