|
Prolotherapy treats chronic pain due to ligament and tendon instability and the resulting joint, muscle, nerve and structural dysfunctions.
"I have discovered prolotherapy and it's like discovering a miracle cure."
E.H. Vancouver
Conditions which may benefit from prolotherapy are:
-
Pain conditions
- Neck Pain
-
Low Back Pain
-
Leg pain
-
Herniated Discs
-
Sciatica
-
Hip pain
-
Knee pain
-
Ankle pain and foot pain
-
Wrist pain
-
Elbow pain
-
Shoulder pain
- Frozen shoulders
- Labral Tears
-
Headaches
-
TMJ (jaw) pain
-
Post Injury/Trauma Pain
-
Fibromyalgia
-
Sports Injuries
- Yoga overstretch injuries
- Arthritis Pain
-
Loose Joints
-
Tendonitis
-
Post fracture treatment
- Rib Pain
- Any joint pain in the body
Prolotherapy / RIT is defined as the injection of growth factors or growth factor production stimulants to produce normal cells or tissue. It can also be described as reconstructive injection. (Reeves 2006) The term comes from “proles” or proliferate - "to stimulate growth”. Simply put, Prolotherapy / RIT consists of injecting a solution that promotes regeneration and healing onto damaged ligaments, tendons and joints.
Modern research has demonstrated this effect of stem cell stimulation of growth factors with Prolotherapy / RIT treatments. Because of this, there is a movement to change the name of Prolotherapy / RIT to something more specific to its physiological action. Hence the term “Regenerative Injection Therapy” or RIT as it is increasingly referred to.
There are references to the use of Prolotherapy like therapies since the time of Pharaoh Amenhotep III in 1350 B.C. when cautery was used to treat animals. Hippocrates, the father of medicine, circa 400B.C. wrote about similar treatments given to wounded soldiers. There are also numerous references to similar techniques in Chinese and Tibetan medical records and even Western Veterinarian journals. The first record of injection proliferants into humans goes back to 1835 with a reference to Velpeau a French physician. Various other physicians had since used proliferants on animals and humans. Dr. Earl Gedney, an osteopath from Philadelphia was the first to use an injection to strengthen sacroiliac ligaments. Dr. George Hackett, a surgeon from Canton, Ohio, active in the late fifties, correlated pain patterns from the strained ligament with instability. He treated thousands of patients with ligament strengthening injections which he named Prolotherapy. He reported a 90% improvement in his patients.
Ligaments are the "stays" which hold the bones of the body together. They constitute a "nylon rope-like" consistency which acts to bind the bones together but also allow flexible movement. They are particularly important for structural stability within the joints and especially the spine. Ligaments are also thought to store elastic energy, like a spring. This springiness of ligaments improves body motion and when they deteriorate, this elasticity and springiness fails. This is evident in all joints especially when using the weight bearing hips, knees, ankles and feet. The springing function can be experienced as well in the arm and shoulder when swinging a tennis racquet or golf club, throwing a ball, or even lifting a cup of tea.
It was Dr. Hackett who introduced the term “relaxation (laxity) of ligaments”. It is understood that in injury the ligaments are frayed and even torn. In the instances of bone fractures, ligaments usually tear before the bone breaks. It is thought, particularly in connection with the spine, that the ligaments become lax because of the shrinkage of the inter-vertebral discs and from direct stretching and damage to the ligaments themselves. Probably both mechanisms are active to different degrees in different people. It is important to also consider that ligaments are rich in pain sensitive nerve fibers and that any damage to them can be the direct cause of pain.
The spine can be described as analogous to a pile of bricks bound together in a mobile column by the ligaments which tie each vertebra to its neighbour creating from this pile a strong and flexible support for the body. It is not surprising that this combination of mobility and support occasionally fails. Through stress, strain, or injury, ligaments can
become stretched or weakened. When the ligaments do not hold the vertebrae in perfect alignment there is a tendency for one or more vertebrae to be displaced or rotated. When this happens the normally perfect and smooth movements can become stiff or "kinky" and the muscles react by contracting or going into spasm to protect the joint. The pelvis, spine, ribs, and neck are particularly prone to minor displacements between the connected joint structures. Chiropractors use the terminology of a "subluxation" to describe this.
Many patients have had the experience they describe as “having put my back out”. Correction with manipulation when properly done can give great relief and restore mobility and function. A common complaint, however, is the ongoing need for these corrections without long term resolution. The underlying cause for the recurrence of these subluxations and abnormal movements is ligament injury or relaxation. By the same token, lax ligaments cause muscles to tighten or spasm in an attempt to stabilize the dysfunctional joints. When repeated massage, trigger point release and other therapies have little lasting effect, one must look to a deeper cause, usually the ligament laxity. Many persons maintain stability by performing regular “core strengthening” exercises. Although it is necessary to have a strong core, if the ligaments are unstable and not holding the joints together, the core strength functions at best like a second tier of stability, helping the symptoms, but not fixing the problem. It is only when the ligaments are stabilized with Prolotherapy / RIT can the joint function normalize, the muscle tension relax and the spasms release.
The symptoms of ligament laxity are multiple and the site of the patient's pain depends on which ligaments are strained. It is usual for pain to move from place to place in the body due to the phenomenon of referred pain as well as mechanical causes. The diagnosis is made first by learning from the patient about his pain and where it is, and secondly, by clinical examination. The diagnosis depends only a very little bit on special tests, such as x-rays and MRI's. These are obtained mainly in order to exclude other conditions.
It is obvious that if something is out of place it should first be put back with adjustments and/or mobilizations and then kept in place by strengthening the muscles and the ligaments. It is a simple concept.
In cases of chronic low back, thoracic, neck or rib pain, the diagnosis of ligament insufficiency may be made in association with a displacement of the sacrum or spinal vertebrae. In such cases the following procedures are undertaken:
- Manipulation to restore normal alignment of the sacrum, spine and/or the extremity joints.
- Prolotherapy / RIT injections, usually weekly, bi-weekly or of longer intervals depending on the case, for six sessions.
- Exercises to ensure healing in the presence of movement.
- Nutrients to support the strengthening of ligaments and joints.
Other factors to address that will affect recovery include hormonal status, quality of the diet, general fitness and healthy lifestyle.
These principles are useful in the management of pain and instability of any part of the musculo-skeletal system. It can be very effective for hip, knee, ankle, foot, hand, wrist, and elbow and shoulder problems. Chronic neck pain and headaches are usually relieved, even after many years of trouble, with Prolotherapy / RIT. It is also effective for TMJ (temporomandibular joint) problems, tendonitis, loose joints, sports injuries and fibromyalgia.
A simple dextrose solution is all that is needed to eliminate pain. Min-Young Kirn, M.D., and associates from Yonsei University Medical College in Seoul, South Korea, studied 64 patients with chronic pain. Dr. Kim compared using a five percent dextrose solution with the current standard trigger point injection solution of 0.5 percent procaine and placebo. The study found that not only did the dextrose solution prove to give statistically significant pain relief against placebo it was that much better when compared to the procaine solution. The study also found that in follow-up, the pain relief with the dextrose solution remained. The simplest Prolotherapy / RIT solution is 12.5% to 20% dextrose with 1% procaine. The dextrose makes the solution more concentrated than blood, acting as a strong proliferant. Procaine is an anesthetic that helps reinforce the diagnosis because the patient may experience immediate pain relief after the Prolotherapy / RIT injections. Many millions of injections have been given safely using this solution. The main side effect has been one to two days of pain after the procedure due to inflammation caused by the injection solution. The dextrose solution, in addition to being safe, will not affect a diabetic's blood sugar level. If necessary stronger proliferant agents can be used. Such agents include sodium morrhuate (an extract of cod liver oil), or a dextrose-glycerin-phenol solution known as PG2. PG2 has been used in several double blind studies that prove Prolotherapy / RIT causes ligaments to rebuild and grow stronger thicker tissue.
Exercise
To stimulate the new growth of tissue the proliferant is injected, but in order to align the new collagen correctly with the existing ligament tissues it is very important for the structures to heal in the presence of movement. This will protect the ligament from forming adhesions to neighboring structures and increase longitudinal alignment of the new collagen. Movement and exercise ensures proper healing. As the healing process goes on for several months, it is recommended that patients continue with exercises for at least three months after the last injection.
Chronic back, leg and arm pain is sometimes due to disc disease. When this is so, medical doctors often recommend anti-inflammatory medication to relieve the symptoms. Although the pain may be eased in the short term the drugs do nothing to heal the spine. Studies have shown that the use of these medications actually weaken ligaments and tendons and increase the long term instability in the joints, as well as damaging the digestive system and being a potential cause of death. A New England Journal of Medicine study determined that 16,500 people in the U.S. die each year from the use of NSAIDs (non-steroidal anti-inflammatory drugs). As well, the FDA recently announced that 450 Americans die each year from the use of acetaminophen (Tylenol).
Often surgery is recommended in an attempt to relieve pressure on a nerve. Although this surgery is often successful in relieving pain, it should be reserved as a treatment of last resort. Not all surgeries are successful, and frequently even successful ones, require further surgery in the future as other discs degenerate because the underlying problems have not been addressed. Surgery requires a long recovery time as well as having much greater risks than other treatments. There is a 3-4% rate of complication for cervical spine surgery, and 4,000-10,000 deaths per million neck surgeries. If you are considering lumbar spinal surgery, realize that there is a risk of death of 7 persons per 10,000 surgeries.
A study of over 2,000 low back pain patients, published in the Journal of the American Medical Association (JAMA) was recently reported in the New York Times. The study clearly demonstrated that patients with lower back pain that had surgery, may have had a short term improvement in pain, but after 3-6 months they were no better off than those that did nothing but wait. As well the study demonstrated that waiting for surgery did not put a patient at risk for further aggravation of the condition. This study does not address the issue of what many prolo doctors observe clinically, which is the reoccurrence of lower back pain years after surgery in many patients and the long term improvement of those cases treated with prolotherapy. To view the report: "Study Questions Need to Operate on Disk Injuries".
It should be understood that the presence of disc degeneration is often seen in cases of chronic back pain but it is also often found in individuals without pain. Even though spinal or disc degeneration may be seen on x-rays or MRI it is not always the actual cause of pain.
Disc disease itself is due to ligament relaxation in the first place. It is the abnormal range of movement caused by relaxed ligaments which allows for most of the abnormal strain on the discs. Therefore, prolotherapy; ligament strengthening treatment is highly recommended for treating disc problems, even if surgery has been recommended. Orthopaedic surgeon Dr. Jean Paul Oullette, of Orleans, Ontario, has stated that after more that 20 years he stopped performing disc surgery, relying instead on prolotherapy to successfully treat these problems.
There are cases of course where surgery is essential and sometimes urgent. Many doctors do realize that in the majority of instances a trial of conservative therapy is best first. Surgeons should, however, recognize that if an operation is needed after prolotherapy has been used, there is an increase in the thickness of the ligaments, so the dissection can take longer to reach the deeper structures (the nerves and dura).
There are instances when the patient feels pain at a site remote from the injured ligament. This is called referred pain. Referred pain from ligaments can mimic sciatica and nerve pain and is often confused with pain due to pressure on a nerve root from an abnormal disc in the spine. Differentiating between these causes is not always easy, but it is exactly this differentiation that is necessary for the skillful and proper resolution of the patient’s complaints and dysfunction. Most cases of back pain, suitably diagnosed, improve with treatment with prolotherapy.
Hackett reported about 90% success. Contemporary research shows similar results. In a double blind trial of Ongley's method performed in Santa Barbara in 1986 on 81 patients, 88% reported more than 50% improvement in their back pain over the six months the trial was "blinded", and at a year the improvement was the same. A similar rate of success is reported from several doctors' offices where circumstances allow the treatment to be offered to a larger variety of patients. Several additional scientific papers have been published on a number of aspects of prolotherapy. Recurrent pain can develop, but is usually less severe, and more easily treated, often with a single visit to the doctor and perhaps one injection. Patients who are treated are, however, not immune to injury—there are no bionic backs.
Soreness and bruising at the injection site and temporary stiffness are normal. Patients often report a numbness over the injection site and tingling or itching. It always passes. Soreness usually lasts for 1 to 2 days then subsides as the ligaments go through their growth and repair phases.
It is not uncommon as one area of the body begins to recover, that other areas of previous injury begin to display symptoms. This is because the symptom of pain is usually the latest expression of a process of adaptation from previous injuries and degenerative changes. For example, you might have injured your knee when younger and limped around for a period of time. The limping put strain on the back, but eventually the knee pain stopped. The strain on the back at some point became aggravated with a lifting injury and a disc problem emerged. Prolotherapy would stabilize the lower back, return normal function, but the untreated knee injury may flare up as the body de-compensates.
Occasionally, for some patients the correction of old traumas will cause a release of long held emotion. This is a positive sign and indicates that healing is occurring.
Not all persons experience the injections as being particularly painful although they often may be. The injections may be more painful, particularly in the first two to three visits. For this reason relaxation methods and local anesthesia of the skin prior to injection may be used. After injection there is usually significant change of sensation with some contraction or release of muscles and changes of blood flow. For this reason it may be useful to have a driver for the trip home and plan on resting for a while after treatment. After the second or third treatment these changes in autonomic nerve function are usually not so profound.
The main side-effect from prolotherapy is one to two days of soreness and stiffness following the procedure. The injected areas may feel achy, and it is common to experience muscle stiffness for a few days. This can be alleviated through alternating hot and cold compresses over the affected area, as well through the application of a "deep heat" like liniment, such as Tiger Balm.
It is very important to avoid anti-inflammatory medication while undergoing treatment, as these will defeat the very purpose of prolotherapy which is to increase inflammation temporarily. This includes anti-inflammatory agents such as Advil, Ibutrophin, Aspirin Clinoril, Voltaran, Motrin, Vioxx, Celebrex, Prednisone, Cortisone etc. All of the above will be counterproductive to the healing process of soft tissues and ligaments initiated by the prolotherapy. It is best to take no medication at all but if the pain is bad enough and relief is required, Tylenol, Tylenol with Codeine or prescription opioids may be used. The regular use of MSM and Glucosamine Sulphate may also lessen the secondary pain reaction. Natural anti-inflammatories, such as bromelain, curcumin, proteolytic enzymes, fish oils etc. are now believed to assist and not inhibit the healing response. It is recommended that although these substances are generally helpful in the healing of injured joints, their use should be suspended the day of prolo treatment to allow the natural inflammatory response to occur.
It is important to note that aggressive exercise may worsen ligament injury and is thus not recommend until Prolotherapy / RIT has strengthened the joint sufficiently to provide pain relief. A useful rule of thumb is "It if hurts, don't do it". Once the healing begins, movement and range of motion exercises are useful to facilitate healing. A formal exercise program is helpful as the ligament strengthens and the joint stabilizes to prevent further injury. It is also important to remember the effect of diet and lifestyle choices on the overall recovery process. Nutritional deficiencies are epidemic in our modern society and this affects both overall health and the healing of ligaments and tendons. Ligaments require proper vitamins, minerals, amino acids and collagen factors to repair. Proper diet and nutrition is imperative for healing to occur. Similarly, lack of proper hydration will hinder healing and cause ligaments to shrink. It is recommended that you drink at least 6-8 glasses of water per day.
Each injection has a strengthening effect that takes about 6 weeks to maximize. It is important to note that it still requires 1-2 months of being pain free after the course of treatment is completed for optimal healing to occur. So don't overdo your activity just because you have less pain. Let nature take its course.
Articles About Prolotherapy
Can prolotherapy help with your condition?
What Are the Risks Associated with Prolotherapy?
by: Ross A. Hauser, M.D.
Every medical procedure has risks - but so does living with chronic pain!
Prolotherapy Articles in the News:
Sept. 28, 2007
Recently endorsed by the Florida Academy of Pain Medicine. Prolotherapy is sparking renewed interest, particularly with regard to treating repetitive stress injuries in professional athletes. In 2005, the Mayo Clinic endorsed prolotherapy, saying it may be helpful when ligament or tendon pain fails to respond to prescribed physical therapy. The procedure is endorsed by former Surgeon General C. Everett Koop, and is part of clinical trial being conducted by National Center for Complementary and Alternative Medicine (National Institute of Health.)
Injections to Kick-Start Tissue Repair
New York Times, August 7, 2007
Shots Bring Headache Relief
Yoga Journal: Sugar Fix For Torn Ligaments
Dr. Allen Thomashefsky
Journal Newspapers Richard Sandler, M.D.
Sweet Relief BIOMECHANICS SEPTEMBER 2004 by K. Dean Reeves, MD (In adobe pdf format)
A Brand New Way To Get Rid Of Pain (Woman's World Magazine) Ross Hauser, M.D.
Watch a Prolotherapy Video with
Dr. Scott Greenberg (11:18)
requires Real Player to view.
to download Real Player
click here
|
