Chronic Soft Tissue Pain: Is Prolotherapy For You?
PROLOTHERAPY is a treatment technique which administers a series of Dextrose (sugar) injections into chronically painful, overstretched ligaments and soft tissues.
It best suits conditions like plantar fasciitis and tennis elbow or low back and sacro-iliac pain due to ligamantous laxity caused by injury, pregnancy or repetitive strain. It is also useful in long standing groin injuries. These conditions usually respond to physiotherapy within 3 months, but if the tissue at fault needs more of a healing boost with collagen rebuilding then prolotherapy is worth considering. You may also hear the term NEUROPROLOTHERAPY which are injections that target injured and swollen subcutaneous nerves (commonly used in the neck and upper back area).
HOW EXACTLY DOES PROLOTHERAPY WORK?
Prolotherapy uses Dextrose (a 12.5% to 25% sugar concentration) and the injections that are given into the areas where soft tissues attach to the bone causing a local irritation provoking a regenerative tissue response. Often lidocaine, a numbing medication, is also injected with the Dextrose. This regeneration comes about by signaling the fibroblast cells to build a structural framework around the injured soft tissue and produce collagen. It is this collagen production and rebuilding that plays a critical role in healing.
The injections proliferate new cells in rapid succession, augmenting and supporting the existing ligament and over time create new ligament tissue.
Neuroprolotherapy or sometimes called Perineural Subcutaneous Injections (PSI) use a lower concentration of Dextrose into painful subcutaneous nerves. The lower sugar injections used are a 5% sugar concentration. This is the same base solution used in hospital to administer drugs intravenously to patients.
Neuroprolotherapy is hypothesized to inhibit nerve inflammation, thus preventing the release of neurotransmitters involved in producing the sensation of pain. Following an injury, the tiny subcutaneous nerves become inflamed and can be felt by your physiotherapist. In fact they feel like small cords of dental floss under the skin. It is these nerves that are target of the injections.
HOW MANY INJECTIONS WILL I NEED?
Prolotherapy treatment sessions are generally given every 2 weeks for 3 months in a series ranging from 6 or more treatments. Many patients continue to receive treatment at less frequent intervals ( known as booster shots) until treatments are rarely required, if at all.
Neuroprolotherapy injections are given over 4 to 6 treatments. Following the first treatment there should be 100% relief of the pain within the first 10 minutes and this relief lasts 4 hours to 4 days. After 6 treatments there should be lasting relief of the pain.
WHERE DO I GO TO GET PROLOTHERAPY?
It is really important to seek Prolotherapy from medical doctors experienced in this technique. Your doctor will perform a thorough musculo skeletal assessment to ensure that your particular problem is suitable for this type of injection.
Physiotherapists at Trimetrics can assess and recommend the suitability of prolotherapy if your condition persists despite other treatments.
According to Dr Jean Gillies at Vancouver Prolotherapy Clinic this treatment has been highly successful for many conditions like plantar fasciitis, tennis elbow, high ankle sprains, cruciate laxity in the knee and back pain due to ligamentous injury.
Dr Gillies is a highly respected rheumatologist who has been doing prolotherapy for 25 years. She examines and assesses the pathology to see if prolotherapy injections are indicated. Sports medicine doctors are also experienced in these injection techniques.
For best results: Physiotherapy after Prolotherapy
To ensure optimal results a physiotherapist can assess your condition post prolotherapy and make exercise recommendations to ensure that you don’t over-stretch a healing ligament. With appropriate exercise, stress forces are created in the right direction through the healing soft tissue to return it to full strength and function. For example if a tennis elbow has been injected, eccentric exercise ( which is loading the tissue as it lengthens) would be introduced. This has been shown to stimulate collagen regeneration. If a ligament in the back has been injected we would avoid exercises that torque and overload that healing ligament. Clinical Pilates under physiotherapy direction is an excellent form of supervised exercise following prolotherapy.
A general overview about Prolotherapy from the NYT.
Prolotherappy for laxity in the Anterior Cruciate Ligament
Chronic groin pain and prolotherapy
Chronic neck pain and prolotherapy
New York Times article on Prolotherapy Injections to Kick-Start Tissue Repair
Journal of Practical Pain Management: Prolotherapy for Low Back Pain
Prolotherapy for Musculo-skeletal Pain: A primer for pain management physicians on the mechanisms of actions and indications for use. Jan/Feb., 2007
Biomechanics: Sweet Relief: The Scientific Research Behind Prolotherapy / RIT
In this study, 97 out of 98 patients with chronic neck pain showed substantial improvement in numerous outcome measures. The improvements in these patients continued through follow up—18 months after conclusion of prolotherapy treatments—and demonstrates the efficacy of this treatment modality.
Efficacy of Dextrose Prolotherapy in Elite Male Kicking-Sport Athletes With Chronic Groin Pain Archives of Physical Medicine and Rehabilitation 2005; 86: 697-702
Conclusions: “Dextrose Prolotherapy showed marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes.”
Long Term Effects Of Dextrose Prolotherapy For Anterior Cruciate Ligament Laxity
University of Kansas Medical Center, Alternative Therapies, May/June 2003, Vol. 9 No. 3
Conclusions: “Dextrose injection Prolotherapy at 2-3 month intervals resulted in elimination of laxity by machine measure in 10/16 knees in the study population, with statistically significant laxity improvement by 6 injections, sustainable through 3 years with periodic injection.”
Knee Arthritis Study Using Dextrose Prolotherapy
University of Kansas Medical Center, Alternative Therapies, March 2000, Vol. 6, No 2
Conclusions: “… substantial improvements in joint pain, subjective joint swelling, flexion range of motion, and tendency for knee buckling…This study result, coupled with findings of a double-blind study on small joint (finger) OA, indicates that dextrose injection may have broad effectiveness in the treatment of joint and soft tissue…In the meantime Prolotherapy with dextrose should be considered as one of the treatments for OA of knee and ACL laxity.”
Low Back Pain:
Retrospective Case Series on Patients with Chronic Spinal Pain Treated with Dextrose Prolotherapy
Results: 91% of patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work.
Conclusions: “Dextrose prolotherapy appears to be a safe and effective method for treating chronic spinal pain…”
A Systematic Review of Prolotherapy for Chronic Musculo-skeletal Pain
Clinical Journal of Sports Medicine; 15(5):E376, September 2005
Conclusions: “Positive results compared with controls have been reported in nonrandomized and randomized controlled trials.”
PRP Regenerative Injection Therapy
PRP Prolotherapy used successfully for professional
Carolyn Bliss MCPA COMP