Many patients come into our office with a date for surgery or, and more unfortunate, a diagnosis of failed back surgery. For the patients who had put off surgery, they have explored their options and have discovered that surgery is not the answer for them. For the patients who had the surgery, they need more options than before.

Ankle and Foot Treatment with Prolotherapy
My ankle hurt A LOT immediately! I had gone up to block the spike and came down on the foot of the spiker (who followed through under the net!). The ankle quickly swelled and the throbbing pain prevented me from sleeping at all that night. I had severely sprained the lateral ligament complex while playing my favorite sport, volleyball. I quickly began a series of Prolotherapy treatments on my own ankle. It went like this (initially). I sprained my ankle on Thursday night. On Friday morning I treated the ankle with Prolotherapy. By the following Thursday it felt good and the swelling was down, I played volleyball Thursday night which led to swelling and pain again (you think?). I repeated this scenario for about six treatments before pausing to consider why I wasn’t getting better, like my patients did with Prolotherapy!


Dextrose Prolotherapy for
Unresolved Low Back Pain

A Retrospective
Case Series Study

Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for chronic low back pain.

Design: One hundred forty-five patients, who had been in pain an average of four years and ten months, were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. This included a subset of 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option. Patients were contacted an average of 12 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.

Prolotherapy After Arthroscopy
I cannot tell you how often I ask my patients why they received an Arthroscopy and what the post surgery report showed, and the answer is so often “I don’t know.” Unfortunately, people agree to procedures, surgeries, or medications without really knowing the reasons for them. Here we will look at a patients’ actual arthroscopy reports with my opinion regarding what they need to look for and questions they need to find out.
 

Dextrose Prolotherapy
For Unresolved Neck Pain
An observational study of patients with unresolved neck pain who were treated with dextrose Prolotherapy at an outpatient charity clinic in rural Illinois. Conclusion: In this observational study, patients with unresolved neck pain reported clinically relevant improvements in their pain level and quality of life after receiving Hemwall-Hackett dextrose Prolotherapy.

Cervical spine injury
From the very beginning of life, the cervical spine (C-spine) is fraught with significant risks of injury. This includes varying degrees of ligament and musculotendon strain or sprain, along with vertebral dislocation or fracture and even spinal cord trauma (e.g., contusion, hemorrhage) with associated neurological effects.

C-spine whiplash injuries can be compounded by brain stem injury due to direct trauma or edema and stroke due to arterial damage and intracranial injuries of varying severity, including coup-countercoup contusion, translational parenchymal tearing, and hemorrhage. These central nervous system injuries can lead to a wide spectrum of neurological and psychological symptoms commensurate with a closed head injury. Cervical sprain injury can also be associated with signs and symptoms of Barré-Lieou Syndrome due to injury of the cervical sympathetic chain.

Prolotherapy for Pelvic Ligament Pain
A Case Report
This case study examines the effect of the addition of Prolotherapy to manual therapy, and pelvic and trunk exercises, in a treatment regime for a patient with pelvic and chronic low back pain (CLBP) who had previously failed manual therapy and exercise alone and in combination. We hypothesized that with continued exercise and the combination of Prolotherapy and manual therapy, there would be better improvement than any single intervention to reduce pain and improve stability in the lumbar spine and pelvis.

The Use of Hormones for Chronic Pain
Anabolic hormone therapies and Prolotherapy are innovative approaches to treating chronic pain. They are complimentary and can be simultaneously administered.
 

Prolotherapy, a non-surgical alternative for torn meniscus
Recently we saw a retired school teacher. She twisted her knee getting out of a car. She had an MRI which showed a meniscus tear. Surgery was recommended with the impression that it would be repaired and that she would regain full pain-free function of her knee.  What did her surgery report show?  As with nearly all of these “meniscus repair” reports that we see, most show that the meniscus was indeed not repaired, but removed.

Grade I Lumbar Retrolisthesis
Prolotherapy is indispensable when considering biomechanical correction in the treatment of pain associated with ligament laxity. This 51 year old male was referred for assessment and treatment of a 15 year history of chronic low back pain. He had been very active his whole life and had sustained numerous injuries playing a variety of sports including hockey and football. He had been spending approximately $5,000 per year on massage therapy, craniosacral therapy, chiropractic care and standard physiotherapy. He was also put on a variety of medications including courses of anti-inflammatory medications, tricyclic antidepressants for analgesia, and benzodiazepines with no relief.

The Theoretical Basis for and Treatment of
Complex Regional Pain Syndrome
with Prolotherapy
In this Prolotherapy article from the Journal of Prolotherapy, Ross Hauser, M.D. says that Prolotherapy, by stimulating ligament regeneration, not only resolves the pain, but also the sympathetic hyperactivity and the related symptoms of CRPS. Prolotherapy is a treatment that patients with CRPS and the doctors who treat them should consider.

Treatment of Joint Hypermobility Syndrome, Including Ehlers-Danlos Syndrome, with Hackett-Hemwall Prolotherapy
Some of the rationale for using Prolotherapy for patients with Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) include that it has a high safety record, is comprehensive (all or most joints can be treated at each visit), is an outpatient procedure, is cost effective (compared to surgery), pain relief is often quick, and it provides joint stabilization. Perhaps its greatest asset is the fact that this one treatment modality can handle most of the painful musculoskeletal conditions that occur in individuals with EDS and JHS.

Facet Joint Injections for Neck and Back Pain
A facet joint injection can be performed for one of two purposes. One purpose is diagnostic in that it confirms or denies that the facet joint is the cause of back pain or neck pain. The second purpose is therapeutic in treating the facet joints. Diagnostically, a small amount of anesthetic is injected into the facet joint near the area of pain. If pain relief results then the facet joint is deemed the culprit of pain. Once the facet joint is pinpointed as the problem area, further injections of anesthetics and anti-inflammatory agents are injected to try to achieve more permanent pain relief.

Ligament Injury and Osteoarthritis
In this Prolotherapy research article from the Journal of Prolotherapy, the relationship of ligament injury and osteoarthritis is  examined and shown to be a convincing one. When there is insufficient ligament support to stabilize joint motion, the resultant increase in joint laxity leads to the development and acceleration of articular cartilage injury. The biomechanical abnormalities caused by joint instability greatly increase impact loading via increased shear and compression forces across areas of contact on opposing cartilage surfaces. Even with early recognition of ligament injury and deficiency, traditional medical interventions do not treat the etiology of the disease. It is for this reason that the prevalence of osteoarthritis will increase as will the number of joint replacements.

A Pain in the Buttock (and back) treated with Prolotherapy and PRP
Many of us who have had back pain will also feel the pain radiating down the leg, into the hip, and into the buttock.  It takes a great degree of skill, experience, and knowledge to determine what the appropriate treatment is for a patient with these symptoms.  We cannot just rely on the MRI, no matter how abnormal the disc or joint may seem.  The following case will illustrate this:
 

The Ligament Injury Connection to Osteoarthritis
In this Prolotherapy research article from the Journal of Prolotherapy, the relationship of ligament injury and osteoarthritis is  examined and shown to be a convincing one. When there is insufficient ligament support to stabilize joint motion, the resultant increase in joint laxity leads to the development and acceleration of articular cartilage injury. The biomechanical abnormalities caused by joint instability greatly increase impact loading via increased shear and compression forces across areas of contact on opposing cartilage surfaces. Even with early recognition of ligament injury and deficiency, traditional medical interventions do not treat the etiology of the disease. It is for this reason that the prevalence of osteoarthritis will increase as will the number of joint replacements.

Prolotherapy and Disc Problems
While disc problems cause back pain and are often responsible for sciatica (leg pain), ligaments that are strained or lax are the most common cause.

Prolotherapy after back surgery
Many people only become aware of Prolotherapy after they have undergone a surgical procedure for back pain. Although the pain may not be as severe as it was before the surgery, most people continue to experience significant back pain after surgery. Why? Because the back surgery involved removing supporting structures, such as a lamina, facet, or disc, thus weakening surrounding segments.

Prolotherapy & Connective Tissue Damage Syndrome:
Why am I hurting, and no one seems to know what is wrong?
Prolotherapy is certainly an important clinical tool to treat damaged connective tissue—ligaments, tendons, cartilage, meniscus, labrum, fascia, etc. But perhaps a greater contribution made by Prolotherapy is that it sheds light on an important medical mystery. That is, when someone has pain in a joint, or in the neck, or back, or when someone has symptoms going down an arm or leg, or various other distressing symptoms, what disease process is actually causing their symptoms? I see patients on a daily basis who have had the origin of their symptoms misdiagnosed. I hear patients on a daily basis give accounts of lengthy odysseys through the health care system, often involving multiple attempted treatments, including operations, who are not better, and perhaps worse, after all the medical attention they have received. Or I see patients with significant symptoms who have been told that “nothing” is wrong—because all their tests are “negative.”

Platelet rich plasma, PRP, Prolotherapy
What is PRP? In basic terms, PRP involves the application of concentrated platelets, which release growth factors to stimulate recovery in non-healing injuries. PRP causes a mass influx of growth factors, such as platelet-derived growth factor, transforming growth factor and others, which exert their effects of fibroblasts causing proliferation and thereby accelerating the regeneration of injured tissues. Specifically PRP enhances the fibroblastic events involved in tissue healing including chemotaxis, proliferation of cells, proteosynthesis, reparation, extra-cellular matrix deposition, and the remodeling of tissues.

Prolotherapy for Bursitis
Almost everyone who comes to my office for Prolotherapy for the treatment of bursitis doesn’t have bursitis.  Once in my life I had a true bursitis and when I did, I couldn’t let anything even touch the skin over it because it was that painful. The person who lets a doctor palpate the area with a lot of pressure with the thumb does not have bursitis. They have ligament sprain or tendon strain or other soft tissue injury. 

The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage of joints such as the knee and hip. Both animal and human research has consistently shown that corticosteroid injections into normal and degenerated knees accelerate the arthritic process.

Coumadin, Aspirin, Blood thinners, and Prolotherapy
A very common question I hear from patients is, can I get Prolotherapy while on blood thinning medication?

When to use Prolotherapy when to use Platelet Rich Plasma
Platelet-Rich Plasma (PRP) Therapy is a particularly hot topic, nowadays—in the laboratory, the clinic, and on the street. A very recent New York Times (NYT) article describes how two Pittsburg Steelers “used their own blood in an innovative injury treatment before winning the Super Bowl.” The article goes on to cite several other sports figures who have also been successfully treated in this fashion. It refers to PRP Therapy as a means of delivering a “growth-factor cocktail” to such injuries as “tennis elbow” or “knee tendinitis” (sic).

Cervical radiculopathy
Cervical radiculopathy, though a serious and disabling painful condition, can often be treated conservatively. At times, Prolotherapy, nerve blocks, chiropractic, osteopathy or physical therapy alone can resolve the condition, sometimes a combination of approaches will be needed. While the person is getting treated, close monitoring by the clinicians is necessary to ensure the condition is resolving. With proper care non-operative treatment of cervical radiculopathy is not only effective but recommended, in these authors’ clinical experience.

Prolotherapy Saved Me From
Bilateral Knee Replacements
abstract
This case study discusses the case of 56 year-old avid body builder, who suffered from chronic, severe, debilitating bilateral knee pain  who was told he needed bilateral knee replacements in order to have any chance at a semi-normal life again, but was told he would likely never lift weights again post surgery. Alek chose Prolotherapy, along with proper exercise and nutritional supplementation over surgery to regain the active life style to which he was accustomed.

Dextrose Prolotherapy and
Pain of Chronic TMJ Dysfunction
Many of the subjective symptoms of pain, stiffness, and crunching sensation in patients with TMJ dysfunction were reduced greater than 50% in 92% of the prolotherapy patients in this study. Full Text

Chronic Pain and Sports Injuries
When a person becomes a physician, he or she learns the Hippocratic Oath which sets down the rules for practicing medicine. The first and foremost rule of this doctrine is “to help, or at least, do no harm.” Musculoskeletal pain issues, such as low back pain, neck pain, knee pain, shoulder pain, elbow or wrist pain, ankle pain, arthritis pain, and the pain and disability of sports injuries, are common complaints heard by many physicians. As a young doctor practicing family medicine, I had patient after patient come to me with these ailments. Being an osteopathic physician, with extra training in the musculoskeletal system and treatment, I knew more than the average medical doctor regarding these complaints, and had extra tools I could use. I was able to help some of my patients get rid of their pain, but for others, the pain would only go away temporarily and would continue to return.

Prolotherapy with Platelet Rich Plasma
Case History: bilateral elbow tendinosis
with underlying joint degeneration

Cynthia is a 45 year old formerly active woman who came to Caring Medical on April 18, 2006 with complaints of bilateral forearm and elbow pain. The pain in the left elbow was present since July 2004 and in the right elbow since February 2003. She had tried many treatments such as cortisone shots, acupuncture, and surgeries (repair of a ruptured tendon in the right arm, radial tunnel decompression and lateral extensor fasciotomy in the left arm) without relief. MRI’s have shown tendinopathy in the both elbows and osteitis in the left elbow. She ranked her pain as a 10 almost 24-7 and she was basically completely disabled in both arms and hands due to the pain. She had 5-10 degrees of limited extension in the left elbow.

Platelet Rich Plasma (PRP) Injections
This article provides the reader with some basic information about platelet rich plasma, also known as PRP. PRP as a Prolotherapy proliferant has become increasingly popular in the pain management field. The basic tenants of PRP preparation and use in the Prolotherapy field are discussed.

Low back pain and sacroiliac (SI) pain
Prolotherapy treatments consist of injections that stimulates the repair of connective tissues such as tendons and ligaments by causing a mild inflammatory response which initiates an immune response. This mimics what the body does naturally to heal soft tissue injuries. Prolotherapy is effective in SI pain because we have found it fairly rare for sacroiliac pain to be caused by a pinched nerve or by a slipped or herniated disc. Much more common is a ligament injury which caused ligament laxity or ‘looseness.”

L4-L5 Back Pain
People want to be healed! For many with chronic pain, they are told there is nothing else that can be done. They are told to live with the pain and cope as best they can. This is simply not true!

I saw a patient with a complaint of at least 15 years of chronic low back pain that interfered with all aspects of his life. He was told by a friend that Prolotherapy might be helpful for him. He had been to a number of therapists, trying multiple modalities and different types of medications used in “pain management.”

The Iliolumbar ligament
This case study examined the effects of a single Prolotherapy injection series on the left iliolumbar ligament. The ligament measurements were split between medial and lateral portions of the iliolumbar ligament and we hypothesized that growth would occur increasing the cross sectional area and thus provided added stability to the pelvis and lumbar spine.

Traumatic Arthritis
Ligaments stabilize joints, if ligaments are loose, the joint is loose. Loose joints means the body will cause muscles to spasm and overgrow bone in an effort to stabilize the joint. Since stabilization will not occur; the joint will begin to make the "cracking" sound. Cracking of a joint means arthritis is starting. Additionally, if the joint periodically swells or feels painful during cold weather, arthritis is starting to form. If a joint or ligament is traumatized by injury and not fully allowed to heal, traumatic arthritis develops. Many of the old-time athletes I see in my practice have some form of traumatic arthritis. However! Exercise and sports participation do not cause arthritis; only an injury to the joint causes arthritis.

Elbow Tendonitis - Rotator Cuff Injury
YD was a 35-year-old avid weight lifter who ceased this activity due to injury. He began to notice pain in both elbows nine months prior to his first visit to Caring Medical. As he lifted weights he felt sharp pain and later experienced throbbing at night. Shortly after the sharp pain occurred he stopped weight lifting and went to see his doctor. He had an MRI and was diagnosed with chronic tendonitis. In addition to his elbow pain he also had pain in his right shoulder that had been diagnosed as a rotator cuff injury. He tried physical therapy for his shoulder with no results. As his pain worsened, he lost range of motion. Eventually he was unable to lift his arms overhead without pain and he lost the ability to perform his physical therapy exercises.

More prolotherapy articles
 

The Journal of Prolotherapy

Prolotherapy Research at
The Journal of Prolotherapy