Tendons are the white fibrous bands which attach your muscles to your bones. Ligaments are the white fibers which surround your joints. (Look at the image of the knee, below, where you can see its tendons and ligaments). They form a girdle around your joints which keeps your joints tracking straight. Ligaments and tendons are made of a protein called collagen. Collagen is what your body uses for structural support. As you age, your skin will have less collagen, so it will sag. In the same way, with age or with trauma, your ligaments and tendons can tear, or get weaker and thinner. The reason ligaments and tendons are white, (see Figure 1), is that they have very few blood vessels, if they were rich in blood vessels they would be red, the color of muscles or blood. Ligaments and tendons attach on the periosteum, which is the blood vessel rich membrane which covers the bone. Prolotherapy works through injecting an irritating solution where ligaments and tendons attach on the blood vessel rich periosteum. This causes inflammation, which brings blood vessels from the periosteum (the covering of the bone where they attach) into the tendons and ligaments, as well as the release of growth factors. When a glucose solution is injected, a large number of growth factors are released. The glucose solution also inhibits the release of growth negating products such as interleukin and tumor necrosis factor alpha) in the area. Blood vessels are the highways your body’s repair cells take to reach a broken area and start depositing collagen there. The enhanced circulation and the growth factors facilitate the deposition of new collagen into your ligaments and tendons, thus making them larger and stronger. Tendons and ligaments can be made up to 40% thicker and 100% stronger with prolotherapy.1
As you age, or if you’re injured, the ligaments around your joints lose some of their collagen and get loose. When this happens the joints no longer track straight, and this causes wear on the cartilage. Cartilage is the smooth cushion that coats your joint surfaces and allows your joints to track smoothly (see Figure 1). When your cartilage wears down, your joint does not track smoothly and this causes even more stress on your ligaments. Because they have a very poor blood supply, ligaments cannot grow in response to this stress. What happens instead is that the blood vessel rich bone will start to proliferate in an attempt to stabilize the joint. We called this condition osteoarthritis. If you look at the fingers, the toes or the knees of someone who has osteoarthritis, you can see that the whole joint is much larger than it should be, due to this growth of bone. When the prolotherapy solution is injected inside the joint, the release of growth hormone facilitates the growth of new cartilage. You can make cartilage 65% thicker with prolotherapy 2. Prolotherapy stabilizes your joints by strengthening the ligaments that form a protective girdle around your joint 3 and helps you regrow cartilage in your joint. This process helps your joints function much better.
Figure 1 diagram of your knee showing the ligaments girdling your joints, tendons attached to muscles and cartilage.