How do we gauge Prolotherapy’s effectiveness in patients? This is a common question asked by people just about to receive Prolotherapy for the first time. Typically there are several variables that are looked at to make sure the Prolotherapy is achieving the results the person desires.
Does Prolotherapy improve Function?
Is the person able to function better? If a person can go up two flights of stairs without knee pain after Prolotherapy, whereas prior to the Prolotherapy this would cause excruciating pain then you know that Prolotherapy is helping their function. Typically people come to get Prolotherapy because there is some function they are not able to do because of the pain. If it is throwing a baseball hard, then we would want the person to get Prolotherapy until this function was able to be performed. Whatever the function is, a person should receive Prolotherapy until they can do the activity they desire without pain.
Does Prolotherapy improve Strength?
Ligament and tendon injury cause muscle strength to go down. When a person receives Prolotherapy one of the noticeable effects is that there strength increases in the area injected. So whether it is the back, neck, knees, or whatever other joint a person should notice an improvement in the strength in the area that received Prolotherapy.
Does Prolotherapy improve Pain?
Pain, as you can see, is only one variable that is helped by Prolotherapy. A noticeable decrease in pain is a great benefit of getting Prolotherapy. Ideally a person would receive Prolotherapy until all of their pain is gone.
Does Prolotherapy improve Stiffness?
It is common for people to have stiffness upon wakening or after activity. Most commonly this is in the lower back or neck, but could involve any area of the body. A great sign that Prolotherapy is working is that there is no longer any stiffness. Once Prolotherapy helps stabilize the area involved, the muscles no longer have to provide this stability so they relax. Once they relax, the stiffness subsides.
There are many areas of the body where by physical examination the doctor can tell that Prolotherapy is working. In the knee it is quite easy to tell a ligament is getting stronger. Other areas, the physician might notice that range of motion has improved or that stability is enhanced.
X-rays are a poor indicator that Prolotherapy is working. The reason being that most ligaments do not show up well on X-rays. I have had repeat MRI’s (also see MRI – See Knee Research Study) and x-rays show improvement after Prolotherapy in various areas of the body including the knees, but don’t rely solely on this indicator.
There is definitely quite a few ways that a person can tell that the Prolotherapy is working. The above is not an exhaustive list, but just a short explanation as to ways a person can tell that the Prolotherapy is accomplishing what it was set out to do…specifically to set the person free…free from pain, immobility, limiting activities, and stiffness.
Unfortunately for most, one treatment of Prolotherapy is not sufficient to cause enough growth of ligament and tendon tissue to permanently eliminate the chronic pain or sports injury. The typical patient requires about two or three treatments, adult athletes typically require anywhere from four to eight treatments.
The inflammatory response typically occurs over a four to six week period, therefore most Prolotherapy physicians see patients for re-evaluation every four to six weeks. Some Prolotherapy doctors may decide to increase the frequency to weekly. This needs to be discussed with your Prolotherapy doctor. Athletes often do not have six weeks to wait for their next treatment. The athlete will tell the doctor something along these lines, “Doctor, the PGA tour starts in six weeks. I need to be healed by that time.” In such an instance, the athlete may be treated weekly or every other week.
The anesthetic in the solution used during Prolotherapy sessions often provides immediate pain relief. The pain relief may continue, after the effect of the anesthetic subsides, due to the stabilizing of the treated joints because of the inflammation caused by the Prolotherapy injections. This pain relief normally continues for a few weeks after each treatment. Between the second and fourth weeks, the initial stabilization induced by the Prolotherapy subsides, and because the initial growth of ligament tissue is not complete, some of the original pain may return during this “window period” of healing. The patient is typically seen for follow-up four to six weeks after the treatment so progress can be accurately assessed, avoiding evaluation during the “window period.” Prolotherapy is performed every four to six weeks because most ligaments and tendons heal over this time frame.
As the healing progresses, the number of injections required per treatment usually decreases. The pain generally continues to diminish with each treatment until it is completely eliminated, often after four to eight sessions. In some cases, athletes or other chronic pain patients will not experience pain relief after their first or second Prolotherapy treatment. This does not necessarily mean that the therapy is not working, but rather it is an indication that the ligaments and tendons are not yet strong enough to stabilize the joints. The amount of collagen growth required for stabilization of the joint is different for each person. A patient who experiences pain relief at rest, but not during activity requires further treatment to strengthen the area. If Prolotherapy treatments are continued, there is an excellent chance of achieving total pain relief with the resumption of all previous activities, including athletics. For the rare person who feels no relief with the third treatment, we do a nutritional assessment to see if there is something impairing the healing process. Some people want to do all of this on the first visit, which is often ideal because all aspects of healing can be initially addressed. Remember that Prolotherapy starts the healing process, the body grows the stronger tissue. The healthier the person, the more the tissue will be stimulated to grow with each treatment. If a person has a depressed immune system because of hormonal problems, nutritional deficiencies, or other medical problems (e.g., diabetes, etc.), these will decrease the body’s ability to heal. Smoking and excessive drinking of alcohol have the same effect. This is where techniques like metabolic typing, nutritional counseling, and overall natural medicine care are encouraged.