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Prolotherapy injection in  knee


“Did You Know Prolotherapy is Among the Most Advanced Forms of Regenerative Medicine Available Today For Repairing Damaged Tissue Fibers and Joints?”

“What does Peyton Manning and a Pueblo CO Acupuncturist Have in Common…?”

Prolotherapy is one of the new secrets from pro athletes, helping them bounce back from frequent injuries and ongoing wear- and-tear, and I think it can help you bounce back from your injuries too.

In fact, that’s how Kobe Bryant came back from what should have been a career ending Achilles tendon tear at 38 years old… He received prolotherapy treatments, as did Peyton Manning.

Hi, my name is Tracey Walker and I’m a Pueblo, CO acupuncturist. I too have personally benefited from Prolotherapy (also known as Injection Therapy), when I suffered a bulging disc with a dowagers hump, as well as an injured shoulder and low back pain.

Prolotherapy has done wonders for my recovery, and now I recommend it to my patients whose injuries cannot be treated by a chiropractor.

Prolotherapy is a cutting-edge form of regenerative medicine that is leading the way in helping to treat both acute and chronic injuries, as well as difficult-to-resolve joint pain. You can benefit from prolotherapy if you have arthritis, a torn ligament, tendonitis, a bulging disc, or pain in any susceptible area such as your neck, lower back, knee or shoulder.

Through utilizing glucose and increasing collagen production to re-create your body’s own natural healing process, prolotherapy is considered one of the most advanced forms of regenerative medicine available today for the repairing of damaged tissue fibers and joints.

How Does Prolotherapy Stimulate Healing?

The way that prolotherapy works is by causing a purposeful, mild inflammation response near damaged tissue that helps new fibers to grow. While usually “inflammation” is thought of as a bad (and sometimes painful) thing, it also has important benefits for stimulating repair-work and healing damaged tissue fibers.

Prolotherapy College describes this process as follows:
  • When ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint.

  • Essentially through performing a very directed injection to an injury site, prolotherapy tricks the body into repairing an area. In the past, prolotherapy injections contained a mix of substances that helped to dull pain and cause a mild inflammation response, including dextrose, saline, sarapin and procaine.

5 Benefits of Prolotherapy     

1. Helps Repair Tendons Injuries

Prolotherapy can increase platelet-derived growth factor expressions that kick off repair of damaged tendons. A 2010 JAMA study compared two forms of prolotherapy (saline and PRP) for treating tendon injuries and found they had similar effects. Both treatments helped treat chronic Achilles tendinopathy, although some speculate that PRP might be best suited for this kind of injury.

2. Helps Treat Chronic Back & Neck Pain
According to Spine-Health, prolotherapy can help heal small tears and weakened tissue in the back that contribute to inflammation, reduced functioning, bulging discs and back pain. The mechanism by which stem cell therapy helps to treat back pain is by shutting down “ligamentous laxity,” which is the activation of pain receptors in tendon or ligament tissues that send painful nerve signals up the back. Damaged tissue in tendons or ligaments are sensitive to stretching, compressing and other forms of pressure, so by reducing these tears, prolotherapy helps to eliminate the root source of pain.

Prolotherapy has successfully been used in pain management for common conditions that affect the back including:

  • Neck pain due to spine related conditions

  • Sciatica/sciatic nerve pain

  • Bulging or herniated discs

  • Degenerative disc disease

  • Sacroiliac problems

  • Rotator cuff injuries extending to the upper back

  • Whiplash

3. Resolves Shoulder Injuries & Pain
Prolotherapy have been shown to be effective in the treatment of shoulder injuries and pain, which are often a result of the rotator cuff being overworked (sometimes from not resting enough between workouts). The shoulder is one of the body parts exposed to the most repetitive use, repeated traumas and degeneration, so athletes, laborers and aging adults are most susceptible to shoulder injuries of all kinds.

A 2009 Journal of Prolotherapy study reported that up to 82 percent of patients treated for chronic shoulder pain (also called frozen shoulder) experienced improvements in sleep, exercise ability, anxiety, depression and overall disability. And 39 percent of these patients were told by their medical doctors that there were no other treatment options available for their pain!

4. Treats Elbow & Wrist Tendonitis
A 2008 report published in Practical Pain Management states that adults who play golf or tennis frequently are some of the more prone to elbows injuries. Prolotherapy is now considered an effective non-surgical treatment option for sport-related injuries. And not only those that affect the elbow (like lateral and medial epicondylitis) but also those causing subsequent pain in the lower back, wrist ligaments or shoulders, plus sprained ankles and other musculoskeletal damage caused by repetitive use and joint degeneration.

5. Treats Injuries to the Hands & Feet
Prolotherapy is now being used to lower pain associated with common hand injuries experienced by younger and middle-aged adults, such as carpal tunnel syndrome, Skier’s or “Gamekeepers” thumb and “Texting thumb,” which are caused by repetitive use and damage to the ulnar collateral ligament.  Recently, doctors have seen a steady increase in injuries triggered from everyday activities like typing, computer mouse use or playing sports.

The thumbs, fingers, hands and feet are also prone to pain caused by osteoarthritis and aging. One study involving over 600 patients with ankle and foot pain that was published in Operative Techniques of Sports found that prolotherapy treatments helped reduce ankle and foot pain associated arthritis, tendon ruptures, plantar fasciitis, misalignments, fractures and ligament injuries.

Prolotherapy Injection in low back
Da Vinci's Anatomy Drawings

History of Prolotherapy

Some sources show that prolotherapy treatments have a very long history, dating all the way back to ancient times. In the fifth century BC, Hippocrates supposedly treated shoulder injuries by cauterizing areas of the shoulder to promote scarring and healing.

In 1835, Alfred A.L.M. Velpeau, MD,1 considered the father of prolotherapy, injected a patient with an iodine solution to treat a hernia. Circa 1880, Rene Leriche, MD, injected ligaments with procaine demonstrating a pain pattern from ligament laxity and injury.

From the 1830s to the early 1920s, hernias were the primary condition treated via prolotherapy.


Prolotherapy in the 1930s-1950s

Modern day prolotherapy owes its origins to the innovation of Earl Gedney, DO, an osteopathic physician and surgeon.  In the early 1930s, Gedney caught his thumb in a surgical suite doors, stretching the joint and causing severe pain and instability. After being told by his colleagues that nothing could be done for his condition and that his surgical career was over, Dr. Gedney did his own research and decided to “be his own doctor.” He knew some members of the American Society of Herniologists who used irritating solutions to repair hernias, and extrapolated this knowledge to inject his injured thumb.

In 1937, Dr. Gedney published “The hypermobile joint,” the first known article about injection therapy (then called “sclerotherapy”) in the medical literature. The 1937 article gave a preliminary protocol and 2 case reports—one of a patient with knee pain and another with low back pain—both successfully treated with this method. Dr. Gedney followed up this paper with a presentation at the February 1938 meeting of the Osteopathic Clinical Society of Philadelphia, outlining the technique.

The 1930s proved to be an explosive time for injection therapy because of the intense histologic research being conducted by Rice, Matson, Harris, White, Biskind, and Manoil. These researchers showed that collagen was being regenerated at the injection site and that there were specific and reproducible cellular events that accounted for the positive outcomes from injection therapy.

During the 1940s and mid 1950s, there was a proliferation of articles about the use of prolotherapy for musculoskeletal system other than hernias.   In the mid 1950s, Dr. Hackett observed that following injection therapy “…the junction of ligament and bone resulted in profuse proliferation of new tissue at this union.” Hence, Dr. Hackett termed the injection procedure, proliferation, which he later renamed prolotherapy, with ‘prolo’ referring to proliferation, or growth, of tissue.

At the end of the 1950s, Dr. Hackett presented his research at national conferences and provided insight to the concept that ligament laxity and enthesopathies are the underlying pathophysiology of chronic pain patterns. Later, Dr. Leedy headed a lecture team of Gedney, Shuman, Willman, Greenbaum, Bumpus, Koudele, and Smith that formed through the Chicago Osteopathic College to present their research findings and lectures.


Into the 1980s

The solutions used then (and now) were primarily dextrose-based, although other formulas are used and can be effective.  Prolotherapy is practiced by physicians in the United States and worldwide, and has been shown to be effective in treating many musculoskeletal conditions, including tendinopathies, ligament sprains, back and neck pain, tennis/golfer’s elbow, ankle pain, joint laxity and instability, plantar fasciitis, shoulder, knee, and other joint pain.

There have been many papers written and published that have advanced the understanding and knowledge of, and outcomes associated with, prolotherapy. For example, in his paper on joint stabilization, Dr. Hackett made the cognitive leap that proliferation included the 3 stages of healing—inflammation, granulation, and maturation—and that ligament laxity causes pain.

In 1983, Liu et al demonstrated that 5% morrhuate sodium produced collagen at the sites in which it was injected.16 In 1985, Maynard et al showed that the morphologic and biochemical effects of morrhuate initiated the injury-repair sequence in tendons and ligaments. Double-blinded experiments by Klein et al and Ongley et al have contributed substantially by using the scientific method with statistically significant results (P <.001, <.004 and <.001) showing the effectiveness of prolotherapy compared to controls.

There were several other researchers who made significant contributions that have helped advance the field. Kent Pomeroy, MD, contributed to improved scientific study design methods as well as data in the important areas of outcome studies,  Dorman contributed surveys of patients, and Faber, Mooney, Leedy, Schultz, Hauser, Dorman and Montgomery wrote editorials in this area. Dr. Faber’s unique contribution was to eloquently explain prolotherapy to the patients on a large scale through many papers and books, especially Biological Reconstruction and Pain, Pain Go Away.

Frequently Asked Questions

Q. What is Prolotherapy?
Prolotherapy (Proliferative Therapy), also know as Non-Surgical Ligament and Tendon Reconstruction and Regenerative Joint Injection, is a recognized orthopedic procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the joint is stabilized, the pain usually resolves. Traditional approaches with surgery have more risk and may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only act temporarily. The original term used for this therapy was “sclerotherapy”, coined in the 1930’s when this treatment was discovered, and included both joint and vein injections. Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.

Q. How does Prolotherapy work?
Prolotherapy works by stimulating the body’s natural healing mechanisms to lay down new tissue in the weakened area. This is done by a very directed injection to the injury site, “tricking” the body to repair again. The mild inflammatory response which is created by the injection encourages growth of new, normal ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area.

Q. What is in the solution that is injected?
Prolotherapy injections contain natural substances that stimulate the healing response, as well as local anesthetic agents to help with the pain of the injection. Traditional formulas include ingredients such as dextrose, saline, sarapin, procaine or lidocaine homeopathies, traumeel and vitamins and minerals.

Q. Is the Prolotherapy treatment painful?
Any pain involving an injection will vary according to the structure or joint treated, the choice of solution, and the skill of the physician administering the injection. The treatment may result in a temporary increase in pain with mild swelling and stiffness. The discomfort usually passes fairly quickly and can also be reduced with pain relievers such as Tylenol or other prescribed medication. Anti-inflammatory drugs, such as aspirin and ibuprofen, are not recommended for pain relief because their action suppresses the desired inflammatory healing process produced by the prolotherapy injections.

Q.  Can Prolotherapy help everyone?
Each patient must be evaluated thoroughly with patient history, physical exam and radiological or ultrasound exam. Success depends on factors which include the history of damage to the patient, the patient’s overall health and ability to heal, and any underlying nutritional or other deficiencies that would impede the healing process. In appropriate patients, prolotherapy has a high success rate.

Q.  What areas of the body can be treated?
Areas/problems treated include: Low back or mid-back pain including degenerative disc disease and sacro-iliac joint instability/dysfunction, neck pain, knee pain, knee meniscal tears, wrist or hand pain, osteoarthritis, shoulder pain including rotator cuff tears, elbow pain including golfers or tennis elbow, foot pain including plantar fasciitis, ankle pain or instability, hypermobility, osteitis pubis, IT band syndrome, piriformis syndrome, temporal mandibular joint syndrome (TMJ), or other musculoskeletal pain or injury.

Q.  How often do I need these treatments?
Treatment intervals vary depending on the specific problem and severity of the area being treated. Typical intervals between treatment are every three to six weeks, with an average interval of once a month, for a total of four to six treatments. However, this can vary and may be more frequent, or take longer, depending on the condition being treated.

Q.  What’s the rate of success in treatment for prolotherapy?
The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used. In patients with low back pain, studies have shown a 85% to 95% of patients experience improvement with prolotherapy (compared to studies showing a 52% improvement with back surgery). Many studies done over the years show a high success rate when prolotherapy is used for various ligament, tendon or joint pain/injuries.

Q.  Is this form of therapy really new?
Prolotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the shoulder joint. Advances in medicines greatly improved on this process, and led to the modern techniques of strengthening the fibrous tissue and creating new, normal collagen, rather than producing scarring to fuse tissues. Since the early 1900’s. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints in the 1940s and 1950s, and spent the rest of his life researching and publishing on the subject.

Also, George Hackett, M.D., wrote a book on this injection therapy, with Gustav Hemwall. MD adding to that publication in the 1950’s. Both Gedney and Hackett’s work is still used today in training physicians. In the years since this early work, techniques and medications have advanced to move from a scarring or fusing effect to a strengthening, regenerative effect, which restores the weakened joint to its original level of stability, without loss of flexibility and function. Advances in Regenerative Medicine have made the use of more advanced formulas possible.

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