It is important to distinguish the increased efficacy of palpatory diagnosis and accurate injection placement that comes with an osteopathic approach to injection therapies. Many practitioners have been trained to place an injection only into the joint space. Although it involves less training, effort and time, this is a limiting approach in terms of efficacy and pain relief.
There are two considerations that make this approach sub-optimal: first, it is the ligaments and tendons around a given joint (whether spinal in degenerative disc disease or a peripheral joint such as a knee) that hold the joint stable and prevent excess wear and tear on the cartilage and/or disc during movement. Injecting into the joint space only does nothing to address this primary cause of joint degeneration. Second, most of the pain receptors are in the ligaments and tendons in and around a joint, not the articular surface of the joint. When we sustain an injury that leads to pain and eventually arthritis, the trauma stretches and may tear to varying degrees the ligaments that hold that joint together. This causes pain because the pain receptors in those ligaments are constantly being stimulated as the excessively loose ligaments are stretched abnormally and allow more play in the joint then was previously present.
The joint instability that results from abnormally stretched and loose ligaments and tendons then causes more wear on cartilage and on the joint space in general, leading to degeneration of cartilage and other arthritic changes such as bone spurs. Bone spurs and other proliferative arthritic joint changes can be seen as the body’s way of trying to stabilize a joint that has too much movement because of injured ligaments.
The above information builds a foundation for understanding why it is more important as a prolotherapy practitioner to accurately diagnose tender ligaments and tendons around a joint by palpation and to inject into all of those, than it is to use an expensive injection agent. The purpose of injecting the ligaments is to stimulate regeneration and strengthening of those weakened connective tissues. Injection into the joint space is part of the process in order to assist regeneration of cartilage, but without also injecting all the relevant ligaments and tendons the results are limited. Any joint injection we do will likely also involve at least five and likely more than ten sites of injection for different ligaments and tendons in and around the joint.