Can Prolotherapy Help Me?
Common Problems That Can Be Treated With Prolotherapy
I would estimate that about 85% of persistent musculoskeletal-type pain comes from damaged connective tissue. The key is to find the specific region that is damaged. This is done by having an experienced Prolotherapist palpate specific structures. If you have what we call the jump sign i.e. you jump when the structure is palpated and your pain is reproduced, you are a good candidate for Prolo. Here are a few common types of problem I treat routinely in my practice.
- Foot & Ankle Problems: ankle sprain or weakness, plantar fasciitis, achilles tendonitis
- Knee Pain: whether due to arthritis, meniscal problem or ligament sprain
- Hip Pain: due to arthritis, bursitis or ligamentous sprain
- Low Back Pain: whether due to disc problem, sciatica or other cause
- Mid Back (thoracic & scapular) Pain
- Rotator Cuff Strain
- Wrist & Carpal Tunnel
- Neck Pain: (cervical) pain of all types whether due to disc or sprain
Foot and Ankle
Foot and ankle problems are commonly due to damaged or stretched connective tissue structures.
In Plantar fasciitis the insertions of ligaments under the foot are stretched, itrritating the nerve endings at these points and causing pain. I usually recommend soft orthotics (arch supports), massaging the damaged areas with a golf ball on a carpet and Prolo to rebuild the damaged insertions. As is the rule with connective tissue problems cortisone injections are contraindicated as are anti-inflammatories such as Alleve or Ibuprofen.
In achilles tendonitis the achilles tendon on the heel is stretched. Cortisone injections are dangerous because there is a high incidence of rupture. I usually recommend mild heel lift to take the pressure off plus Prolo to stimulate healing of the damaged insertions.
Recurrent ankle weakness and sprains are not uncommon. Prolo can target the affected regions and rebuild the damaged structures. The surgical approach to ankle weakness does not have a very good track record and, in my view, should be kept as a last resort in case Prolo is not successful.
Knee problems are one of the most common problems I deal with in my practice. In the case of arthritis, patients often arrive saying that their x-rays revealed bone-on-bone and they were given the options of a cortisons shot, antiinflammatories and, when they couldn’t stand the pain anymore, knee replacement.
With Prolo we have a totally different approach. First of all it is important to appreciate that the ligamentous capsule that encases the knee not only holds the knee together but it also holds the knee apart. In other words the stiff fibrous ligaments suspend the femur on the tibial plateau and are largely responsible for the joint space. As you regenerate the ligamentous support the joint space is reestablished. Many people don’t realize that the joint space comes from the ligamentous support as much, if not more, than the cartilage.
Prolotherapy is very useful to treat osteoarthritis (wear and tear arthritis) of the knee and most types of knee injuries.
When I examine the knee I am particularly interested to see what specific structures are causing the problem. Is it the Medial Collateral ligament (MCL) or the Pes Anserine which inserts medially below the knee. If the knee is locking then MRI is indicated to confirm meniscal tears. If this is the case and the locking persists, arthroscopic surgery is indicated. I consider this particular procedure as quite elegant and have no problem referring my patients for it. Having said this the vast majority of patients with chronic knee pain can do very well with Prolo. Since surgery always has its’ risks we recommend that nonsurgical approaches like Prolo be fully explored before resorting to knee replacement.
As an additional note I think it is important for many patients witth knee, hip and/or low back problems to get proper orthotics (arch supports). As we age the foot arches weakens and we start to pronate as we put weight on the foot. This in turn causes extra stress on the knee, hip and pelvic/low back. By supporting the feet with orthotics we keep the foot in anatomic position and optimize the biomechanics.
Hip and Knee problems are amongst the most common problems I see. This is partially due to their weight-bearing status and therefore more wear and tear. Just like the knee, we can reestablish joint space with prolotherapy. I had one patient who had serial MRIs before and after prolo. Her Orthopedist could not believe the improvement in the joint space. When we treat the hip in prolo we usually also have to inject the gluteal attachements in the pelvis and muscle attachements down the femur (called the TFL).
Low Back Pain
Again, a very common complaint. Since pain often radiates and is nonspecific, it is critical to find which structures are damaged. Is it the pelvis, sacro-iliac or lumbar spine that is the culprit? Good medicine begins with making the right diagnosis. MRI is useful but sometimes misleading because it shows abnormalities which may or may not be the real cause of the pain. Studies have shown that 40% of normal people (i.e. without pain) have disc abnormalities. It is also true that stretched ligaments and tendon insertions are not picked up by MRI. In other words the most common causes of backpain are missed by MRI and not recognized while the cause of the pain may be erroneously attributed to a disc problem. This misdiagnosis may lead to inappropriate treatments including epidurals, possible surgery and long-term pain management with narcotic pain killers.
Mid and Upper-Back Pain
These pains are commonly due to thoracic or scapular strains and sprains. A good Prolotherapist should be able to find the source of the pain by palpation. A word of caution. If the pain is over the thoracic ribs, the injections have a small chance of causing a pneumothorax. Be sure that your Prolotherapist has had a lot of experience before you undertake any rib shots. If a pneumothorax does occur usually these resolve spontaneously but they can cause problems. I always ask my patients to hold their breath when I do the shots since I feel the danger is the lungs moving across and tearing on a needle that may have inadvertently found its’ way into the thoracic cavity. I think a small puncture of the static lung by a needle tip is unlikely to cause a problem.
Rotator Cuff Strain
Shoulder problems are common because the joint is so shallow and dependent on the ligaments and surrounding muscles (rotator cuff) to give it stability. MRI is useful and picks up rotator cuff damage but often misses problems with the underlying capsule (i.e. the ligaments that hold the joint together!).
Wrist & Carpal Tunnel
I commonly have patients with wrist pain that can be easily helped with Prolo. One patient had severe pain for years and had tried splints and been to the best hand surgeons in the country. She was almost at the point of retiring from her Nursing careeer because she couldn’t function. It took eight or ten sessions but she improved dramatically. She is now pain free and able to function normally. Last I heard she had returned to scuba diving and was heading for the Caribbean.
As far as Carpal tunnel goes, I have often found this to be a misdiagnosis. In my experience it is important to check the neck, shoulder, elbow and wrist for potential sources of pain. If any damaged connective tissue damage is found, I would suggest that you fix this before considering Carpal tunnel surgery.
(Cervical) pain of all types whether due to disc or sprain. Neck pain is a common complaint whether due to whiplash, or a degenerative process. It is important to examine the suboccipital region (base of the skull), cervical spine including the facet joints and scapular regions for potential ligament or tendon trigger points. MRI is useful to pick up disc problems but of course misses the stretched tendon and ligament structures which are so commonly the culprits. In the end, unfortunately, the source of the pain is often misdiagnosed leading to inappropriate treatments that are unlikely to solve the problem and may actually aggravate the condition.
Headaches are very commonly due to damaged neck or scapular connective tissue structures. When ligament and tendons are damaged the surrounding muscles go into spasm to try and splint (and protect) the damaged structure. This often leads to so-called tension headache or are a trigger for migraine type headache. I have had many patients over the years whose chronic headaches are cured with eight or ten sessions of Prolo.