Glossary for Doctors and Patients

Connective tissues: Supporting tissues including cartilage, bone, ligaments, and tendons. They are derived from the mesoderm and are comprised of cells and large amounts of intercellular materials composed of fibers in a matrix which may be liquid, a gelatinous liquid, or solid (as in bone or cartilage). Both the fibers and the ground substance vary according to functional requirements. Fibroblasts are the specific cells responsible for the formation of the intercellular materials. They are polymorphic and pluripotential, and specialize or differentiate into specific tissues such as chondroblasts, chondrocytes, osteoblasts and osteocytes. Macrophages are the second most common connective tissue cells. Connective tissue fibers are either collagenous or elastic. Collagenous fibers form the bulk of tendons, ligaments and fascia and are pliable but tough and practically not extensible. Elastic fibers are stretchable and rubbery, vary in length, and are homogenous rather than composed of individual fibrils as in collagen. Cartilage contains no nerves and is nonvascular. It derives its nutritive fluids from the perichondrium and the joint fluids themselves.

Desiccation: Connective tissue, due to its poor blood supply, is subject to dehydration. As tissue dries out, it loses its structural strength and elasticity, becoming more brittle. Strain on these desiccated tissues causes fraying and tearing. Well-hydrated tissue, by contrast, is both stronger and more elastic, and is more able to absorb the strains of physical trauma without breaking. Malnutrition and aging all contribute to loss of elasticity and desiccation of connective tissue.

Dextrose and Growth factors: Dextrose is natural sugar which when injected in a strong enough concentration into the fibro-osseous junction, induces a hyper-osmotic effect which mimics the chemical changes of trauma and inflammation and initiates the migration of fibroblasts to the site of injection, where they get to work repairing and strengthening the tissues. Dextrose can create growth without inflammation.  Research on a variety of human cells exposed to as little as 0.3% to 0.6% dextrose (the normal cell has 0.1% dextrose in and around itself) indicates that within minutes to several hours the cells begin to produce growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFB), epidermal growth factor (EGF), basic fibroblast growth factor (BFGF), and connective tissue growth factor (CTGF).  Note that both fibroblasts and cartilage cells respond to a variety of growth factors, which are often named for the first cell in which they are discovered but usually act on a variety of cells.

Fibro-osseous junction: The area of attachment of connective tissues to bone, such as tendons, muscle, ligament insertions. Most sprains to tendons, ligaments, and joints occur at the fibro-osseous junction.

Procaine: A mild and widely used local anesthetic used in both prolotherapy and trigger point therapy injection solutions. Procaine exerts a wide range of physiological benefits including: the dilation of capillary beds, (which provides increased blood flow), increased delivery of oxygen, nutrients, and proteins to tissue, hydration of dried out connective tissue, reduction of pain transmission, and relaxation of muscle bundles.

Proliferation: The stimulation of connective tissue repair using agents that increase growth factors at the site of injury. Dextrose is the safest and most used prolotherapy solution. When combined with procaine or lidocaine, dextrose has been demonstrated to induce the proliferation of fibroblasts to lay down new connective tissue in tendons and ligaments. It increases both the volume and tensile strength of tendons and ligaments.

Prolotherapy: “The rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferation of new cells.” Websters Third New International Dictionary

Referred (Trigger Point) Phenomena : Sensory and motor phenomena, such as pain, tenderness, increased motor unit activity (spasm), vasoconstriction, vasodilatation, and hypersecretion caused by a trigger point, which usually occur at a distance from the trigger point.

Regenerative therapy: The range of treatments that cause or encourage the growth and repair of weakened and damaged connective tissues. Prolotherapy injections, trigger point injections, hormonal support, and nutritional support all contribute to the production of growth factors that encourage the growth and repair of connective tissue.

Sprains and Strains: Connective tissues and cells form the interface between kinetic tissues such as muscle, and static tissue such as bone and form the capsules around joints of the body, holding the joint in place while allowing free range of motion. Connective tissue often is both fibrous and elastic, and is sometimes referred to as fibro-elastic, meaning it is tough yet elastic and resilient. It has a high tensile strength which is enhanced by the way it organizes itself in networking fibers. In response to over stretching, it is much more likely to develop micro-injury rather than yield to outright rupture. These injuries are referred to as sprains. The vast majority of tendon or ligament injuries are of the over-stretched variety. Over-stretching causes micro tears, fraying, and partial separation. If minor enough, even the poorly vascularized tendon or ligament can and do heal on their own. The rest of them don't heal, and produce the chronic shoulders, elbows, knees, low backs problems, etc., we so commonly see in the walking wounded who never get back to full function. Full rupture of a tendon or ligament is relatively rare and the only repair is surgery.

Trigger Point: A focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception. Types of trigger points include myofascial, cutaneous, fascial, ligamentous and periosteal trigger points.