Prolotherapy / PRP Treatments

Have you ever injured yourself? Torn a ligament? Twisted an ankle? Separated a shoulder? If you weren’t healing and were experiencing inflammation, the likely treatment option offered by your medical doctor would be a cortisone injection. Cortisone is a powerful anti-inflammatory. But, what if this treatment is actually counterproductive to the long-term healing effects you are seeking? Enter prolotherapy and PRP (platelet-rich plasma). Prolotherapy, also known as “nonsurgical ligament reconstruction,” and PRP, also known as “platelet-rich plasma,” are treatments for chronic musculoskeletal pain. The word “prolo” is short for “proliferation,” as prolotherapy treatment enhances the growth and formation of new ligaments, tendons, and cartilage in areas where there is weakness or excess scar tissue. PRP does the same thing as prolotherapy, but uses your own platelets in the injection process. Any joint in the body (e.g. knee, shoulder, ankle, wrist, hip) can be treated successfully with prolotherapy, regardless of when the injury happened. The treatment is also beneficial for most types of musculoskeletal pain.

Three Reasons Why Prolotherapy/PRP Treatments Surpass Cortisone Injections

1. Prolotherapy/PRP rebuilds tissue, and over the long term, cortisone can be destructive to tissue. With prolotherapy/PRP, the initial reaction of the treatment is localized inflammation, triggering a wound-healing cascade leading to increased blood supply and flow of nutrients and growth factors. This stimulates the tissue to repair itself by deposition of new collagen, the material that ligaments and tendons are made of. The new collagen then shrinks as it matures, leading to ligament/tendon tightening and increased strength.
2. There are no negative side effects to prolotherapy/PRP, while cortisone injections can case long-term nerve damage. I recently had a patient who had a cortisone injection in January 2016, and eight months later, he is still experiencing numbness in his patellar tendon where the cortisone was injected! Other long-term consequences of cortisone injections include thinning of the skin, easy bruising, weight gain, puffiness of the face, higher blood pressure, cataract formation, thinning of the bones (osteoporosis), and rare but serious damage to the bones of the large joints (called “avascular necrosis”).[1]
3. A prolotherapy / PRP treatment is not as painful as a cortisone injection while it is administered. While many are nervous about injection therapies, administration of a prolotherapy / PRP treatment is not very painful. Many patients are pleasantly surprised with the treatment, especially if they have previously had a cortisone injection. There may be pain and discomfort after the treatment as the healing process is activated, but this is typically short-lived.

What is the Injection Solution

The basic prolotherapy solution is 12.5% to 20% dextrose with 1% procaine. The dextrose makes the solution more concentrated than blood, acting as a strong proliferant. Procaine is an anesthetic that helps reinforce the diagnosis because the patient may experience immediate pain relief after the injection. The dextrose solution, in addition to being safe, will not affect a diabetic’s blood sugar level. Other injectables may be added such as hyaluronic acid or vitamin B12 (methylcobalamin). The hyaluronic acid would be added in cases of osteoarthritis where cartilage regeneration is the desired outcome, and methylcobalamin is used in nerve regeneration. Homeopathic remedies may also be added to help speed the healing process; these will vary depending on the type of injury.

How Many Treatments Are Necessary?

The response to treatment varies with each individual and the extent of trauma to the ligament, tendon, or cartilage, as well as individual rates of healing. Some people require a few treatments (e.g. 3 to 6), while others may need 10 or more. Once you begin treatment, you will be able to assess how you are responding. Wound-strength studies show that it takes 6–12 months for maximum tensile strength to occur without prolotherapy, and even then the resultant wound has approximately 60% of the original strength. With a prolotherapy treatment every 2 weeks, healing can occur in 1–2 months, while with a PRP treatment, the rate of healing is reduced even further. Prolotherapy can be combined with PRP, ultrasound, acupuncture, physiotherapy, laser therapy, chiropractic treatments, homeopathy, and nutritional supplements to obtain the best results.

 “But What If I Am Afraid of Needles?”

If you felt fear or anxiety from a needle the last time you experienced it, it’s likely that you experienced a heightened state of awareness and activation of memory formation in the amygdala. This explains why you may have a strong association with needles and fear. Your fear is not irrational; it is simply human nature at its best! The question is: “Can we find a way to override this evolutionary response?” Absolutely, yes! Here are four simple tips on how to control our emotional response in fearful situations.

Learn to Deep-Breathe and Meditate: Various studies have demonstrated that perception of pain can be significantly reduced by mindful meditation sessions that help calm the nervous system. Also, try this Simple Meditation:

◉ Find a comfortable position, with your back upright and hands resting where they feel relaxed. Put the tongue to the roof of your mouth.
◉Try to become as relaxed as possible. Feel the sensations of your body, and relax areas of tightness. Breathe through your nose.
◉ Begin to tune into your breath. Feel the natural flow of air, in and out. Try to feel where one breath begins and the other ends—steadily slowing down your breath when it feels right, while bringing your breath down to your abdomen. It is important that you match the rhythm of your in breath to that of your out breath.
◉ Try to focus on only your breath. When your mind wanders, try to continuously bring it back to your breath and the present moment.
◉ Continue for at least 5 minutes. When you feel lost in your thoughts, come back to only your breath. Repeat this exercise daily for added health benefits.
Use positive affirmations: These are affirmations that you can say to yourself to help relax. Acknowledge that you are afraid, but you are not actually in danger. For example “I’m okay, this is my fear of needles, but I have the power to get over it!”
Try acupressure,an ancient Chinese healing method that involves applying pressure with the fingers or hands on certain points of the body. Acupressure can be used to reduce anxiety and stress prior to needle injections. Some Pressure Points To Use On Your Own:
◉ PC 6: Measure down with three fingers from your wrist. Where your third finger touches the middle of your wrist is the acupuncture point know as PC6. Take your thumb and apply firm pressure to this point until you feel mild discomfort. Only apply enough pressure to interrupt the normal blood flow but not too much that it causes pain. Hold this pressure point and gently knead your thumb in a tight circular motion for about 2 minutes. Do this to both wrists and you will feel a reduction in anxiety.
◉ Ears:Gently massage your ears with your thumb and forefinger. There is no exact pressure point; simply give yourself a relaxing ear massage. Pull down gently on the lobes, and rub the inner surface of the ear for about 2 minutes.
yourself: If you managed to successfully get an injection that you would have normally missed due to fear, reward yourself! You will begin to associate the needle with a positive reward, not with pain or fear.

Pain From Injections

Not every patient experiences pain with the injection. Nevertheless, the injections can be painful, particularly in the first two to three visits. After an injection, there is usually a significant change in sensation, with some contraction or release of muscles and changes in blood flow. For this reason, it may be helpful to have someone drive you home after the treatment, so you can rest. After the second or third treatment, these functional changes are usually not as profound.

Secondary Effects

Soreness and bruising at the injection site and temporary muscle stiffness are normal and may last for 1 to 2 days. The use of over-the-counter anti-inflammatories is discouraged, as these will defeat the purpose of the injections which is to temporarily increase inflammation. You can apply alternating hot and cold compresses over the affected area. Traumeel cream or a “deep heat” like Tiger Balm can be used if additional relief is needed. Using MSM and glucosamine sulphate may also lessen the secondary pain reaction. Natural anti-inflammatories, such as bromelain, curcumin, proteolytic enzymes, fish oils, etc., will help the healing response; however, it is recommended that they be stopped the day before, day of, and day after a prolotherapy treatment to allow the natural inflammatory response to occur.

Exercise

In order to align the new collagen correctly with the existing ligament tissues, it is very important for the structure to heal in the presence of movement. As such, gentle walking is recommended after treatments. This will protect the ligament from forming adhesions to neighboring structures, and increase the correct formation of the new collagen.