Prolotherapy
and the Unstable Knee
 Noel Peterson, ND
When Mark injured his knee last
spring playing tennis, he expected it to heal on its own. His
orthopedist ruled out the all too common
torn meniscus or
ACL tear, and recommended
ibuprofen, which helped the pain but did not make his knee
feel stronger. After six months, he still had pain which
prevented him from being able to play his game. His injury was
getting more painful and limiting and after six months, his knee
felt vulnerable and painful with any deep bend or rotational
exertion.
When I examined Mark, I found an
unstable tibialfibular ligament (the connective tissue that
holds the head of the fibula to the lateral condyle of the
tibia), a weakened fibular collateral ligament, and a torn, weak
tendon of the biceps femoris muscle attachment at the head of
the fibula. We scheduled a series of
Prolotherapy injections, and three months later his pain was
gone and he was back on the tennis court.
What is Prolotherapy?
Prolotherapy is defined in
Webster's New Collegiate Dictionary as "the rehabilitation of an
incompetent structure such as a ligament or tendon, by the
induced proliferation of new cells." It was developed over fifty
years ago as a natural non-surgical method of assisting the body
in healing injured tendons and ligaments. Prolotherapy helps
your body make new cells, which strengthen lax or torn tendons
and ligaments. (Ligaments are the tough tissues which connect
bones to bones, and tendons are the tough tissue which connect
muscles to bones)
How is Prolotherapy
performed?
Prolotherapy technique consists of
using a fine needle to inject a proliferative solution into
incompetent tendons, ligaments, and joints for the purpose of
stimulating new growth and repair, thereby promoting joint
stability and reduction of pain. The most common substance used
is dextrose (a kind of sugar) diluted with procaine (a local
anesthetic). When injected into the torn tendon or ligament, the
dextrose and procaine solution induces a physiologic reaction
that stimulates the healing processes to resume, and induces the
migration of fibroblasts (the body’s repair cells) to the site
of injection. Fibroblasts lay down new connective tissue and in
so doing, enlarge and strengthen the damaged tendons, ligaments,
and cartilage.
Do Prolotherapy injections
hurt?
Prolotherapy injections are
performed with a lot of care and a little local anesthetic. The
pain of treatment is minor and only temporary when compared to
the chronic pain of tendon and ligament injuries.
What kinds of injuries
respond to Prolotherapy?
Soft tissue injuries (strains,
sprains and bruises of muscles, tendons, fascia, and ligaments )
are the most common injuries encountered in sports, auto,
household, and work accidents. These injuries produce chronic
pain in the hands, elbows, shoulders, hips, knees, and feet, as
well as neck, ribs, back, and sacrum. The majority of these
injuries heal through the body's own internal mechanism of
producing inflammation which triggers the proliferation of
fibrous tissue that mends the damaged areas. The majority of
these injuries heal, but many go on to chronic pain and
dysfunction, and many common antiinflammatory drugs used in
these cases actually inhibit the repair of these damaged cells.
Why would you still have
pain and weakness, even after a healing period of weeks or
months?
The answer lies in the fact that
both ligaments and tendons have very poor circulation, and it is
this lack of circulation which deprives them of the nutrients
they need to heal properly. When ligaments become relaxed and
weak, the nerves within and around the ligaments and tendons
become stretched and irritated, and pain results.
What about conditions such
as arthritis?
There are many forms of arthritis,
the most common being osteoarthritis. Osteoarthritis is the
gradual degeneration of joint surfaces, caused by overuse and
under repair. Over time, this wear-and-tear of cartilage
progresses to the point that the cartilage is worn thin and pain
results. Degenerative joint disease can progress to the point
where the patient needs a total hip or knee replacement.
Prolotherapy has been proven to reverse the degeneration of
joints when the condition is treated early enough.
Other forms of arthritis are
autoimmune mediated, such as Rheumatoid Arthritis, Lupus, and
Ankylosing Spondylitis. Unfortunately, these forms of joint
disease do not respond to Prolotherapy.
How can you strengthen
tendons and ligaments?
Unlike muscle tissue, exercise
cannot build, strengthen, or repair ligaments or tendons.
Prolotherapy has been shown to increase the size of tendons and
ligaments up to 40%. It has also been shown to increase their
tensile strength by as much as 200%. Prolotherapy thickens knee
cartilage and relieves the pain of degenerative joint diseases.
and no scar tissue is formed (as would be the case in surgical
procedures). The tissue formed from Prolotherapy is healthy,
strong, flexible ligament or tendon tissue. Once the ligament or
tendon has been repaired by Prolotherapy, the nerves are no
longer stretched or irritated, the pain goes away, and normal
function follows.
What are the side effects
of Prolotherapy?
Some patients experience pain and
swelling at the injection sites for 1-3 days following the
procedure. To counteract this, we recommend that patients take
acetaminophen or hydrocodone with acetaminophen for pain, but
not aspirin or anti-inflammatory medications like Advil which
can inhibit the healing response. Patients can also apply moist
heat and ice alternately to the area 3-5 times a day for 10 to
20 minutes as needed, and perform moderate exercise such as
walking, but should avoid strenuous exercise or work with heavy
lifting. Often specific exercises are prescribed to follow-up
the injections. The natural proteolytic enzyme Bromelain can
also be taken for swelling if needed. Reports of more serious
complications have been extremely rare, and are associated with
the inadvertent injection into the spinal canal or the lining of
the lung rather than into the affected ligament or tendon,
causing spinal fluid leak, nerve damage, or pneumothorax.
Who performs Prolotherapy?
The injection technique involved
in prolotherapy requires skill and care. Dr. Peterson is
certified in Prolotherapy techniques, and has been treating
people for the past 4 years. Dr. Chong has recently completed
his training and is now accepting new Prolotherapy cases as
well.
|
