Prolotherapy
If you suffer from issues like lower back, muscle, or joint pain, prolotherapy can be an effective way to help manage your condition.
About Prolotherapy
If you suffer from issues like lower back, muscle, or joint pain, prolotherapy can be an effective way to help manage your condition. Specializing in osteopathic care and comprehensive pain management, Dr. Jennifer Stebbing DO founder of Musculoskeletal & Sports Medicine in Camas, Washington, provides a number of treatments that promote healing, improved function, and reduced pain. To find out if prolotherapy can help relieve your musculoskeletal pain, call or book an appointment online today.What is prolotherapy?
Prolotherapy (proliferative therapy) was the first regenerative treatment for joint arthritis. It is a simple elegant procedure used to strengthen the bonds between tendons and ligaments to bone. Tendon and ligament injuries can result in pain, weakness, and reduced function in areas all over the body.What are ligaments?
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.What are tendons?
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.What can be treated with prolotherapy?
Prolotherapy is a safe, non-surgical treatment that can help reduce pain, stabilize your joints, and restore your mobility. Dr. Stebbing uses prolotherapy injections to treat many musculoskeletal conditions, including:
- Chronic back pain
- Neck pain- especially whiplash injuries
- Rotator cuff injury
- Early Arthritis
- Ankle sprains
- Scoliosis
- Temporomandibular joint (TMJ) disorders
- Pain after car accidents
Pain after surgery
Carpal Tunnel Syndrome
Hypermobility Syndromes, such as Ehlers-Danlos Syndrome
How does prolotherapy work?
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. Normal healing occurs regularly in our bodies, in the form of inflammation. When an area is injured, platelets rush to the area, they initially stop the bleeding. Then they release growth factors that encourage a new blood supply to the area, orchestrate the events that follow, encouraging collagen repair that is needed to complete the healing.
Please call or email Dr Stebbing to determine if you are a candidate.
Prolotherapy For Ankle Pain
Ever since I can remember, I’ve had a problem with what my mom called ‘weak ankles’ and I wore ‘special shoes.’ Despite this I was active; played sports, cheerleading, dancing, aerobic exercise and daily jogging all the while not wearing those ugly ‘special shoes’ and impacting already compromised parts of my body beyond those ‘weak ankles.’ By my late 30’s I switched to power walking because I began experiencing what I thought were shin splints. A few years later a large lump developed at the bottom of my right leg just where the top of my foot bends at the ankle. An ultrasound showed what looked like a cyst sitting on top of the sapheneous vein. RX was to get off my feet and rest. Over the years pain and or swelling became chronic. I also started to have lower back and neck soreness and visiting a physical therapist was becoming a yearly event. I continued to be very active in spite of aches and pains that seemed to haunt me almost daily. The worse of my complaints was the right ankle which was rolling inward more. Multiple diagnoses were made from arthritis to taleus slip. At one point I was in a soft cast because of what was thought to be a hairline fracture. This complete immobilization seemed to work for about 3 weeks then pain and swelling returned. I had a drawer full of orthotics that did not work. As the pain got worse, it began interfering with daily activity. I was very discouraged. The doctors just didn’t have any answers.
Then I was referred to Dr. Stebbing. I was told by my PCP, Dr Jen thought differently: Give her a try. She impressed me with her level of understanding, care and ability to explain in detail what was wrong. She patiently showed me how the ‘weak ankle’ was affecting my whole body. She was confident she could help me. She did not just prescribe another pair of orthotics or send me to a physical therapist. She knew I had to have that pain go away. She explained and suggested prolotherapy. I must admit this new treatment seemed a little like voodoo. I had to go home to think about it. I did my own research and found it was well practiced in Europe and many U.S. athletes were traveling there for the help they could not get in the states. Still I hesitated. Not covered by insurance further complicated my decision.
Over the next few weeks pain progressed to where the only way I could put any weight on my right foot was to walk on my toes as if I were wearing high heels on one foot. On a scale of 1 – 10, the pain was in the upper ranges; some days as high as 9 with sharp stabbing that bought me to my knees (10). In early 2012 I called Dr. Jen and made my first appointment for Prolotherapy. With the help of my husband, I limped into her office. He’ll tell you he carried me in. The relief from treatment was immediate and long lasting. Since then, I’ve returned for successful treatment of 3rd stage ankle sprain, knee and hand injuries all due to a bad fall in 2014. Tomorrow I undergo my first PRP (platelet rich plasma) treatment of these injuries. I have all the confidence it will be successful.
Dr. Jen is knowledgeable, patient and thorough in her approach.
Bottom line? She is amazing!
– Connie
Process & After Care
Understand the unique process to set the right expectations on your treatment day.
Ultrasound-guided Injections
Prolotherapy is an injection procedure using dextrose, which is sugar water. It is injected onto the attachment of ligaments, tendons, joint capsule, and fascia to bone. It is a cost-effective, precision-based treatment that Dr. Stebbing uses initially on nearly everyone. The needle contact with bone induces a small injury. The injury is perceived by the body, which rapidly sends platelets to the area.
An anesthetic numbs the treatment area and reduces pain or discomfort. Each needle injection, no matter what is being injected, is precisely placed with the help of an ultrasound machine, which allows for visualization of the body part and the needle.
The imaging is done in real-time as if it were a movie, not a snapshot. The needle is guided to its destination, and Dr. Stebbing watches whatever substance she injects through the entire process. The ultrasound is used during the entire treatment process to identify the injured areas.
Aftercare Expectation
After the procedure, it’s normal to experience swelling or pain for a few days. Depending on your injury, you may have to wear a brace, sling, or crutches to ensure you heal correctly. In many cases, physical therapy is required to achieve a full recovery.
Let Your Body Heal Through Inflammation
The body recognizes these injections as small injuries and signals for the platelets circulating in your bloodstream to come to the area to stop the bleeding and creating a healing response.
The First Phase:
The first is an inflammatory phase, which begins when platelets are drawn to a site and become activated, releasing the growth factors necessary for healing. This phase lasts 3-5 days, and is an important time to avoid anti-inflammatories (such as Ibuprofen, Naprosyn, Diclofenac, Aleve), as inflammation promotes healing.
The Second Phase:
The second phase, the proliferative phase, occurs over a period of weeks. During this time, cellular material forms in a layered approach, and new blood vessels form. The layers of differentiated cells form a matrix that strengthens the injured tissue. This is the phase of healing when tissues are most prone to re-injury. It is important to moderate activity to avoid re-injury during this time.
The Third Phase
After the procedure, it’s normal to experience swelling or pain for a few days. Depending on your injury, you may have to wear a brace, sling, or crutches to ensure you heal correctly. In many cases, physical therapy is required to achieve a full recovery.
Why Choose Us
Dr. Stebbing is a highly rated independent female Sports Medicine doctor and osteopathic physician in Camas, WA.
Integrity
She and her staff pursue open, honest relationships, working to establish trust to ensure the best possible outcome for each patient.
Dedication
Dr Stebbing is dedicated to providing the optimal treatment options for each patient. With this in mind, she works tirelessly to find complementary providers (physical therapist, naturopathic physicians, exercise specialists, nutritionists, physicians and other healers) to assist with improving nutrition, exercise and mindset while healing. She encourages patients to take ownership of their health.
Resourcefulness
She thinks outside the box, gathering comprehensive information, thoughtfully problem solving, and actively incorporating new ideas and strategies, all with the aim of optimal results.
Frequently Asked Questions
Has there been any research on prolotherapy?
Carefully conducted research shows evidence of reduced pain in patients with knee osteoarthritis. Research for lateral epicondylitis and Achilles tendinosis is currently underway. However, prolotherapy’s clinical use over the last 80 years to treat pain, prior to MRI and surgical interventions, has established a foundation for proven healing. Now ultrasound guided prolotherapy injections have improved the accuracy of treatment.
How long does it take for prolotherapy to work?
Multiple sessions are typically needed to treat each area, with benefit accruing over time. Prolotherapy is typically repeated in 2-4 week intervals for three to six treatments. Timing varies according to individual needs and the degree of injury.
Who are good candidates for prolotherapy or any of the other regenerative treatments?
Patients who are healthier heal faster. Younger patients heal incredibly fast and require less treatments. 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. Consuming an 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.
How does PRP injections compare to prolotherapy?
Many of the same principles apply. PRP is not comfortable and requires anesthesia. Nerve blocks and local anesthesia are done to give local relief. Because PRP is viscous and there are other pain pathways, besides nerve pain, there may be some injection discomfort that lingers. Injecting PRP slowly improves pain tolerance. In certain patients, oral medications can be used to assist with pain. Nitrous oxide is available and is extremely beneficial. In addition, we welcome having patients bring in their own music. Tapping, meditation and other techniques are also helpful. That being said, the benefit is significant. (see testimonials). The pain compared to having joint replacement is days, not weeks.
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. There is a definite benefit with incorporation of these soft tissue techniques within two weeks of a treatment.
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 should be expected post procedure?
The inflammatory response is greater with PRP, so 3-5 days of increased swelling with or without pain is normal. Some people have little to no swelling or pain after 24 hours and others have more. The use of crutches for 1-3 days to avoid weight bearing is suggested for treatment of the lower body. A sling for the upper body is helpful. Compression of the joint is helpful. Avoidance of heat during the first 24 hours helps reduce the inflammation that would be increased as blood vessels dilate. Ice slows down the inflammation, which is used at times with people who experience a lot of discomfort.
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.
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 2-4 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 biomechanics. If you have a relationship with someone skilled in this, we will communicate with them as part of the treatment plan.
Is there any safe exercise?
Aerobic exercise in the form of elliptical machine or stationary bike or swimming can be continued depending on the injured area.
Stabilization exercise, such as pilates, gyrotonics and some forms of yoga work well. We want to keep the tissue pliable, but not overstretched, which can happen if you aren’t careful while doing yoga.
Avoid strength training until you have painless full range of motion and have built up some of the stabilizer or core muscles of the joint. (Usually 6 weeks after treatment). Resistive bands are a good way to build up stabilization of a joint, start with yellow bands and progress thru the rainbow. Exercises using your body weight as the resistance are a further progression of stabilization into strength exercises. Typically the earliest strength training would occur at 6 wks to 2 months.
Prolotherapy For Hip & Back Pain
For a few months I could not walk, stand, or lie down without severe pain in my left hip as well as all the way down my left leg. Sitting was my only position of comfort and use of a wheelchair or a walker was the only way I could move around without pain. This condition came on suddenly and lasted for months. I was not excited to use drugs that would just temporarily relieve the pain. My primary-care physician recommended that, in addition to PT (which was essential but alone did not eliminate the pain), I made an appointment with Dr Jennifer Stebbing, who, she said, was doing some interesting work that might be helpful. I finally followed her advice and good advice it was!
Dr Stebbing was, indeed, helpful!! Some immediate relief of pain came from her release of trigger points that had developed in my left thigh and leg. That relief was most welcome, but I knew it was temporary until the cause of those trigger points was resolved. Then came the real magic!! After examining multiple images of my spine and hip, Dr Stebbing pinpointed signs of degeneration and weakness in a number of ligaments, tendons, and muscles that support my spine as well as some in the hip. Degeneration sounded pretty hopeless to me, but I had not heard of orthobiologic treatment. She told me it was possible to improve many degenerative conditions using injection techniques, in the area of weakened ligaments and tendons. Like most, I am not fond of injections but felt the procedures were well worth a try if they worked and put an end the pain I had been experiencing. IT WORKED!! After two treaments, the pain disappeared completely for a full week followed by some minor discomfort off and on after that week. A final treatment in the same area around the lumbar region of my spine was done and since that treatment I have had NO MORE PAIN and no return of trigger points.
It is now well over a month after that final treatment; I have had no more treatments, and all of the pain is still gone! I can again walk without pain and unassisted (the wheelchair and walker are in storage). The focus of the approach was to encourage healing and repair of the tissues that were causing the pain (in conjunction with exercises from PT to strengthen my core). Amazing and very exciting to me!! No drugs, no surgery with replacement parts—the injections encouraged healing and repair of my own tissues.
Oh yes, did I mention that I was almost 86 years old when I had this done? Thus, this seems to be a procedure that can help some of us in our later years and is not only for the young or for active athletes. I am delighted that I found Dr Stebbing and that I learned about these injection treatments. I would consider this again for the same structures, if needed, or for any other degenerative tissues in my body that hinder my ability to live an active yet pain free life and for which this procedure ahs been helpful! Thanks to Dr Stebbing and her staff and to those who have enveloped and continue to develop this area of medicine.
– Peg
Other Treatments You Might Be Interested In…
Dr. Stebbing offers many non-surgical treatment options. Here are some treatments you might be interested to consider along with Prolotherapy.
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