Prolotherapy (short for proliferant therapy) treats pain arising from joints, tendons, ligaments, muscles, and the connective tissue that holds these structures together. Pain from these structures may be due to injury, overuse, normal wear and tear (degeneration) and nerve injury or irritation.
Prolotherapy uses solutions such as concentrated dextrose that produce a minor injury or inflammation to these structures. Connective tissue such as ligaments and tendons have a very poor blood supply and this severely limits the ability of these tissues to heal themselves as living tissue needs a healthy blood supply to maintain nourishment and repair itself.
A tendon, for example, is made of millions of individual collagen fibers woven together much like a cable is comprised of individual wires that adding greatly to its strength. Through normal wear and tear and overuse, microtears occur in these individual collagen fibers, which heal with scar tissue. This process begins long before any sort of pain message is relayed to the brain. This scar tissue is not as strong nor does it have the same strength as healthy tissue.
As the process continues over time, more microtears develop leading to more scar tissue and finally significant pain and decreased function of the tendon. This degenerative process is known as tendinopathy and also occurs in ligaments and the synovium (the connective tissue that holds bones together). This process of degeneration of ligaments and synovium occurs in conjunction with osteoarthritis and leads to pain, instability, and decreased function of the joint and structures in question. Nerve endings in these tissues may become chronically irritated as well. When this occurs, the situation is much like an exposed electrical wire with current running through it that never shuts off.
When prolotherapy injections cause local injury and irritation, it serves as a “wake up call” to the body that there is a problem that needs to be fixed. This alerts the body’s repair systems to try and start to heal the injured structure. This injury will help increase blood supply to the area, which aids the healing process. Part of this healing process involves the regeneration of collagen fibers. This helps the injured structure regain its normal function leading to a decrease in pain. If tiny nerve endings are entrapped in the scar tissue, prolotherapy can shut off these nerve endings by simple osmosis leading to a decrease in pain.
Most patients will need a series of 3-5 injections over a number of weeks. The dextrose solution is mixed with an anesthetic and may be done under ultrasound guidance and visualization to ensure precise placement of the solution in the injured area as well as avoiding areas that should not be injected such as blood vessels and nerves.
This is a very safe and well-tolerated treatment as there are no drugs (other than local anesthetic) being injected. The site of injection will be sore for a number of days and Dr. Stiene will discuss with you limitations based on the soreness that you experience. You may be prescribed mild pain medicine, but anti-inflammatory medicine needs to be avoided during the treatments.
Prolotherapy is most often used as part of an overall comprehensive treatment plan that may include other regenerative treatments such as PRP and stem cells, activity modification, physical therapy, bracing, and joint fluid therapy.
It may take 6-8 weeks before a significant decrease in pain is noted. Prolotherapy, for the most part, is a healing treatment. By nature of its healing process, pain relief follows.
Prolotherapy rarely works alone. This is the main reason that insurance companies, as well as Medicare, do not cover the treatments. Research has shown prolotherapy can be very effective when combined with other treatments and we have found this to be the case as well. However, it is unlikely insurance will cover the treatments until it has been shown to be an effective “stand-alone” treatment. Recent research has shown this to be the case in humans, but for the time being insurance carriers view the treatment as experimental.
Prolotherapy has been around for many years and because large pharmaceutical companies and surgical instrument companies have no financial stake there is very little advertising directed at the public.
Dr. Stiene and his staff will be more than happy to answer any questions regarding this type of treatment and if it may work for you.