Continuing Pain and Muscle Spasms After Acetabular Fracture
In this article, we will discuss how muscle pain is a symptom, rather than the underlying cause of chronic pain. Patients who have been told for months or years that muscles are their problem or suffer from recurring muscle spasms may have a missing diagnosis of joint instability. Joint instability, or looseness in the joint, is caused by ligament injury/laxity. Injured or overstretched ligaments can produce diverse symptoms, and one of the most common of these is muscle spasms and tightness.
Muscle spasms instantaneous response to a ligament injury
Ligaments are the primary stabilizers of the joint as they hold bone to bone. Muscles are responsible for joint movement but are not meant to stop bones from moving excessively. When a joint is unstable or "loose", it is because the ligaments become overstretched or injured. Muscle spasms occur as a way for the body to protect a loose joint from damaging nerves and other local tissues. When lax ligaments cannot hold the bones together as they should, the surrounding muscles are recruited right away.
"the reaction time for an unwarned victim to develop sufficient muscle force to brace the spine is approximately 200 msec"…"this is longer than the time to peak trauma that was observed in the present study which was less than 125 msec."1
Since muscles aren't meant to stabilize a joint, they have to continuously work harder. This leads to tightness and spasms. It also tends to lead to a series of treatments that focus only on the muscles. Common treatments people try for muscle spasms are massage, physical therapy, stretching, ice, Botox and trigger point injections, as well as prescription muscle relaxers. However, these treatments are a temporary solution because the muscle tightness and spasms are frequently a secondary problem and not the root cause. The root cause is more often joint instability from ligament laxity. Ligaments and muscles cannot be treated the same way if the goal is to actually resolve the problem, versus just temporarily alleviating the muscle soreness and spasms. For instance, ligaments have a poor blood supply and muscles have an excellent blood supply. (See figure.)
Common muscle spasm treatments you have probably already tried
Massage, ultrasound, stretching, physical therapy, trigger point injections can all provide relief of tight muscle or muscle spasm but the relief is usually only temporary. We are fans of these treatments when the problem is truly a muscle problem. We even use many of these adjunctively to Prolotherapy to help soothe muscles and encourage healing while the joint is stabilizing in the long-term since ligament repair happens over weeks and months. The point of this article is that anyone dealing with chronic muscle spasms and painful muscle tension for months or years should be evaluated for ligament laxity and joint instability. If the problem was truly a muscle issue, physical therapy would have solved it, massage would have solved it, etc. If the muscle tension returns, again and again, you have to ask yourself… WHY?! The reason is simple: unresolved joint instability due to loose ligaments are causing the muscles to overcompensate. The muscles need a chance to relax, but they cannot do that if the ligaments will not do their job.
Instability in the spine frequently leads to muscle spasms, tension, and headaches
Muscle tightness and spasms can occur with rest or activity when joint instability is present. Resting does not cure joint instability. Massage will loosen and soothe tight muscles, but the tightness will return if the joint instability is still present. Physical therapy can help keep muscles toned and strong enough to offer temporary stability of an unstable joint. However, joint instability is a progressive disorder and is not cured with physical therapy because it does not address ligament weakness. Trigger point injections performed with local anesthetics such as lidocaine can also offer temporary relief of painful muscle tightness. However, corticosteroids are often used for trigger point injections which can lead to further degeneration of tissues. The possibility of temporary relief from steroid injections is not worth the progression of tissue damage.
Prolotherapy stabilizes joints in order to provide long-term relief from muscle spasms
If the progression of joint instability is not stopped, the body will continue to stabilize the joint through muscle spasms and swelling, and, in the long-term, by overgrowing bone. This is all done because, unlike muscles, ligaments have a harder time repairing on their own. Ligaments need a direct boost to re-engage the healing mechanisms of the body. Thus, Prolotherapy injections are performed to the ligament attachments around the joint. Prolotherapy is the only treatment for loose/injured ligaments. It works with the body's natural healing cascade and, over time, the ligaments are strong enough to stabilize the joint, allowing the muscles to relax.
Ways the body compensates for joint instability
Any treatment that only addresses the muscles will not give long-term or lasting relief from spasms. If you have been treated for muscle tightness or spasms without lasting relief it is time to seek an evaluation for joint instability and potential treatment plan from a Prolotherapy specialist.
1. Graur JN, Panjabi MM, et al. Whiplash produces a S-Shaped curvature of the neck with hyperextension at lower levels. Spine. 1997;22(21): 2489-94.
Source: https://www.caringmedical.com/prolotherapy-news/chronic-muscle-spasms-tightness-can-indicate-ligament-problem-muscle-problem/