Torn, Weak or Stretched

Ligaments are cable-like structures that hold your bones together and allow you to walk and move without falling apart.

Ligaments are flexible, but they do not stretch very far which is a problem when spraining a ligament, twisting a knee, taking a bad fall, suffering whiplash or lifting an object that is too heavy. These injuries involve the Ligaments that can tear or fray.

These injuries set up a healing process called inflammation to repair the injured Ligament. The injured person knows the process is happening when they feel pain, heat, not swelling and cannot move the injured joint.

If the healing process is completely successful, the Ligaments will be returned to their normal strength and length, and the injured can return to normal activities. If this healing process does not completely work, the Ligaments may heal stretched. This "stretched out" Ligament will lead to a situation which can cause pain and discomfort with movement.


When a Ligament is "strained" or injured, some of the strands or threads that make up the cable become over-stretched and broken. The torn or strained Ligament is really millions of tears of these strands which are molecules of collagen.


Loose Ligaments allow the joint to move beyond the normal range of motion. The abnormal motion allowed by the strained Ligament will produce painful sensations and make the injured aware of the problem. These sensations also include feelings of "numbness and tingling", and a phenomena of referred pain. This referred pain is created by the Ligament laxity around a joint but is felt at some distance from the injured joint.

The abnormal joint movement also creates many protective actions by adjacent tissues. Muscles will contract in an attempt to pull the joint back to the correct location or stabilize it to protect it from further damage. We than feel the muscle spasms which are related to the ligamentous laxity.


There is a tendency to treat muscle spasms as the primary cause of the Ligament problem, and many medical treatments may be directed toward the muscular spasms and not to the primary cause, the Ligamentous Strain. If the joint is slightly out of place because of the ligamentous laxity, it may respond to manipulative care. Such manipulative techniques will often give good relief and occasionally permanent relief.

If lax Ligaments can lead to muscle spasm, loss of movement and all sorts of painful sensations and feelings, surgery may be the answer. However, before surgery is performed there is one non-surgical treatment for this Ligamentous strain or laxity problem called Prolotherapy. In order to understand Prolotherapy one must understand how the body heals Ligament damage normally. The healing process is called Inflammation.

You Have To Understand Inflammation

Inflammation has several distinct phrases:

1) The Acute Inflammation phase

2) the Granulation phase

3) the Remodeling phase.

The "Healing Cascade" is basic to all injuries regardless of the location or tissue.

These three phases each have their own cellular and chemical processes and changes. Each phase is dependent upon the previous phase for initiation of the next step.

Understanding Inflammation is key to gaining an insight into how Prolotherapy works. The first phase is called Acute Inflammation and is about one hundred hours long.

This step begins at the time of the injury when the Ligament and the adjacent cells are broken open and their contents spill at the wound site.

The ligamentous and cellular debris and a number of chemicals in the fluid or plasma around the broken -open cells attract an influx of white blood cells call Leukocytes. Their job is to clean out the bacteria and prevent infection at the injury site.

Many of the chemicals released during this phase will be broken down into messengers or chemical signals that tell cells to become active or inactive during the phase of Inflammation. Some of these chemicals are called Prostaglandins which can cause pain at the injury site.

The second phase in the healing process is the Granulation phase which attracts an important cell called the "macrophage". As the macrophages arrive at the injury site, they begin to "clean up" the area through a combination of digesting the broken-down cell parts and secreting enzymes that break down many of the damaged Ligament molecules. The macrophages also release a number of hormones that will bring more cells to the injury site.

The macrophages are followed by fibroblasts which, when turned on, rapidly make massive amounts of the basic building blocks of Ligaments and Collagen.

The third phase of healing is called "wound contraction". During this phase, the new collagen deposited at the injury site will be organized into a new Ligament. As the Collagen fibers wind around each other, they begin to contract and the molecules become shorter and tighter. Water is squeezed out (like water in a sponge) which causes shrinkage.

As the millions of Collagen fibers lose water and shrink, the ends of the Ligament will be slowly pulled together and the laxity will decrease. The healing of the skin wound is underway as the edges of the wound pull tightly together near the end of the healing process.

SUMMARY: Inflammation is very important to healing a damaged ligament. It is a multi-phased process with the end product being the production of Collagen which has formed threads of a new Ligament. The technique is painful but safe and effective in decreasing the pain of abnormal joint movement or Ligament laxity.

SIDE NOTE: Aspirin and other nonsteroidal anti-inflammatories (NSAIDs) can knock out or surpress the healing response by interfering with the prostaglandin growth factor pathways. While previously thought to be safe, research has shown that aspirin is not without significant side effects concerning Inflammation. In addition to well-documented adverse effects this medication has upon healing in the stomach, it may directly inhibit the healing of injured Ligaments. Colorado University Medical Library, Denver CO

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The information on this page is for educational purposes only and should not replace consultation with a health care provider. The material offered here is not intended to diagnose, treat, cure or prevent disease and is available to the general public via various public sources.