Prolotherapy for Sport – Joint – Muscle and Ligament Injuries
Chronic arthritis pain
- Back pain
- Prolozone – new treatment coming in October 2015 (read more)
- Sports injuries
Backache is one of the commonest complaints. Maybe it is right about the upright posture thing! Though my bet is the little guy on the left must get a lot of backache walking like that! He needs posture training. The second fellow has a constant sore neck.The complex nature of spinal structures means there can be many possible sources of pain. Maybe that is why there are many treatment methods! Finding the cause is often difficult and you could get 5 different opinions from 5 different health experts!
Chronic Back Pain
When back, neck or other pain is unresolved, many patients go from from doctor to doctor, physio, osteo, chiro, acupunturist, massage and so on. The stress alone winds up pain; it becomes a brain chemical problem as well. Many of these patients do very well with prolotherapy (see details later)
Some reasons for the difficult diagnosis is that certain structures are deep and inaccessible to examination. Moreover, pain from damaged ligaments or other structures can not only be felt by the patient at the site but also pain can be ‘referred’ away from the area, throwing more confusion as to the cause. Imaging techniques – xrays, shed limited if any, light on cause. CT and MRI scans can be more helpful in determining causes such us compression on the spinal cord or nerve roots from prolapsed discs. More often than not, these techniques exclude a diagnosis rather than accurately pin-point the cause. So it comes down to taking a good history, examination, experience and deducing the cause. Suffice to say, many spinal problems can have more than one pathology going on with pain arising from ligament strains, stretching, tearing and inflammation. These become more lax over the years and so allow more laxity in the multiple and intricate joints. This leads to inflammation and pain. These discussions can equally apply to any joints in the body.
Pain has to be one of the most studied subjects in medical research. Not only can pain be form an obvious source but also as distant from any injury site. Moreover, the level of pain can be hugely altered by the state of mind, chemical imbalances, depression, anxiety and personality. This pain is called ‘central pain’. It requires far different medicine or treatments than local pain.
This can be a first line treatment for chronic joint and ligament pain and also for acute injuries.
This term was first used by George Hackett in the 50’s. He described the results of injuries as ligament relaxation. Original terms used for prolotherapy were sclerotherapy or proliferent therapy. The concept was to inject into the vicinity of ligament attachments, a solution that would cause proliferation of new ligament tissue ie ‘regrow’ and strengthen the ligament. Many different solutions were used in those early days. Modern proliferant solutions are a lot safer.
Many research articles and text-books have been produced on Prolotherapy even up to current times. The concept of how prolo works is debated still. The fact remains, that injecting a harmless yet specific solution into or around certain parts of the damaged ligament results in reduction in pain and regrowth of ligament collagen fibres.
In fact, Hackett concluded that ligament relaxation was the initiating problem that lead to joint instability, wear and tear even disc prolapse. He said it was crucial to correct this laxity with prolo of you were to get to root cause of pain.
Of course other factors come to play such as increased muscle tone and spasm to support or splint the damaged ligament and joint function. Tight muscles become sore and can develop specific tender points called Myofascial Trigger Points (MFTP’s) which also can be very painful locally AND refer pain and other unusual symptoms to distant areas. Skilled practitioners can recognise these patterns and quickly locate the source and treat.
Pain is complex. It results from damage, release of chemicals to induce inflammation designed to commence a repairing process. These chemicals also stimulate nerve fibes which in turn transmit pain information to the brain which we the ‘feel’. Al along the way, other processes can ‘modulate’ how much pain we actually ‘feel’. When we go to the dentist out toothache feels better. At the doctor’s, the stomach ache temporarily settles – much to our embarrassment. If we are tired or depressed, pain levels increase and so on.
Many times, that initial ‘good’ inflammation can go ‘wrong’ and not heal. It becomes chronic ie persistent. Chronic inflammation is what often drives people from pain treatment to pain treatment.
It is thought that the prolo solution at first settles the chronic inflammation, perhaps by reducing the proliferation of new blood vessels, blocking pain transmission and so on. With repeated injections, new collagen fibres grow from the bone cells where the ligaments attach (the ligament entheses) up into the damaged ligament – strengthening it. The attachment of the ligament also improves – like a re-welding. Its called a ‘fibro-osseous weld’. I call it ‘spot-welding’ the ligaments back on to the bone. Whilst not completely accurate, it creates the image.
There is no other treatment which has this potential. Anti-inflammatory drugs are very effective pain control, but they may do more harm long term to the healing outcome, not to mention risks of stomach ulceration and bleeding.
The right side shows the complex ligament structures of the lumbosacral region.
The letters indicate key pain areas which have characteristic pain referral patterns – that are not the usual dermatome areas which most practitioners are familiar with. On the left, is shown typical injection points.
(courtesy of Hackett-Ligament and Tendon Relaxation)
Pain Pattern for BACK
Pain referral patterns are looked for to identify the suspect ligament, then under local anaesthetic, the ligament injected. We look for pain relief immediately or soon after to assist confirm diagnosis. Treatment is repeated at 2 weekly intervals. The total number of injections may vary from just one to 6-10.
Pain Pattern for NECK
Symptoms can refer (radiate) from specific neck ligaments to distinct locations in the head, face, arms to hands. Pain, numbness, heaviness, tingling etc are complaints many patients have with neck ligament laxity and inflammation. Associated almost always is muscle spasm, where tight tender bands are palpable within the muscles.
Along these at specific locations are MFTP’s which can also refer pain patterns.
Which patients are suitable
- Chronic low back ache
- ‘Sciatica’ – there are at least 5 causes of sciatic like pain, not just disc prolapse.
- Referred pain patterns
- Mid thoracic pain
- Neck pain
- Rotator cuff (shoulder pain)
- Tennis elbow
- Knee pain – arthritis
If you have low back pain and any of these symptoms, ligament laxity is likely and there is a good chance prolo will benefit:
- persistent pain of 6 months or more
- improves after various treatments as outlined above or
- doesnt improve after treatments
- youre told you have ‘degenerative’ arthritis or discs so live with it
- persistent pain after surgery
- pain limits your activity
I am indebted to Dr. Ross Hauser, MD, and Marion Hauser, MS, RD, for permission to use information and diagrams from their excellent book ‘Prolo Your Sports Injuries Away!’ Pages 110, 111, 112, 115 and 478 – Beulah Land Press, 2001.
Almost any joint-ligament injury can be very responsive to prolo. In fact some expert prolotherapists around the world will ONLY use prolotherapy for ligament damage. Steroid (cortisone) injections should never, or very rarely, be used into ligaments as they weaken the ligament tissue long term.
- Acute back injuries
- Chronic recurring strains especially suitable
Diet for athletes
Traditional is high carb but better is higher protein content. The outdated Food Pyramid has produced an obesity pandemic. Enlightened nutritionists are downplaying carbs and increasing protein and high quality oils.
Here there are widely differing views from the orthodox. Many now believe it isn’t a good thing to rest joints and ligament too long. In fact exercise and movement enhance tissue regrowth and remodelling. The vast amount of healing and new collagen formation is done by the 6th week. It starts after only a few days. You can see the danger of using cortisone, execss rest, Anti-inflammatories and ice during this phase. It is still healing even into the 12th month – when a badly strained ligament may still only be 70% of its full strength.
Early mobilisation is superior to prolonged. See table:
RICE or MEAT?
Immediately after injury ice may relieve muscle spasm and pain. Dont use it after this as it will interfere with healing. Heat on the other hand promotes blood flow, and stimulates healing. So that really means no RICE apart from the very first 24 hrs or so.
RICE is (Rest-Ice-Compress-Elevation)
MEAT is (Movement-Exercise-Analgesic-Treatment )
Analgesics (pain relief). Use minimal drugs, avoid NSAID’s, natural proteolytic enzyme supplements are very good at reducing bruising and swellig (such as papain from papaya and bromelain from pineapple). take in sufficient amounts is can outstrip NSAID’s as well as quantums safer.
Treatment – heat, physio techniques, PROLOTHERAPY ideal if available
The Technique of Prolotherapy
Following an examination and diagnosis, Dr. Reeder locates the ligaments most likely to be responsible for the pain pattern. Pressure on these will usually elucidate similar pain but not always. Antiseptic solution is applied to the points and a tiny ‘bleb’ of anaesthetic is injected into the skin. The prolotherapy solution is then injected at the points right into or near the problem ligaments. Some conditions require a technique that does not actually touch the ligament or tendon.
Depends on number and time but on average NZD$220 for full regional treatment. ( Plus preliminary consultation at usual rates)
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