Adapted from the Journal of Prolotherapy website:
WHAT IS PROLOTHERAPY?
Prolotherapy is a treatment that stimulates the body to repair painful areas. Specifically it involves the injection of natural substances into painful areas to stimulate the body’s own repair mechanisms to strengthen and heal injured structures. Mostly, Prolotherapy is used to strengthen ligaments and tendons. Ligament injury is presumed to be the preliminary cause of joints that become degenerated. This along with the fact that most degenerated joints have tenderness at ligament attachments around the joint, account for the fact that degenerative arthritis and degenerated structures typically respond beautifully to Prolotherapy. Prolotherapy is a great treatment for pain arising from ligaments, tendons, and degenerated joints.
WHAT DO YOU MEAN “STIMULATES NORMAL HEALING?”
The body heals by inflammation. When an athlete has a hard work out and hurts after it, this occurs because the workout has inflamed the muscles. The normal inflammatory healing reaction is what will not only repair the damage from the workout, but also cause the muscle physiology to actually change to make the muscle fibers bigger, stronger, and have more blood supply. Prolotherapy is a treatment that stimulates the normal healing reaction. So Prolotherapy, like exercise, can cause structures like ligaments and tendons to become stronger and thicker. Because Prolotherapy stimulates normal healing, athletes and people who are active typically love the therapy because they can work out through the course of receiving Prolotherapy.
WHAT DO YOU INJECT DURING PROLOTHERAPY?
While part of the “art” of Prolotherapy is what is actually injected to stimulate healing, most Prolotherapists use a base solution of hypertonic dextrose. The dextrose is a sugar made from corn. Also included in the standard formula is lidocaine or procaine (for short-term pain relief), and vitamin B12.
DO THE INJECTIONS HURT?
Yes, while the injections hurt, lidocaine or another anesthetic is put into the solution to decrease the pain. Also a lidocaine or anesthetic cream can be rubbed on the skin to make the injections less painful. Some people receiving Prolotherapy will take a narcotic like Vicodin, or a relaxant such as Xanax before the procedure. Some who get a lot of areas treated will need intramuscular or intravenous Demerol or other forms of conscious sedation to help them get through the procedure. Realize though, 95% of folks just grin and bear it and get through the Prolotherapy procedure fine. In expert hands, Prolotherapy just takes a few minutes per session.
WHAT ARE SOME OF THE CONDITIONS THAT RESPOND TO PROLOTHERAPY?
• Tendon strains
• Incomplete tendon tears
• Incomplete Ligament tears
• Ligament sprains
• Degenerative joint disease
• Spine arthritis
• Fibromyalgia pain
• Frozen Shoulder
• Adhesive Capsulitis
• Loose Joints
• Subluxing Joints
• Hypermobility Syndrome
• Bone spurs
• Plantar Fasciitis
• Pelvic Floor Dysfunction
• Pubic Symphysis pain
• Tennis Elbow
• Meniscal tear
• Labral tear
• Post Surgery Pain
• Osteoarthrits pain
• Pyriformis Syndrome
• Iliotibial pain
• Chondromalacia patella
• Shin splints
WHO IS THE IDEAL CANDIDATE FOR PROLOTHERAPY?
The best candidate for Prolotherapy would be one who obviously has an injured structure causing their pain that responds to Prolotherapy. This typically is an injured or torn ligament or tendon, or a degenerated joint or spine.
If a tendon or ligament is completely torn then surgery is typically warranted. If a nerve is getting pinched, again, surgery may be warranted. Even in these two scenarios it is typically recommended that an evaluation be done by a qualified Prolotherapist. Sometimes the patient, or even their doctor, thinks someone has a pinched nerve or complete tear, but when evaluated by a Prolotherapist that is just not the case. The person then receives Prolotherapy and responds well to the treatment. In summary, to determine if you are a good Prolotherapy candidate, it is best to get an evaluation by a Prolotherapist.
HOW MANY TREATMENTS ARE NEEDED?
Most conditions require three to six sessions of Prolotherapy. Obviously some conditions respond with one or two visits, while chronic degenerative joints may need therapy for one to two years. The answer to this question can be best found by talking with a Prolotherapist about your specific condition.
HOW OFTEN DO I NEED TO GET TREATED?
Most people receive Prolotherapy every four to six weeks. In some instances treatments are given every week to two weeks. The number of treatments and how often a person is treated is dependent on a lot of variables. It is best to discuss this with your Prolotherapist at the initial consultation.
WHAT DO YOU MEAN BY CHRONIC PAIN?
Most painful conditions that do not improve completely by three to six months typically will not “spontaneously” get better on their own. At this point the person is said to have a chronic condition, or chronic pain. One of the treatments that should be considered once a pain is chronic is Prolotherapy, primarily because it stimulates the painful structure to repair and the cure rate is very high.
I JUST INJURED MYSELF. CAN I GET PROLOTHERAPY?
It is common for someone who has been cured of their chronic pain with Prolotherapy to get Prolotherapy for acute pains. Acute pain is a pain that just started. Prolotherapy can typically speed up the healing process. This is especially critical for athletes who do not want to lose a lot of training time. So yes, even for an injury that just occurred, Prolotherapy can be used.
PROLOTHERAPY AND SURGERY. HOW DO THEY COMPARE?
Prolotherapy and surgery have not been compared to one another in a scientific study. The anecdotal evidence from patients and Prolotherapists is that a person should try Prolotherapy before surgery in most cases. There are definitely emergency conditions that require immediate surgery. Since typically we are talking about chronic pain for these conditions, most Prolotherapists, and even most surgeons, would say that conservative treatments should be tried before surgery. Prolotherapy is a more conservative treatment than surgery. In the end, most Prolotherapists believe Prolotherapy will be the treatment of choice for most chronic painful conditions. This will eliminate the need for a lot of the surgeries that are currently being done.
WILL THERE BE SORENESS AFTER PROLOTHERAPY?
Yes. Most people leave a Prolotherapist’s office walking somewhat like Frankenstein. This soreness though is a “good” kind of soreness. You know, the kind of soreness you have when you had a good workout. The muscles tighten and yes, it is painful, but not awful. Typically the area feels tighter and stronger right away. You shouldn’t have awful, awful pain after a Prolotherapy treatment. If you do, please call your Prolotherapist’s office and report it. Sometimes pain pills or muscle relaxers are needed for a short time.
WHAT SHOWS THAT PROLOTHERAPY IS WORKING FOR SOMEONE?
• Pain level is decreasing.
• The amount of pain medication required is decreasing.
• Function or activity level is increasing.
• Clicking or grinding of the joint is decreasing.
• The area moved better (muscle spasms going away).
• Patient is happier.
• Exercise level is increasing.
• Tenderness in the area of pain is decreasing.
Most people get treated until they are pain free or almost pain free. Prolotherapy regenerates structures for many months after the last treatment. This is why some people stop getting Prolotherapy when they are 90% pain free. If the pain does not totally remit in a couple of months after the last session, then another treatment or two may be needed.
WHAT IF RESULTS ARE NOT SEEN IMMEDIATELY WITH PROLOTHERAPY?
Typically, two out of three people who receive Prolotherapy feel better after the first treatment. Some folks have to get a few treatments before feeling better. If someone has not had any improvement by the fifth or sixth treatment, typically Prolotherapy sessions are stopped.
CAN PROLOTHERAPY REGENERATE CARTILAGE?
There is anecdotal evidence that Prolotherapy can regenerate articular cartilage. Cases have been reported where people have not needed knee and hip replacements because of Prolotherapy. While the results are preliminary, it is the hope of the Journal of Prolotherapy to publish more and more case reports and x-ray/MRI evidence that cartilage regeneration does take place with Prolotherapy.
WHAT ARE THE RISKS WITH PROLOTHERAPY?
Prolotherapy, like all injection procedures, carries with it a risk of infection. Typically with Prolotherapy treatments in general, there is a risk of increased pain, swelling, bleeding, bruising, and redness. Depending on the area involved, there can be a risk of pneumothorax (puncture of the lung), nerve injury, ligament injury, tendon injury, muscle spasms, spinal headache (spinal leak), and synovitis (joint swelling/pain). Like all medical procedures, Prolotherapy carries risks. These risks should be discussed with the doctor doing your Prolotherapy.
WHAT IS THE SUCCESS RATE FOR PROLOTHERAPY?
This is also a great question, but it really depends on the person. For some who have hip arthritis and do not want a hip replacement, “success” may be just getting back to walking pain free, while others with the same condition want to get back to playing racquetball. To give exact percentages of “success” with Prolotherapy is impossible unless the person’s exact goals and condition are known. In general, the success rates with Prolotherapy are excellent. Upon the initial visit, the Prolotherapist will identify the typical and expected number of treatments and expected response. Again, medicine is not an exact science. While a “normal” response for early arthritis of the knee is seen in say, six treatments, some people will require four and others will require ten. Some will not respond. Someone getting Prolotherapy should realize any doctor doing Prolotherapy is not “God” and cannot totally predict the future. Those with a lot of experience are generally close with their estimates as to number of treatments and response, but no one can predict the future 100%.
WHAT DOES PROLOTHERAPY COST?
Prolotherapy requires an initial consult - a 1 hr visit in which we confirm that prolotherapy is appropriate for you, and future sessions are booked 1 month apart. An initial prolotherapy visit costs $200, and future prolotherapy sessions are $125 each. Package options are available, speak with Dr. Dunstan for more details.