What is prolotherapy?
Prolotherapy stimulates the body’s natural healing process to regenerate and repair damaged tissue. Since its appearance in the 1940s, it has steadily earned a reputation as an important treatment in the areas of pain management and injury rehabilitation. A growing body of research and clinical experience by naturopathic, osteopathic, and medical doctors is showing efficacy in treating joint instability, tendinopathy, ligament laxity, back pain and damaged ligaments or tendons. This includes many causes of shoulder, knee, elbow, hip, foot and back pain. While other therapies such as cortisone injections simply mask pain or provide temporary relief, prolotherapy has the potential to provide actual and complete healing of the injured tissues - often eliminating the need for surgery or delaying it significantly.
What conditions does prolotherapy treat?
In general instability and or pain in any joint can be benefitted by prolotherapy. This includes:
Shoulder: Instability, impingement syndrome, rotator cuff injuries, SLAP injuries/labral tears, arthritis
Hip/Pelvis Instability, arthritis, pelvis tendinosis and pain, hip stabilizing muscles/tendons, chronic IT band tendonosis, Chronic hamstring strains/tears
Spine: Arthritis, instability, whiplash, disc disease rib dysfunction, spondylosis, pain after surgery, low back pain, sciatica, neauralgia
Elbow: Instability, arthritis, tennis elbow/lateral epicondylosis, golfers elbow/medial epicondylosis, other tendinosis/tears
Knee: Arthritis, ligament instability and tears, peripheral meniscal tears, Runner's knee (tendinosis), Osgood
SI joint: Arthritis, instability
Pubis Symphysis: Osteitis pubis, instability, sports hernia
Wrist/Hand: Thumb arthritis and instability, carpal bone instability, carpal tunnel syndrome, TFCC tears, finger arthritis.
Ankle/Foot: Arthritis, instability and chronic ankle sprains, Sinus tarsi syndrome, Achilles tendonosis/tears, plantar fascitis
Other: Neuralgia, muscle spasm, other acute and chronic injuries, regional pain syndrome, other neurogenic pain
Note: Other conditions not listed may also benefit from prolotherapy
How does it work?
Prolotherapy comes from the term “proli” as in proliferate or “to grow”. Injecting a solution—the proliferant—into injured tissues initiates a local immune and inflammatory response that is responsible for healing. New blood vessels form, nutrients and oxygen arrive, damaged tissue is removed and over time new tissue is laid down and restructured creating a stronger end product. Strengthening and tightening the injured structures allows the muscles to relax and pain signals to shut-off.
What can I expect from the treatment itself?
Treatment lasts roughly 30 min depending on the area affected and exact nature of the injury. Depending on which specific techniques are utilized the procedure may vary slightly but follows the same general flow. The doctor will palpate and feel around the area of concern and on structures that affect that area (nerves, muscles etc.), often placing marks on the skin that serve to guide the injections. Superficial injections just below the skins surface are often performed first with deeper injections (at ligament and tendon attachments) following. Superficial sites may then be revisited and re-injected if pain persists. As with any procedure involving a needle there can be a certain amount of pain but in general it is well tolerated with patients reporting minimal discomfort. Following treatment you may experience achiness and stiffness, which may increase as the anesthetic wears off (within 1–3hours). This is part of the healing process and will gradually improve over 1–3 days.
How many treatments are required?
For prolotherapy, most patients require three to six treatments on average. Some will respond quite quickly requiring fewer treatments while others may need up to ten or more in order to stimulate healing properly. Treatments are spaced by three to six weeks to allow the healing process time to work. NPT often requires 6-8 treatments with pain resolution lasting progressively longer after each treatment. These may be performed weekly, biweekly or as the pain guides. Other procedures may be performed at more frequent intervals.
How do I know that it’s working?
Some prolotherapy patients begin to see benefits in as little as two weeks following the first treatment. For others it may not be until four to six weeks after the first treatment. Throughout your treatment we will evaluate your pain and movement to assess progress. If no benefits are seen after 3–4 treatments it may be necessary to re-evaluate whether this treatment is right for you. Improvements may last for up to three years after the last treatment. If pain or instability returns fewer and less frequent treatments are often required to produce benefits.
When can I return to work/exercise?
A return to normal and functional movement is an important part of the healing process. Controlled movement and mobilization promotes faster tissue healing and better recovery following treatment. Depending on the nature of your work or activity you may be able return the same day but caution is advised as the anesthetic alters pain perception and strenuous or explosive activity may result in further injury. Do not to exceed 75% of your normal intensity or activity for the first few days following treatment with a gradual return to more strenuous activity.
What can I do to help increase healing?
Activity and movement are necessary in order to restructure and strengthen the new tissue. Being active and physically fit will improve recovery. It is important to strengthen areas of weakness and specific programs may be prescribed. If you smoke, quitting will help maximize healing. If you need help, let us know. A healthy diet including adequate protein will also assist healing in providing key nutrients to support growth and healing. Other supplements and dietary changes may also be prescribed.
What can I take for the pain?
Because these procedures work by stimulating and regulating the healing inflammatory response anything that interrupts this is counterproductive. Do not take NSAIDS (aspirin, ibuprofen, naproxen etc.). Baby aspirin for heart conditions is an exception. Heat may soothe the soreness but ice may slow the healing process in the acute phase. Acetaminophen (Tylenol®) may be taken for the short-term. Discuss your options with your ND.
Is it safe? What are the risks?
The injections and solutions are very safe and there is no evidence that a condition has become permanently worse due to prolotherapy. As with any procedure involving needles there is the risk of irritation or infection. Depending on the area treated there is also risk of puncturing arteries, nerves, spinal fluid or lung tissue. The complications are rare and are minimized by a skilled and knowledgeable therapist. Infection risk can be minimized by proper care of the injection sites post-treatment. Allergic reaction to the solutions are also rare but have been reported. Be sure to inform your doctor about any allergies you may have. On the whole, complications are uncommon and every attempt to minimize and manage these risks will be taken.
Is prolotherapy for me?
Prolotherapy is not a cure for all types of pain. Nor does it always eliminate 100% of one’s pain. It is, however, very good at addressing pain due to joint and ligament instability. Because multiple systems are ultimately connected—the knee bones connected to the hipbone—and a problem in one area can actually present itself in another it takes a skilled practitioner to determine the underlying cause. While many injuries or pain may respond to physiotherapy or chiropractic, those due to chronic or traumatic injury where the tendons, ligaments or joint capsules are weakened, or where chronic pain signals stuck “on” require the structural cause to be addressed. Prolotherapy techniques truly get to the root cause in these cases.
What should I do prior to treatment?
Inform your doctor about any supplements, herbs or drugs you are taking, especially if they are for pain or joint problems.
Stop taking all anti-inflammatory medications and natural products at least 4 days prior to treatment (except baby aspirin taken for the heart). If you are unsure whether something is contra-indicated please call the clinic or ask your doctor.
Inform your doctor about any allergies you may have including those to fish, corn, sugar, anesthetics, latex, or painkillers.
Eat a light meal 1–2hrs prior to treatment.
Drink plenty of water the day before the procedure as well as the day of.
If available, bring any x-rays or imaging studies of the area to be treated.
What should I do after to treatment?
DO NOT take anti-inflammatories (pharmaceutical or natural) for at least 4 days after the injections, as these will interfere with the healing process. If you are unsure about anything you are taking please call the office.
You may take acetaminophen (Tylenol®) or other approved medications for short-term pain relief following treatment. Acetaminophen is taxing to the liver so do not exceed 4000mg per day. If you consume three or more alcoholic drinks per day or have a history of liver issues ask your doctor about other options.
Remember that it is important to address the underlying cause rather than cover up symptoms. Pain is a protective mechanism. Further injury may result if pain is dulled and movement or return to activity is too quick.
Heat may be used to reduce pain but refrain from using ice during the first week.
To reduce risk of infection, avoid swimming pools, hot tubs, and lakes as well as topical oils, creams, lotions etc. at the injection site for five days after treatment.
Some patients experience episodes of pain in the first two weeks after treatment. This is normal and should not be cause for alarm. However, call the clinic if you have questions or are concerned.
Avoid strenuous activity the day of your treatment as pain perception is reduced (due to the anesthetic) and further injury could occur. In general, a reduction in activity is advised following treatment with a gradual return to your usual routine, as you feel able (usually within two to four days). As a rule movement is important and inactivity will decrease optimal results.
Pain relief is most commonly noted at 2-6 weeks following treatment with joint strength and stability increasing with each treatment and lasting up to three years from the last treatment. The process is gradual and patience is required but the results are considerable and often permanent.