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Prolotherapy is a 60 year old injection technique using dextrose (sugar water) and lidocaine. Prolotherapy targets hypermobile joints and/or pain related to ligament or tendon attachments to bones. A controlled injury is induced in these areas to encourage the ligament or tendon to heal in a shortened position. Prolotherapy has been used to treat chronic back and neck pain for years. It can be used to treat carpal tunnel syndrome, ankle sprains, partial tears of the rotator cuff, TMJ, arthritis pain, scoliosis and a host of other musculoskeletal issues. Carefully conducted research shows evidence of reduced pain in patients with knee osteoarthritis. Research for lateral epicondylitis and Achilles tendonosis is currently underway. Multiple sessions are typically needed to treat each area, with benefit accruing over time.
The concept behind prolotherapy is that musculoskeletal pain can be caused by ligament or tendon injury. Ligaments connect bone to bone. They are both strong and pliable. Ligaments are composed of fibrous bands which are multi directional and interlacing, allowing them to control any motion of the joint. They are important for joint stability. Instability or ligament laxity at the joint can eventually lead to arthritis, an abnormal bio-mechanical wear pattern. Although ligaments are able to withstand a lot of force, repetitive injuries can weaken them. If ligaments don’t heal, even small movements of the involved joint can cause pain.
Tendons attach muscles to bone. In certain instances, such as Achilles tendonitis, tennis elbow (lateral epicondylitis), or jumpers knee (patellar tendonitis) the attachment is injured. This causes pain whenever the muscle is under a weighted stress. Like ligaments, tendons should heal within six weeks, but if their healing is interrupted, pain, weakness and/or dysfunction occurs.
Both tendons and ligaments attach to bone. The treatment of prolotherapy involves injecting dextrose (sugar water) at the attachment of ligaments or tendons to bones. Lidocaine is used to numb the skin prior to injection. The idea is to create a controlled inflammatory response, promoting the creation of a stronger bond between the ligament/tendon and bone. This “inflammatory cascade” occurs normally during healing but is often interrupted by the use of anti-inflammatory medication (ibuprofen, Aleve, prednisone, etc.) and re-injury, leading to incomplete healing. Two to three months of prolotherapy helps complete the healing process. Postural exercises, arch supports, avoidance of tobacco and anti-inflammatories, correction of hormonal abnormalities, good nutrition and supplements also promote healing.
Most patients report several days of soreness following prolotherapy. Two weeks later, there is a brief flare-up response with some additional soreness. Prolotherapy is typically repeated in 3-4 week intervals for at least three treatments. Timing varies according to individual needs.
Who are good candidates for prolotherapy or any of the other regenerative treatments?
Patients who are more healthy heal faster. Younger patients heal incredibly fast. Diabetics, patients with chronic inflammation, daily alcohol use, use of anti-inflammatory medications and smokers, don’t heal fast, so more treatment sessions are needed. Patients whose diet has 8-9 servings of fruits and vegetables have a good source of vitamins that allow for healing. Adequate amount of protein is important to heal, as amino acids are needed to repair an area. Patients whose hormones are in the ideal range heal faster.
What should I expect during the first visit?
The first visit is a time where you share all the information about your injury (lab work, x-rays, MRI, consultations with other providers, including surgical reports) and let me know what your goals are. An exam is preformed of the joint(s), including an ultrasound evaluation and reviewal of your previous films. Please ask questions. We will discuss options for treatment, which may include further evaluations with X-rays, orthotics, exercises, and non-surgical treatment options that I can provide. If your injury is best treated with surgery or in conjunction with another colleague, this will be discussed. Please take notes and bring another person with you, as the information can be extensive and it is easy to forget the amount of information that I provide.
Should I alter my medication so that you can see how much pain I am in?
No, however if you would like to pursue any of the regenerative treatments immediately, there should be a period of 2 weeks without anti-inflammatory medication (ibuprofen, alive, naproxen or corticosteroids). Tylenol and low dose aspirin are OK.
How painful are the injections?
The injections are never performed without local anesthesia both superficial and deep. If you have difficulty getting numb or experience more pain or are extremely needle phobic, there are other ways to make you more comfortable. Prolotherapy is an injection that occurs at the attachments of ligaments and tendons to bone. When the bone is injected, people experience a buzzy discomfort. Some people describe it as nervey. This dissipates immediately. Usually a bruised like discomfort remains for the next 24- 72 hours. There can be a sense of tightness during the first day. On occasion, patients experience pain for 3-5 days. Anything longer should be a reason to call.
What can I do after I get injected?
Avoid all anti-inflammatories. Move gently during the immediate 3-5 days after treatment. You may return to your normal activity after the initial pain and swelling have gone away, avoiding injury. For example, substitute running with elliptical, swimming or stationary cycling if the treatment was to a hip, ankle, knee or foot. Likewise avoiding swimming for shoulder injuries, substituting swimming with walking, stationary cycling, elliptical or the like. Weight lifting for the upper body is fine when the lower body is treated (and vice versa) if it is already part of your routine. Avoid the temptation to get a project done if the pain subsides and you start to feel better. Healing typically takes about 6 weeks. We usually repeat the prolotherapy injections as 3-4 weeks. Correcting the biomechanics of how you move can also prevent further injury. Many chiropractors, athletic trainers, physical therapists can assist with correcting posture and bio-mechanics. If you have a relationship with someone skilled in this, we will communicate with them as part of the treatment plan.
Do I need to take a day off work?
On the day that you receive prolotherapy treatment, going back to work is not a common practice. However, returning to work the next day should not be an issue.
Is there any limitation to chiropractic or osteopathic manipulation?
Yes, any manipulation that can cause ligament strain of the joint treated with prolotherapy should be avoided. In general, this encompasses any High Velocity, Low Amplitude techniques, including using a drop table for the area that was treated. Soft tissue techniques, such as muscle energy, facilitated release, counterstain, balance ligamentous tension, fascial stretching, and massage are fine. I’ve noticed that two weeks after treatment with prolotherapy, there is a definite benefit with these soft tissue techniques.