What is Prolotherapy?
Prolotherapy is a form of regenerative medicine that uses a series of precisely targeted injections to stimulate the body’s natural healing powers for repairing soft tissues injuries. It is an in-office series of injection treatment that has been safely and effectively used for almost 80 years. Soft tissue injuries can include damage to ligaments, tendons, muscles, fascia, and joint capsules. In prolotherapy treatments a substance (most commonly dextrose or sugar) is injected into the site where the soft tissue is injured, most often where it attaches to the bone. The process calls in the body’s repair cells to heal and strengthen weakened or damaged tissue.
How Does Prolotherapy Work?
Prolotherapy works by creating a short duration of well controlled inflammation in an area of tissue injury. We have to understand that acute inflammation is the body’s attempt to heal itself, let’s say in the setting of a broken bone, an ankle sprain or even a paper cut. Chronic inflammation is what we all understand to be the process behind most disease states.
Prolotherapy can be thought as the opposite of a steroid injections or cortisone shots. Injections with Cortisone, an anti-inflammatory steroid medication, works by blocking inflammation, which is widely used to decrease pain and swelling after tissue injury.
The acute events after an injury, such as swelling, pain and redness, are the body’s natural attempt at healing the injured area. The use of steroids or NSAIDs, to reduce inflammation and reduce pain, can have short term improvements, but also has the potential to limit the amount of tissue repair, which may eventually weaken the body’s soft tissue.
Prolotherapy, on the other hand, stimulate our bodies natural healing by promoting inflammation and initiating an acute immune response, in the specific area or injury or weakness, which can help the body strengthen the tissues back to pre-injury state.
Most often prolotherapy is used to repair damaged tissue from old injuries. In this setting the area is not acutely inflamed, and the body has stopped trying to heal or repair the area. Prolotherapy is like a “trick” that mimics an acute injury, without actually damaging the soft tissues to be healed. That trick calls in the healing response to area to be healed and the body does the rest. Prolotherapy is not glue, cement or a screw, it is a signal to the body to heal damaged tissue.
What Conditions are Treatable with Prolotherapy?
Any condition of connective tissue weakness, including low back pain, neck pain, whiplash, knee pain, ankle/foot pain, Sciatica, rotator cuff tear, tennis elbow, golfer’s elbow, patellar tendinitis, Achilles’ tendinitis, etc. As long as there is a partial tear, and the tendon is not completely ruptured or retracted, there is a chance for prolotherapy to work.
How do you know if you have chronic ligament weakness?
A physical exam by a well trained physician will detect soft tissue injuries and laxity. Many patients complain to have chronic trips and falls, chronic muscle spasms, pain that is worse with long periods of inactivity ie. sitting or standing still for any extended period. Some patients claim to be addicted to working out stating that they need to in order to feel good. Others state the opposite that no matter what they do or who treats them they can’t seem to stabilize their bodies. “ I alway have to work on my posture, it is exhausting”
Why? The ligaments are designed to hold the bones together. If the ligaments are not able to do their job properly, the muscles are recruited to hold the bones in place. Muscles are not designed for this type of work, they fatigue easily which leads to to further soft tissue break down.
Even when a natural healing process occurs the body is unable to heal back to 100%. Prolotherapy is the key to regenerating the integrity in the soft tissue structures, allowing the muscles to relax and the pain to subside, permanently.
What Substances are Injected?
There are many options for prolotherapy injection, but most solutions include some type of sugar. Sugar is effective, low cost and one of the main contents of your bodies cells. During a traumatic injury, the cells spill their contents into the extracellular fluid, the sugars alert the immune system that there has been a cellular injury, it is detected by immune cells spurring the immune system into action, healing the damaged injury. Prolotherapy “tricks” the body into thinking that you’ve had an acute traumatic injury, which it promptly tries to heal. The benefit
That you’ve had an acute traumatic injury, which it promptly tries to heal. The benefit of this trick is getting the body to create a healing response without actually damaging the body.
What is PRP, or Platelet-Rich Plasma Injection, and How is it Different from Prolotherapy?
Platelet-Rich Plasma, or PRP, is a patented, high-tech version of prolotherapy that uses the patient’s own blood. A patient’s blood is withdrawn from the veins, and then spun in a special centrifuge to concentrate the platelets. Platelets contain growth factors which contribute to the rapid healing of the tissue in question. It is a stronger healing response and likely to be a bit more efficient, shot-per-shot, than regular prolotherapy because these growth
factors are concentrated. It it is more expensive than regular prolotherapy, and reserved for patients who need to return rapidly back to sports or work or for those with labral tears and more complex cases. Prolotherapy works effectively in most cases helping to save time and money.
Does it Hurt?
Prolotherapy is an injection, and can be expected to hurt about as much as any other injection. It creates inflammation, which can produce discomfort and soreness, but most people seeking treatment are looking to eliminate pain, so the overall effect is usually one which actually ends up alleviating pain. Every patients response is unique and some down time should be considered the day of and after an injection however, many patients resume normal activities that same day.
How Much Does it Cost? Will my insurance cover it?
Despite its long history of safety and effectiveness, prolotherapy is not usually covered by most insurances. In this office, we try to make prolotherapy as affordable as possible. The cost of injection will be discussed in the office visit or can be discussed with our receptionist.
If Prolotherapy is so Effective, Why isn't it More Popular?
As a natural therapy, with no patentable drugs through which to profit, prolotherapy is not promoted by any drug companies. As a low-cost alternative to Surgery, it is not popular among doctors who perform surgery for a living. Dr. George Hackett, an orthopedic surgeon, and co-author of the 1950’s text on the subject, was thrilled to have such an option to offer his patients. His colleagues were not so thrilled. Prolotherapy is only now beginning to get wider recognition, thanks to dedicated practitioners and to the patients, who are now able to educate.
Thanks to dedicated practitioners and to the patients, who are now able to educate themselves via the internet and other sources.
I have been told that I need joint replacement. Will Prolotherapy help me?
Maybe. Most patients are able to successfully postpone joint replacement with prolotherapy or PRP. Some postpone for years, but it will not create a brand new joint. Cartilage is very difficult to regenerate because it is very dense and has a poor blood supply of its own. Most cases of osteoarthritis have scarring of the bone underneath the cartilage which prevents the blood from nourishing it.
Prolotherapy/PRP is known to improve osteoarthritic complaints, but it is likely to be from increasing the blood supply to the cartilage, or from strengthening the surrounding soft tissue (ie. tendons and ligaments). It is unlikely that significant amounts of cartilage is being built in the process. Prolotherapy works best on tendons and ligaments.
Degenerated joints have loose ligaments because the cartilage loss has narrowed the joint space, stabilizing the surrounding area of the joint help to alleviate pain and improve function.
How Many Treatments Will I Need?
The number of treatments varies with each individual. The majority of cases require three to four injections. The number of injections needed also depends on the healing capabilities of the individual and the extent of the tissue injury. If a tendon is hanging by a thread, it will take a long time to build it back up. If multiple joints are involved some joint may take longer to heal than others.
Do I need an x-ray or MRI before I Come?
It always helps to see an x-ray or MRI to visualize the anatomy and the tissue injury if visible. If no studies have been done, a good physical exam should elicit relevant findings, and help to direct the treatment appropriately. If needed imaging study subsequently, it will be ordered.
What should I do in preparation of Prolotherapy?
Avoid anti-inflammatory medications such as Aspirin, Advil, Motrin etc for 7-10 days to optimize healing. If you are unable to avoid anti-inflammatory medications it is still possible to regenerate damaged soft tissue however it may require an additional one to two injections. Wear any supportive braces or compression sleeves as indicated to help stabilize or “mold” the joint to proper alignment as healing proceeds.
Osteopathic manipulation aids the process by enhancing fluid circulation, balancing the surrounding tissue strains, aligning the bones and ligaments. Heat is indicated to improve fluid circulation whereas cold should be avoided as it has potent anti-inflammatory effects.
Keep activity moderate and do not attempt to advance physical activity until the healing process is complete and you are given the green light to push it again. In many cases an increase in the amount of time spent stretching and decreasing high impact activities, such as running, is advised.