Prolotherapy (proliferative therapy), also known as sclerotherapy, ligament reconstruction therapy, and fibro-osseous injection therapy, is a recognized procedure that stimulates the body’s natural healing processes to strengthen joints weakened by traumatic or over-use injury. Joints when ligaments or tendon attachments are stretched , torn, or fragmented, become hypermobile and painful. Traditional approaches with surgery and anti-inflammatory drugs often fail to stabilized the joint and relieve this pain permanently.
Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new fibrous tissues, resulting in permanent stabilization of the joint.
WHAT IS PLATELET RICH PROLOTHERAPY (PRP)?
PRP is a component of your blood (plasma) with concentrations of platelets above normal values.
PRP typically contains 3-8 times the concentration of normal platelet levels. After injury, platelets are on the front line of the healing response and play a critical role by releasing growth factors. These growth factors influence tissue repair in a variety of different cell types including tendon, muscle and cartilage cells.
PRP was first used in dental and oral surgery to improve soft tissue healing in the 1990s. Its usage in the treatment of musculoskeletal injuries and sports medicine has increased over the past decade.
HOW DOES PROLOTHERAPY WORK?
With a precise injection of your own platelets directly on the site of the torn or stretched ligament or tendon, prolotherapy creates a mild, controlled injury that stimulates the body’s natural healing mechanisms to lay down new tissue on the weakened area. The mild inflammatory response that is created by the injection encourages growth of new ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area. Injection of varicose veins and other similar abnormalities creates a mild inflammatory response causing them to contract so that they become smaller or even vanish.
WHAT IS THE SOLUTION THAT IS INJECTED?
It is your own platelets but more concentrated.
HOW IS PRP PREPARED?
PRP is prepared by centrifuging your whole blood sample. The centrifugation separates the platelet rich plasma from platelet poor plasma and red blood cells because of differences in specific gravity.
HOW MUCH BLOOD IS DRAWN?
• In our practice, we follow the Harvest System protocol (Harvest Technologies)
-20 mL of whole blood is drawn to generate 3 mL of PRP for small applications, elbow, foot, ankle.
-60 mL of whole blood is drawn to generate 7-10 mL of PRP for the hip, buttock and shoulder.
WHAT ARE THE RISKS OF PRP?
Since PRP originates from a concentrate of your own blood, safety concerns are minimal.
As with any injection, sterile technique is performed to avoid infection
IS PROLOTHERAPY TREATMENT PAINFUL?
Any pain involving an injection will vary according to the structure to be treated, the choice of solution, and the skill of the physician administering the injection. The treatment may result in mild swelling and stiffness. The mild discomfort passes fairly rapidly and can be reduced with pain relievers such as Tylenol. Anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the injection.
CAN PROLOTHERAPY HELP ANYONE?
Each patient must be evaluated thoroughly with patient history, physical exam, X-ray exam, and full laboratory work up before treatment will be administered. With this information, your physician can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patient’s overall health and ability to heal, and any underlying nutritional deficiencies that would impede the healing process.
WHAT CONDITIONS ARE COMMONLY TREATED WITH PRP THERAPY?
• Chronic tendinopathies
-Elbow (lateral and medial epicondyle, a.k.a. tennis and golfer’s elbow)
-Shoulder (tendinosis, partial thickness tears)
-Hip (gluteal, adductor, and proximal hamstring tendons, a.k.a. bursitis)
-Knee (patellar tendon, a.k.a. jumper’s knee)
-Foot/ankle (Achilles, peroneal, plantar fascia)
• Chronic pain from osteoarthritis
-Knee (often of value after treatment with steroids or viscosupplementation no longer helps)
-Shoulder (glenohumeral and acromioclavicular)
-Ankle and foot
-Subacute and chronic symptomatic intrasubstance muscle tears
HOW OFTEN DO I NEED THERE TREATMENTS?
The treatments should be administered every one, two, or three weeks, as determined by your treating physician.
WHAT IS THE RATE OF SUCCESS IN TREATMENT?
The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used. In patients with low back pain with hypermobility, 85% to 95% of patienst treated experience remission of pain with this form of therapy. In comparison, the Journal of Bone and Joint Therapy reports on a 52% improvement in patients treated surgically for disc involvement. Varicose veins can usually be 90% to 100% eliminated. Spider veins can usually be improved 70% to 90%.