Treatments

Prolotherapy

Prolotherapy is a non-surgical treatment for disorders of the joints caused by laxity of the support structures, the tendons and ligaments. It has been used in the U.S. since its development in the 1930's. Prolotherapy has been endorsed by C. Everett Coop MD, our former Surgeon General. It is a natural treatment that stimulates the healing of these tendons and ligaments. It is useful to treat any pain problem of a joint but most often used for back pain, neck pain, shoulder pain, elbow pain, sacral pain, knee pain and ankle pain. Effective treatments can be done in recent as well as old injuries. It is appropriate for most patients as long as they do not have any underlying conditions that would hinder their ability to heal properly. Although it will not necessarily reverse arthritic change it is often used to reduce pain and discomfort by increasing stability in the spine and peripheral joints.

Anywhere in the body where two bones come together to provide motion there is a joint. These joints are held together and stabilized by cable-like tissue called ligaments and the attachments of the muscles, which are called tendons. Over time, these attachments get stretched out and weakened from injury, repetitive overuse, or even just the wear and tear of life. This leads to a "laxity" or looseness of the joint. Just as a loose wheel on your car creates malfunction, laxity in the joint makes it so the joint cannot do what it is supposed to do well. This causes further wear on the joint and more laxity and more problems. It can be a downhill slide. To make matters worse, the places where the tendons and ligaments are stretched out start to hurt as your body tries to tell you that there is something wrong. The body tries to heal by creating inflammation and swelling but often it cannot do a complete job because these areas also have a limited blood supply Contrary to what we are told on TV inflammation is the natural first response of the body to injury. As long as it doesn't get out of hand it is actually a good thing! We often interfere with this process by taking medications because we are more focused on the pain than the cause; and this is understandable, because it hurts!

So what do we do? Conservative measures like physical therapy and exercise should usually be tried first but when unsuccessful we have to look further. Sometimes the answer has to be surgery because the ligament is torn and the only way out is to sew it back together. Sometimes medications are used to manage the pain but they don't really help the ligaments to heal. Prolotherapy is a treatment strategy, however, that is based on healing. Along with nutrition and exercise (necessary for any of the above to succeed) prolotherapy can help to heal and stabilize the joint reversing the downward, painful spiral.

Prolotherapy is a low-risk, non-surgical treatment done by injection. It can be done safely in an office environment without the need of general anesthetics or heavy sedation. The areas where the tendons or ligaments attach (the enthesis) are injected with an irritant/local anesthetic solution. The irritant part of the solution is usually a sugar like dextrose, although many others may be used, such as glycerin, phenol, sodium morrhuate or even growth factors obtained from the patient's own blood. This irritant stimulates a healing response by creating a micro-injury at selected sites. It is similar to setting controlled burns in a forest to prevent forest fires. This begins with inflammation which is the first phase of healing and this is followed by regeneration of the collagen in the tendons and/or ligaments. The local anesthetic is used to improve patient comfort during the procedure as well as to help confirm that the solution is actually placed at the pain generator. The procedure can then be repeated every four to six weeks until the desired effect is achieved. Although unusual, complications include bruising at the site, a temporary increase in pain at the site, infection, nerve irritation and allergic reaction. Since prolotherapy actually stimulates regeneration in repairing the tissue, what you get as a result is what you keep. There is no need for continued treatment.

In order to be as effective as possible with optimal results it should be accompanied by proper rehabilitation and physical therapy. This means attention to diet, nutrition, and exercise. This will not only help with optimizing the results of the prolotherapy but also consists of the same ideas that will help improve your overall health in the long run. Prolotherapy is often the first step on the road to better health.