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Prolotherapy

Prolotherapy is a regenerative injection procedure. This means that is helps to regenerate damaged tissue. This injection treatment is a safe non-surgical approach for chronic injuries, pain and arthritis using injections to stimulate healing and repair of damaged tissue.

Common conditions treated with Prolotherapy include: osteoarthritis and instability of joints in areas of the body such as the;

  • spine
  • SI joints
  • pubis symphysis
  • shoulder
  • elbow
  • wrist
  • hand
  • hip
  • pelvis
  • knee
  • ankle
  • foot

Injured joints, muscles tendons and ligaments in particular do well with Prolotherapy. The repair and healing process usually takes from 4-8 weeks. Prolotherapy has been used to treat pain and injuries for more than 60 years and the results have been consistent and positive. Up to 90% of appropriate patients receive good to excellent results in pain relief and improved function. In addition, the use of pain medications can often be greatly reduced or even stopped over time after the treatments. Much of the pioneer work was done by Dr. George Hackett who proved that strengthening damaged tissue also relieves pain.

Prolotherapy to a knee.

How does it work?

Several areas of injury may not heal completely due to lack of proper treatment or poor blood supply. This is why ligaments, joints and tendons are often affected. If left untreated, these damaged ligaments can become loose and allow bones to shift causing a lot of muscle spasms and eventually premature arthritis. Prolotherapy intervenes by stabilizing these structures and decreasing the progression of pain degeneration and aging. Prolotherapy causes inflammatory changes initially for the first week after a treatment which then attracts fibroblasts which can form new collagen and therefore repair injured and unstable tissues and joints from 3-6 weeks after a treatment and the maturation phase continues from 6 weeks to 18 months after an injury or Prolotherapy resulting in collagen density improvement and tissue strength.

What about the procedure itself?

Prolotherapy is a safe procedure when performed by a trained and highly skilled physician who has an in depth knowledge of anatomy and experience using this injection technique. The use of needles involves some risks but complications are rare. Solutions have been shown to be safe and do not contain cortisone which can cause degeneration of joint and ligament tissue. The most common side effect is discomfort from the injections as well as temporary soreness, stiffness and occasional bruising. Although injection discomfort cannot be eliminated it is usually well tolerated in most cases. Local anesthetic is often used prior to the injections to decrease discomfort. If necessary, pain can also be reduced by the use of prescription oral medications.

What can I expect with Prolotherapy?

Depending on the area treated and the number of injections, most patients can return to usual activities during the next day to 2 days. The actual treatment lasts from a few minutes to 30 minutes. Approved medications or acetaminophen (Tylenol) may be taken for discomfort following injections.

However, anti-inflammatory drugs should not be taken during the treatment at least 5 days but preferably for two weeks before and after each treatment because they will increase the risk of bleeding and interfere with the intention of the treatment. Anti- inflammatory medications include Advil or Ibuprofen, full strength Aspirin (325 mg), Aleve or Naproxen, Prednisone, steroids, other NSAIDS such as Celebrex, Voltaren or Arthrotec. Some herbal supplements which also have anti-inflammatory properties should also not be taken such as Cercumen, and arnica.

A light meal and plenty of water about 1-2 hours before the procedure is recommended. Water improves hydration and lessens the discomfort of the injections and food reduces the likelihood of dizziness or fainting. Most people can drive after the procedure but occasionally some people are very prone to faintness so if you are, please arrange for someone to drive you home after the treatment.

Prolotherapy cannot cure every painful condition but most patients treated by Prolotherapy will have received at least 50% relief of their pain within 2-10 treatments, the average number needed being about 6. Treatments occur at intervals usually every 4 weeks.

What are the major risks of Prolotherapy?

  1. Infection due to the needling. Therefore do not go into public swimming pools, hot tubs or lakes for 3-5 days after each treatment. Showering the day of or the next day is fine.
  2. Pneumothorax or puncture into the lung, very rare ( I am very careful)
  3. Bruising – temporary
  4. Nerve irritation – this is temporary
  5. Allergic reaction – if you are allergic to corn or xylocaine

What can I expect right after a treatment?

Prolotherapy will not result in immediate pain relief. However, some patients report improvement in as little as two weeks following a treatment. As ligaments strengthen and joint stability improves, results become more consistent and noticeable with improvements in function and decreased pain. Improvement can continue up to three years after the last Prolotherapy treatment.

Typically post injection stiffness and soreness can be expected and is necessary for the healing process to being. This usually only lasts for a few days. Heat usually soothes the soreness but ice will slow the healing process. No anti-inflammatory drugs should be used as it will interfere with the intention of the treatment. The only exception is baby aspirin (81mg) for cardiac reasons. Regular use of narcotics should be avoided because they also inhibit the immune system and slow the healing. Tylenol is recommended if needed for a short time after injections.

Movement and exercise are recommended as soon a possible after each Prolotherapy injection. The amount will depend on one’s fitness level before. However, don’t OVERDO IT. Pace yourselves, remember this is supposed to gently challenge the body to allow healing and not to destroy the treatment either. Massage therapy should be avoided for three days after a treatment to reduce a risk of infection. Physiotherapy can be resumed immediately after the treatment and can help with correcting associated muscular and proprioceptive issues. Most patients can return to school or work the same day unless there is a great deal of stress in the area treated do to the work. But be careful. When you leave the office, most people feel pretty good because there is some anesthetic in the area,. It is easy to overdo it in those first 8 hours after the treatments. There is no evidence of any condition becoming worse from Prolotherapy treatments.