Prolotherapy is a treatment that utilizes our own musculoskeletal system’s natural healing capacities. Prolotherapy induces changes within weakened dysfunctional soft tissue that leads to increased strength and firmness. Treatments involve an injection series performed by gently peppering a stimulating solution into a weakened structure or joint. Our immune system is stimulated both mechanically from the needle via microtrauma, and physiologically from the medication “cocktail” that is injected. The procedure induces inflammation followed by healing and ultimate functional restoration. The Prolotherapy solution at the Orthohealing Center consists of a dextrose solution as well as Serapin or Traumeel which are both plant extracts with known healing properties. All injections are guided under musculoskeletal ultrasound to achieve precise delivery of the proliferant to the target structures.
Joints exist at the junction where two bones meet up (also called joint articulation). On the outside, joints are incased in a fibrous capsule made up of ligaments and soft tissue. Within the joint, the two bony ends are lined with cartilage, and there is synovial fluid between these bones that acts as a cushion. Joints remain healthy when they are stabilized in the right position, so that the muscles that attach to them (via tendons) can perform in a way that gives maximum joint strength, endurance, and mobility.
Tendons are thick cable-like structures, control joint motions, and attach muscles to bones. When inflamed, painful or weak—tendons can alter the way a joint moves. Ligaments hold bones properly together by ensuring correct placement of the bony ends that make up the joint. Stretched out or tight ligaments from chronic poor positioning/posture, or acute trauma such as whiplash or fall, can cause abnormal ligament lengthening or shortening.
If the supportive anatomy about the joint is not functioning properly, the joint will not function properly. Dysfunctional joints can lead to pain, restricted activity, instability, secondary muscle spasm and tendonitis. The most common pathological trio treated with prolotherapy includes abnormal and excess joint motion, loose weak ligaments, and tight deconditioned muscles. Many times, the first symptom of excess motion is masked from learned conscious or purposeful compensatory techniques to inhibit further injury; therefore the joint can actually appear to be tight and hypo mobile (stiff).
Stretched- out weak ligaments from acute or chronic causes, or ligaments responsible for “double jointedness”, can interfere with joint mobility and potentially lead to excess increased movement of the bones that glide against each other in the joint. Instead of a rhythmic fluid motion that is at ease, there is disharmony in the interaction of the bones in the joint leading to multiple possible symptoms. Some people describe it as feelings of instability or give-way, or perceive a sense of weakness or vulnerability in a joint especially when active and using the joint. Pain may be associated, especially over time. Sometimes, there is auditory clicking or mechanical locking/catching described. These are bony surfaces slightly moving in an altered position or angle, causing micro-grinding. There may be intermittent swelling, or development of reactive bone spurs that can impinge on other structures in the near vicinity. Over time, there may be visible or palpable assymetries in bony surfaces that are reported by some patients.
The normal wear-and tear that occurs inevitably on our weight-bearing joints as we age, is at risk for accelerated or early arthritis when there is chronic excess joint movement. Ligaments that are especially at risk are those that have been traumatized in the past, whether it be major trauma, minor repetitive micro-trauma, or anything in between.
Classically and in common practice, Prolotherapy is not performed routinely under image guidance. However, due to the rapid advancements in the Musculoskeletal Ultrasound technology, all prolotherapy performed at the Orthohealing Center is under this image guidance, thereby allowing ideal needle placement to the exact areas in need of treatment. In some cases, it is possible to “track” joint stability as time goes by via real-time musculoskeletal ultrasound serial imaging.
The most common locations and causes of joint instability and their sequelae include the following:
- Neck achiness and mechanical symptoms such as cracking or reduced range of motion that can radiate to traps or cause headaches; may be associated with head/neck heaviness in setting of poor posture. Prior whiplash injuries can cause mild to severe symptoms over time.
- Low Back/Sacroiliac Joint instability, which may be accompanied by subtle Scoliosis or Leg Length Discrepancy
- Ankle instability usually outward in setting of prior ankle sprain or repetitive microtrauma.
- Shoulder instability with tendency to move too much forward with certain motions; usually history of major dislocation or minor subloxations
- Excessive rib movement in rib cage either front or back with associated discomfort and mechanical mobility issues in that area.
- Patellar (knee cap) instability, elbow instability, and hip instability.
- End-stage arthritis in non-operative candidate or failed arthroscopy for shoulders, hands, hips, knees and ankles/feet.
Over time, the surrounding muscle groups that support the joint become overused since they need to compensate for the insufficient ligaments and prevent excess joint motion. Ultimately, these muscles can become tight and overactive, forming firm bands of contracted spastic muscle fibers leading to “trigger points”, which can radiate to distant regions and cause other symptoms, mimicking pinched nerves for example. If these muscles do not relax naturally as the effects of prolotherapy take place over time despite integrating physical therapy, pain from muscle spasm may be persistent due to a phenomenon called Central Mediated Pain. These cases are typically more resistant and require additional muscle interventional treatments.
Not everyone is a candidate. If there is underlying significant arthritis that has failed cortisone injections in the past, or corresponding major tendon/muscle injuries such as tears, calcifications, or excess spasm, these may need to be treated with different injection modalities, with or without prolotherapy. These include: viscosupplementation (“gel injections) into degenerative joints, PRP (Platelet-Rich Plasma Therapy) into injured or degenerated tendon, dry needling/trigger points and potentially Botulin Toxin into persistent tight muscles that are producing chronic pain. Sometimes, Deep Tissue Laser Therapy will be recommended as an adjunct, depending on the diagnosis and chronicity of the problem. Some conditions that affect joints are actually due to shortened chronically contracted ligaments—these conditions do not respond to Prolotherapy, and other injection modalities may be suggested altogether.
Since all prolotherapy procedures are performed under ultrasound guidance, risks and complications are minimal. Reactions to prolotherapy are typically related to the discomfort of the procedure which may last for several days. Because inflammation is desired, anti-inflammatories are discontinued one week prior to first prolotherapy injection, and should not be resumed until the prolotherapy treatments are complete, unless otherwise recommended by the doctor. Blood work may be requested prior to the first injection, depending on whether there are other comorbidities that need to be considered (diabetes, anemia, blood disorder, inflammatory arthritis, autoimmune disorder, etc.). Typically, prolotherapy injections are done 1-2 weeks apart although in some situations they can be spaced out by 3-4 weeks. Symptoms can improve for up to 3-6 months after the prolotherapy treatments are complete.