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Prolotherapy

What is Prolotherapy?

Prolotherapy is provided by Dr. Bright and stands for Proliferation Therapy. It may often be referred to by other names such as Collagen Induction Therapy or Sclerotherapy. It is a medical procedure which involves the injection of biologically active substances such as 12.5-15% dextrose mixed with local anesthetic and possibly other proliferant agents depending on the individual practitioners preference. The substances behave as growth factors for Collagen production. The injections are directed into injured areas, particularly ligaments or tendons at their insertion on bone and stimulate tissue regeneration and repair of the injury. Prolotherapy solutions can also be injected into joints. Stronger customized solutions including P2G (phenol-glycerine-glucose), sodium morrhuate may also be used by some practitioners to promote faster healing.

Plasma Rich Prolotherapy (PRP) is the most effective form of Prolotherapy and involves the use of an individuals own platelets which are found in blood. A quantity of blood is drawn and then centrifuged which separates the platelets which contain the individuals own growth factors. The platelets are then injected into the injured tissue.

The goal of prolotherapy is to stimulate collagen formation and deposition through an inflammatory response. By doing so,tendons and ligaments are strengthened and joint stability is enhanced. The injected materials as mentioned previously behave as "growth factors', causing an intense proliferation, in the area injected of specialized cells called Fibroblasts. It is these cells that produce collagen, the elastic tissue of the body. Collagen is found in ligaments, tendons and joint capsules and when strained or weakened lead to pain and dysfunction.

Animal and human studies do demonstrate that this occurs:

  1. Liu YK, Tipton CM et. al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connective Tissue Research 1983; 11:95-102.
  2. Maynard JA, Pedrini VA et. al. Morphological and biochemical effects of sodium morrhuate on tendons. J. Orthop Res 1985; 3: 236-48
  3. Klein RG, Dorman TA, Johnson CE. Proliferant injections for low back pain: histologic changes of injected ligaments & objective measurements of lumbar spine mobility before and after treatment. J. Neurol Orthop Med Surg 1989; 10: 141-4.

Injections are done, on average, once every one or two weeks, usually for three to five or sessions. Sometimes more than six are needed or even multiple and repeated injections are needed in some individuals with severe or longstanding problems.

Anti-inflammatory drugs (like Advil, Ibuprofen, Celebrex) must be stopped during treatments, as they will have an inhibitory effect on collagen synthesis. Ref: Elder CL, Dahners LE, Weinhold PS. A cyclooxygenase-2 inhibitor impairs ligament healing in the rat. Amer J Sports Med 29: 801-5.

Effects are best when combined with manipulative correction and specific focused exercise. Avoidance of excessive joint manipulation may be necessary.

You will normally expect increased pain/soreness for the first three or four days post-injection (Tylenol No. 3, pain rubs, ice-hot packs may be used). For marked low-back/pelvic instability, a Serola sacroiliac belt can be worn daily to ensure healing with correct alignment. Regular graduated activity is encouraged as well. You should avoid Stairmaster, Step mills or excessive high impact/running activities.

Ligament healing is also promoted with a good diet with adequate protein and good "fats" (i.e., omega 3). Refined carbohydrates should be avoided. Appropriate vitamins/minerals. (Prolo-Support, EC Matrix, Collagenics etc.) should also be taken to ensure good collagen synthesis. 

What are some of the conditions Prolotherapy and Plasma Rich Prolotherapy (PRP) may help?

  • Mechanical or degenerative back and neck pain
  • Discogenic back pain
  • Spondylolysis with or without Spondlylolisthesis
  • Sacroiliac strain or Instability
  • Joint and ligamentous laxity due to trauma e.g. chronic ankle, knee sprains etc.
  • Arthritic joints e.g. knee which are often associated with laxity
  • Rotator cuff tendonitis or tears
  • Tennis or golfers elbow
  • Plantar fasciitis
  • Medial and lateral collateral ligament weakness or tears
  • ACL tears
  • Weak ankles due to laxity 

EVIDENCE BASED RESEARCH FOR PROLOTHERAPY INCLUDE:

  1. Klein RG, Bjorn CE, DeLong B, Mooney V. A randomized double-blind trial of dextrose-glycerine- phenol injections for chronic low back pain. J. Spinal Discord 1993: 6:23-33.
  2. Ongley MJ, Klein RG, Dorman TA, Eck BC. A new approach to the treatment of chronic low back pain. Lancet 1987; 2:143-6.
  3. Reeves KD. Treatment of consecutive severe fibromyalgia patients with prolotherapy. J Orthop Med 1994; 3: 84-89.
  4. Vajaradul, Y. Double-blind clinical evaluation of intra-articular glucosamine in outpatients with gonarthrosis. Clin Therapeutics 1981; 3: 336-43.
  5. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000; 6: 68-80.
  6. Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and Trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med 2000; 6: 311-320.
  7. Pavelka K, Gatterova J et. al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3 year randomized placebo-controlled double-blind study. Arch Intern Med 2002; 162: 2113-23.
  8. KO GD. Prolotherapy: a new "old" treatment for chronic back pain. J. Natural Med. 1998; 1: 12-15.
  9. Yelland M, Bogduk et. al. Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine 2004; 29: 9-16, suggests that the needle itself may have a therapeutic effect as both groups improved.
  10. Pain Medicine, volume 13, issue 8, pages 990–999, August 2012.  The effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A randomized Crossover Study.
  11. Panels of Family Medicine May 2013 Supplement.  Dextrose Prolotherapy for Knee Osteoarthritis: A randomized controlled trial.
  12. Plastic and Reconstructive Surgery: November 2008–Volume 122–Issue 5–pages1352–1360: Proliferation–Promoting Effect of Platelet–Rich Plasma and Human Adipose Derived Stem Cells and Human Dermal Fibroblasts.
  13. Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh H. Hyperosmolar Dextrose Injection for Recalcitrant Osgood–Schlatter's Disease.  Pediatrics, 2011:128 [5]: e1121–e1128

Is Prolotherapy covered by OHIP?

Unfortunately Prolotherapy and Plasma Rich Prolotherapy (PRP) are not covered by OHIP. Most Insurance plans will not cover them either. You should personally check with your carrier and provide them with a copy of the above scientific references if you wish to attempt to obtain coverage. This is not something our office will do for you!

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