Prolotherapy

Prolotherapy – An underused but effective injectable treatment for musculoskeletal conditions

Today I will start by telling you about what prolotherapy is and its origin. After that I will talk about its uses, mode of action, procedure and whether prolotherapy is for you.

1- What is Prolotherapy?

Firstly the word Prolotherapy comes from  “Prolo”. Prolo  is the short for “Proliferative”  which in Ancient Greek means “Fruitful” (Polukarpos)

Prolotherapy is an injection-based therapy for chronic musculoskeletal pain conditions, for instance knee osteoarthritis, As a result Prolotherapy helps to repair damaged cells or tissue in our body.  Moreover Prolo-therapy may reduce pain and improve function of the damaged area.

Certainly the first documented use of Prolotherapy was in the 1930’s in America by Dr Earl Gedney. He used it on himself to heal his injured thumb caught in a door with subsequent impressive results, according to reports by his peers and himself.

However Prolotherapy fell into oblivion until it was reintroduced in the 70’s by doctors and chiropractors in America. Since then Prolotherapy use has increased but at a slow rate, especially since PRP therapy appeared in the 80’s which displaced it.

Most importantly the main advantage of Prolotherapy over PRP is its cost as the former is significantly cheaper. However Prolotherapy is not as effective as PRP when it comes to help tissues to regenerate.

Commonly Prolotherapy injections are normally given in damaged joints, ligaments or tendons hoping to alleviate pain and to initiate the repairing process.

That is to say Prolotherapy injections are made of an irritant solution, usually dextrose or saline water. Prior to the injection a local anaesthetic will be injected to numb the skin to minimise discomfort.

2- What is Prolotherapy used for?

Prolotherapy may be used to alleviate the pain and to restore lose of function in the following conditions:

  • Back and neck pain affected by facet joint Osteoarthritis
  • Knee and shoulder osteoarthritis
  • Rotator cuff injuries and tennis/golf elbow
  • Fibromyalgia – Tender points
  • Plantar fascitis
  • Ligament sprains – MCL and LCL in knees
  • Joint laxity and instability
  • Muscle injury and tears.

However Prolotherapy has its own limitations. For instance Prolotherapy may help a partial tendon tear to repair itself but not a full tear where surgery might be needed.

3- How is Prolotherapy given?

Prolotherapy is usually an office-based procedure. In some cases the aid of an ultrasound scan may be needed. This can be done in the doctor’s office too.

The treatment consists of several one-single injections (between 3 and 4) given at 4 week intervals. This will increase the prolotherapy repairing effect and reduce the pain.

After your doctor explains you the treatment, uses and possible adverse reactions or complications, you will sign a consent form.

A local anaesthetic is then used to numb the skin at the injection site. This usually reduces any discomfort to a minimum.

Then your doctor will inject the prolotherapy into the damaged area.

The whole procedure is done under aseptic clean conditions to minimise the risk of infection.

You will be asked to wait in the premises for 10-15 mins. You may take paracetamol but anti-inflammatories are not recommended for 48 hrs. as they could interfere with your prolotherapy treatment.

Your doctor will advise you not to carry out any high impact or strenuous exercise following the injection for 2-3 days, such as jogging or playing football.

4- Is Prolotherapy safe?

Needless to say Prolotherapy has been proven to be a safe, effective and relatively inexpensive non-surgical treatment.

Use of ultrasound guidance for injections may or may not be needed, depending on the specific problem being treated. Ultrasonography is a painless and harmless image diagnostic technique.

Most importantly there is no evidence so far despite concerns on cancer or tumour growth after Prolotherapy or PRP.

5- Is Prolotherapy for me?

An open honest conversation with your doctor is necessary to find out if Prolotherapy is the right treatment for your specific condition. Sometimes other treatments such as PRP therapy or surgery may be recommended. Subsequently every particular case needs to be assessed by the doctor.

Prolotherapy is not a very expensive procedure. For further details please contact us for a estimate quote.

Conclusion

Prolotherapy is a low cost, effective and minimally invasive  treatment for multiple musculoskeletal conditions such as knee osteoarthritis. Furthermore Prolotherapy is underused in Australia when compared to its widely and popular use in America.

However Prolotherapy  is not effective in conditions where a surgical repair may be needed, for instance in a full thickness tendon tear.

Furthermore Prolotherapy is not as effective as PRP therapy, being the latter more expensive.

To sum up Prolotherapy presents as a promising new regenerative treatment for musculoskeletal conditions.

 

Bibliography

Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Bertrand H et al. Arch Phys Med Rehabil. 2016 Jan; 97(1):17-25.

Prolotherapy for Refractory Rotator Cuff Disease: Retrospective Case-Control Study of 1-Year Follow-Up. Lee DH et al. Arch Phys Med Rehabil. 2015 Nov; 96(11):2027-32.

Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. Abd Elghany et al. J Back Musculoskelet Rehabil. 2019;32(1):55-62.

Utility of Prolotherapy for Upper Extremity Pathology. Dwivedi S et al. J Hand Surg Am. 2018 Jun 23.

Effects of dextrose prolotherapy on contusion-induced muscle injuries in mice. Tsai SW et al. Int J Med Sci. 2018 Jul 30;15(11):1251-1259.

 

 

 

 

 

 

 

 

 

 

The 5 Keys to Regenerative Medicine

1. WHAT is Regenerative Medicine?

It’s the field of Medicine which deals with treatments that when applied to damaged body tissues, such as tendons or joints, help them to heal by stimulating natural repair.

The regeneration of healthy tissue occurs through natural processes stimulated by these treatments.

Regenerative Medicine embraces various treatments such as Platelet Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), Prolotherapy and the use of semi-synthetic drugs such as Pentosan.

Arthritic hands

2. How NEW are these treatments?

Some of these treatments have been used since the early 1930’s . This is the case of Prolotherapy.

PRP  first saw the light in the late 80’s in Dentistry. Since then it has evolved exponentially expanding to other fields of Medicine. There are 3 major types of PRP therapies:

  • Pure PRP

  • Leukocyte Rich PRP (LR-PRP)

  • Leukocyte Rich Plasma (LRP)

MSC therapy involves tissue engineering where pluripotential cells harvested from the bone marrow, fat tissue or blood are manipulated and then injected into damaged tissues such the heart muscle, where healing will take place and repair may happen.

Through Tissue Engineering Gene therapies have emerged as a promising but experimental treatment to help damaged tissues to repair more quickly.

 

3. Which CONDITIONS can be treated?

In damaged joints (osteoarthritis) and tendons (tendinopathies) PRP and Prolotherapy have shown to help patients with pain and stiffness. Also certain degree of repair has been proof through imaging (MRI and Ultrasonography). In other conditions such as fibromyalgia, plantar fascitis, knee sprains, back and neck pain and muscle injury PRP have proven promising results.

Mesenchymal Stem Cell therapy is currently being used to repair damaged organs such as the heart (Congestive Heart Failure), spinal discs (chronic lower back pain), diabetic nephropathy and Rheumatoid Arthritis, etc.

Severe Arthritis of the right knee

4. WHERE can I find these treatments?

Some of these treatments are widely available such as Prolotherapy or PRP. Many Sports Medicine clinics and GPs worldwide are offering them. The price for a Prolotherapy treatment varies from AUD $100 to $250. PRP therapy is slightly dearer ranging from $350 to $1000 depending on the area and condition to treat.

However MSC therapy is currently used only in clinical trials in humans mainly in America, Europe and Japan.

Runner tying up shoes before run

5. WHERE to from here?

Regenerative Medicine is 21st century medicine. Even though it first appeared in 20th century its full potential to heal and even cure certain health conditions will reveal through the next decades as it is blooming worldwide.

Still traditional therapy where a drug is given to reduce symptoms such as a painkiller to treat pain will continue. However as Regenerative Medicine therapies become more available and new treatments appear, it will eventually become mainstream medicine.

A dream in Regenerative Medicine

PRP – Platelet Rich Plasma

What is PRP?

PRP or Platelet rich plasma is a concentrate of platelets which when injected in human tissue can help to heal damage cells by stopping inflammation and promoting tissue regeneration.

PRP provides a promising alternative to surgery (or at least delays it) by promoting safe and natural healing without surgery.

For 30 years, the application of autologous PRP has been safely used and documented in many fields including; Orthopaedics, Sports Medicine and wound care.

What are platelets?

Blood contains plasma, red cells, white cells and platelets. Platelets are small discoid cells with a life span of about 7-10 days. Platelets contain inside clotting and growth factors.

During the healing process, the platelets are activated and stick together. Then these growth factors are released by the platelets activating the inflammatory cascade thus stimulating the healing process.


When to use PRP?

Although PRP therapy is still considered an experimental therapy, its use has shown an exponential growth in the last 5 years.

Frequent uses of PRP therapy include:

  • Treatment of musculoskeletal conditions such as osteoarthritis of knees and hips, tendon injuries (Achilles, hamstrings, tennis elbow), shoulder and hip bursitismuscular tears (hamstring, quads),  joints and ligament sprains  (ankle, knee).
  • In Aesthetic Medicine where it may help skin to regenerate and to maintain its radiance and elasticity.
  • Diabetic and vascular ulcers treated with perilesional PRP therapy have shown a greater healing and regeneration cell rate.
  • Hair loss caused by androgenic alopecia.  PRP therapy may help  hair growth in patients who had failed to previous treatments with Minoxidil and Finasteride.

PRP injections. The procedure

  • Assessment of the problem/injury. At the first appointment, the doctor will take from you  a detailed clinical history of your injury or specific problem that may require PRP therapy, as well as any other medical conditions and current treatments that may be important.
  • This will be followed by a thorough physical examination.
  • Depending on the situation, you may be requested additional tests such as a blood test or an x-ray/MRI to confirm the diagnosis and pinpoint the injury site for injection.
  • Usually it is during this first consultation when a treatment plan with PRP is outlined to you  and the procedure itself is agreed.
  • Blood collection. On the day of the PRP injection the doctor or nurse will take a blood sample from your arm (5 to 20 ml in a special sterile container). The amount of the sample depends on where the PRP will be injected.
  • PRP injection. Your own blood (autologous) will be then spun down at a specific force and time in order to separate the different blood components into 2 different layers, the PRP layer and the red cell layer.
  • Then the PRP layer will be drawn into a syringe and injected into the region of interest, for example into a your knee.

Is PRP safe?

Because PRP therapy is an autologous therapy (the patient’s own blood components are injected in his own body) the probability of an allergic reaction is very unlikely which can occur when other substances such as steroids or hyaluronic acid are used.

Multiple studies have shown PRP therapy to be a safe and a well tolerated new therapy.

Even though there are potential side effects and complications inherent as to any medical procedure, only mild and self-limiting adverse effects in a small number of patients have been reported.

You may experience mild pain and/or slight swelling which usually resolves spontaneously in 24 to 48 hours.

Less common side effects such as stiffness, syncope, dizziness, headache, nausea, sweating, and palpitations may appear but they are all self-limited.

Sporadic adverse effects of temporary mild rash, local numbness, and itching sensation have also been reported. Pain can be prevented by the use of a local anaesthetic prior to the PRP injections.

After the infiltration you may apply ice to ease the pain. The use of painkillers is also recommended to minimise discomfort, except the use of anti-inflammatories as these drug may alter the effect the regenerative effect of the PRP.

What is the downtime with PRP therapy?

Usually we will recommend you  a couple of days of rest from activities such as yoga, running or the gym . Also the use of anti-inflammatories or ice is not recommended as they could potentially affect the effectiveness of the PRP treatment. Paracetamol instead will be a good painkiller option.

How much does PRP therapy cost?

As PRP therapy is still an experimental treatment there is currently no Medicare rebate in Australia, hence it is a private fee only. For a detail outline of the costs please contact us