15 Sep Help Your Injuries Heal With Prolotherapy At TC “Any Joint, Large or Small”
Prolotherapy is a very old-line treatment that is becoming popular again because it is simple, inexpensive, and effective in assisting the body to heal injuries and the effects of aging on joints, ligaments, tendons, and muscles. The original version of prolotherapy dates to antiquity, 4000+ years ago, when people treated both human and animal injuries of ligaments, tendons, and joints using heated wires, daggers, or rods to cause small burns. Healing the burn, the body also healed the ligament or tendon. Back then, it was assumed that the healing was due only to scarring, though today we recognize that it is due to the heat ‘up-regulating’ tissue structural protein production, plus local release of cytokines and platelets from the associated bleeding. I have been using prolotherapy in daily practice since 1984 and greatly value it for its ability to help my patients to have less pain and more normal daily function. Common reports are, “this treatment has helped me to get my life back!” and “I’ve been able to stop my pain pills!” which, of course, makes ME feel pretty good. The primary down-side is an achy pain for 24-36 hours. Possible complications are the same as with any injection treatment: infection, injury of nerve or blood vessel. I have never had any such, though, in 30 years and 50,000 patients.
The name prolotherapy is derived from “proliferant” therapy, to “proliferate” (cause increase in the numbers of) new tissues and new cells. In other words, prolotherapy stimulates tissue regeneration. Before this was recognized, the treatment from the 1880‘s onward was called “sclerotherapy” (scar-therapy) and in ancient Greek, Roman, and Egyptian times, “point-firing”. A Egyptian stelae was translated as, “King Amen-Hotep III went down to his stable to give fire to his horses.”
Interestingly, “point firing” is still used in veterinary practice, though the veterinarian now just plugs the probe’s cord into an electrical outlet, rather than “firing” it to dull red heat in a charcoal brazier. Today, the word, “sclerotherapy” still exists but refers only to injection treatment of varicose veins, to scar them shut without surgery. It is a very effective treatment.
Mechanism of action: prolotherapy uses simple solutions based on dextrose (a 10-carbon sugar) to cause local cellular dehydration: the local cells go from grapes to rasins. The leaked liquid contains, among other things, “growth factors” (previously called ‘cytokines’), which are proteins that cause specific actions by special cells (macrophages, osteoblasts, fibroblasts, stem cells) to create new tissue. One example is VEGF, “vascular endothelial growth factor”, which causes new blood vessels to grow, needed at any injury site to bring additional nutrients there. In human scale terms, it is the equivalent of causing new roads or railways to be built into an area flattened by a hurricane in order for rebuilding to begin or be supported.
Treatment can be made of TMJ, neck bones, spinal bones, sacroiliac joint, pelvic joints and ligaments, and any joint large or small. Patients report pain and dysfunction due to sports injuries, car crashes, falls, or simple wear-and-tear from having been on the planet a long time. Headache? Jaw noisy or painful? Neck pain? Weak ankle from old high school injury? Low back pain? Chiropractor is frustrated because they put your joints back in alignment, but they fall out again? Prolotherapy can treat them all.
Once a decision is made (by patient+doctor) as to what joint or body area is to be treated, the skin is cleansed, marked, numbed with local anesthetic, and then injected down deep where the ligament or tendon joins the bone, or where the joint capsule (enclosing sack) is located. Materials used are 15% dextrose in ¼% lidocain, diluted with normal saline. Joints require a 25% dextrose, without lidocain.
Patients report an initial deep, dull, achey pain at the treated area which gradually fades over 24-36 hours. They usually tolerate this with no medication, but Tramadol or Tylenol can be used if needed. However, NO non-steroidal anti-inflammatories (NSAID) including aspirin may be used because these block the treatment and even can nullify it. Most people don’t know that aspirin is an NSAID.
Patients usually report the beginnings of improvement within 7-10 days, but often must wait 2-6 weeks for peak changes, though it is recognized that production of new protein at the injection site continues for over 100 days. Many patients have told me the improvement was gradual enough that it wasn’t until 2-3 months later they suddenly and shockingly realized they were now easily doing things that had been painful or impossible prior to treatment. To paraphrase Mel Brooks, it’s GOOD to have pleasant surprises.
Repeat treatments, if needed, can be done at two, four, or six week intervals depending on healing speed and patient needs. Treatment failures, though rare, do exist but eventual success is had even with them by improving nutrition and/or switching from plain dextrose to PRP (platelet-rich plasma) prolotherapy.
Two retrospective patient outcome studies showed that the prolotherapy success rate is well over 80% “Good” or “Excellent” as graded by patients themselves. Smokers, however, had lower success rates, around 60%. There was a research article published last year in the Journal of Family Medicine regarding treatment of arthritic knees using dextrose prolotherapy. Outcome success was excellent in improving objectively measured strength, range of motion, and even cartilage regrowth and in resorption of calcium spurring.
Merle Janes, MD