Picture used with permission from Ligament and Tendon Relaxation Treated by Prolotherapy © 1991 Gustav A. Hemwall, M.D. Hemwall, Hackett foundation
 

Prolotherapy

Prolotherapy is a well established medical technique that treats chronic pain from lax ligaments or injured tendons around the joints or areas of muscular attachments. This procedure stabilizes, strengthens, and supports these injured areas restoring proper function by proliferating new ligamentous tissue.

 

Conditions which may respond to prolotherapy includes:
     Prolotherapy   aka: Regenerative Injection Therapy

1) Whiplash and associated soft tissue injuries
Barre – Lieou syndrome
Dizziness, visual blurring, loss of balance, ringing in the ears, runny nose, salivation, problems swallowing, horse voice, nausea, vomiting, nervousness, and headaches.
Post whiplash – eliminated by prolotherapy
2) Rotator cuff tendonitis
3) Recurrent shoulder dislocations
4) Tennis/golfers elbow (“chronic tendinosis”)
5) Knee, ankle sprains/strains
6) Low back strains
7) Herniated discs
8) Sciatica
9) TMJ
10) Migraines
11) Post surgical pain
12) Fibromyalgia
13) Sports injury

 

Signs and symptoms that may be improved

  • arthritis in any joint in the body
  • any popping, grinding, clicking, or snapping in a joint (all of these are signs of joint loosening and instability)
  • any joint which is only partially helped by osteopathic or chiropractic adjustments/manipulations (or when adjustments or manipulations help but don't hold) .
  • manipulation frequently makes big improvements quickly. If prolonged manipulation is necessary this is an indication of joint instability and injection reconstructive therapy may be helpful.
  • any musculo-skeletal problem which has failed with surgery and other methods
  • any condition which is helped by a brace, splint, crutch, walker, lift or wheelchair. People that need these aids frequently have weakened or lax joints.
  • deep aching which is alleviated some by constantly changing positions
  • symptoms of decreased strength and endurance
  • increased pain with increased activity (swimming, biking and walking may be exceptions)
  • various conditions such as osteoporosis with compression fractures, muscular dystrophy, multiple sclerosis and spinal defects such as scoliosis and slipped spine
  • any joint which swells chronically may be a candidate for resolution with this therapy. Swelling may be an indication of chronic friction from instability
  • any joint, tendon, ligament, cartilage, for which cortisone, Indocin, Nalfon, Clinoril, Feldene, Motrin or other anti-inflammatory drugs has been used may respond to reconstructive joint injection therapy
  • conditions like carpal tunnel syndrome, rotator cuff tears and temporal mandibular joint dysfunction may also respond to joint reconstruction injection therapy because joint, ligament, tendon, disc and cartilage weakening are involved

The above signs and symptoms that may be improved are from kalinda.com


This modality of treatment is used mainly in chronic or recurring pain in the head, neck, back or any joint of the body.  Weakened ligaments and tendons are frequently the underlying problem of these pain syndromes.  A weak ligament and tendon at its point of attachment to the bone will yield on tension and permit excess pull on the non-stretchable sensory nerve fibers, causing not only local pain but also radiating pain to distant areas with specific and predictable pain patterns. 

Movement may aggravate the damaged nerve in the ligament and produce a pain that feel like a shock giving the impression that a nerve is being pinched.  It is a nerve type pain due to a stretched ligament, not a pinched nerve.

Weak ligaments can also be the cause of dysfunction at a joint and/or of a displacement that occurs within a joint, both of these conditions being a cause of chronic and/or recurring pain syndromes. 

(If the ligament is strengthened with prolotherapy, the nerves in the ligaments do not fire off, thereby relieving the pain.

But what happens when the low back pain, and headaches from a whiplash injury, just will not get better?  Or, the athletic injury that continues to cause nagging pain and is preventing you from staying active, especially keeping you from the sport you love the most? 

Usually, the first line of therapy to the injured area is rest, ice and anti-inflammatories, NSAID’s, and narcotics, but is this pain really from a drug deficiency?


Rest, Ice, Anti-inflammatory, NSAIDs  

Ice versus heat

Heat increases blood flow, therefore brining healing nutrients to the area of injuries as well increased immune response thereby increasing healing time, range of motion, speed of recovery and collagen formation.  Ice has the opposite effect.

 

Anti-inflammatories

These substance stop the release of chemicals called prostaglandins (which at sites of injury cause increased vasodialation of non injured blood vessels bringing healing and repair to the injured area).  Anti-inflammatories ultimately decreased blood flow to an injured area decreasing complete healing.    They also inhibit proteoglylan synthesis (a component of ligament cartilage tissue) decreasing elasticity and compressive stiffness articular cartilage.

Inflammation is the body’s own way to control infection and heal.  Collagen synthesis and remodeling of wounded areas  occurs because of our bodies incredible self-healing capabilities.  If this becomes unbalanced, as with the inhibition of collagen synthesis in the presence of NSAIDS,   then one will see this lack of healing which ultimately gives way to accelerated tissue breakdown of the collagen matrix, leading to degeneration of the cartilage (osteoarthritis) tendons, (tendinopathy)  and surrounding  ligaments (joint instability).  Instead of repair and regeneration, the latter occurs in part because of an imbalance of the collagen remodeling with a definite trend to collagen breakdown.  The above at times is directly associated with injury, age, immuno-mediated collagen vascular disease, nutrients deficiencies and other  metabolic disturbances.   While not all NSAIDS are the same there is a general tendency towards studies indicating a general inhibition of would repair and collagen synthesis  by these drugs.

Recent news showing carboxylic derived NSAIDS such as Vioxx (rofexib), Bextra (voldecoxib), Celebrex (celeroxib) has had evidence or suggestion cardiovascular risk when taking these medications.  More recent was the addition of Naproxen (naprosyn  a,eve).

To many people suffering with pain and  after consulting uninformed doctors, they are at loss as to find alternatives for their suffering,  especially  those treatments and therapeutic remedies with less adverse side effects.

See following links for alternative solutions

http://heel.ca/news/detail.jsp?id=57

http://heel.ca/pdf/fact/Arthrobase FS_EN.pdf

http://heel.ca/pdf/fact/Traumeel_en.pdf

http://heel.ca/pdf/studies/Zeel comp vs Cox2.pdf

 

Corticosteroids

Prednisone, Cortisone

These drugs weaken synovial joints, supporting structures ligaments and tendons leading to more pain and m ore steroid injections.  These drugs work by inhibiting the synthesis of protein, collagen and proteoglycans in articular cartilage.  They also inactivate vitamin D thereby limiting calcium absorption from the gut, and ultimately leading to weakness as to where ligaments and tendons attach to bone (the fibrosseous junction).

 

Narcotics:

Great at alleviating pain without interfering with inflammation but long term addiction and dependency can be a problem as well as covering the primary problem they are trying to alleviate. When conservative therapy consisting of the above, rest, ice and pain medications fail and they usually do, because they only mask or cover up the underlying problem.  Then other types of treatment are often tried such as acupuncture, physiotherapy, massage, chiropractic, along with neurological, and orthopedic consultations with no long standing resolution of symptoms or restored mobility and function.  Each method of therapy promotes its own methods.  It is the recognition of this problem which is bringing the orthopedically trained holistic physician and naturopathic physician back to mainstream.  The combination of medicine, nutrients, exercise, injections, mobilization, and mind body approach is to the patient’s best advantage.  It is worth the effort to seek out a physician who understands and is trained in these principles.

In a significant number of cases, despite a reasonable treatment plan and consistent effort from the individual residual pain and dysfunction may persist.  Ongoing chronic pain is often quite disabling and may affect job performance, recreational activities and activities of daily living.  Along the way a doctor may state that you have to live with it….there is nothing you can do about it” or say that surgery is the only option.  That news is frustrating and discouraging!  Where is one to turn, “Prolotherapy.”

The signature finding is pain that  you can put a finger on  This may be at the top of the neck or base of the skull for headache pain, the top of the shoulder, the inner or outer elbow, the sides of the knee, or the groove between the inner edge of your hip bone and your tail bone (the sacroiliac joint), or a number of other common places where these tissue injuries occur.  If you can precisely point to you source of pain, there is an excellent chance that Prolotherapy will resolve or at least greatly improve it.


Procedure

Prolotherapy involves injection of a mixture of the following medications – dextrose (sugar water) Xylocaine (numbing medicine), sodium morrhuate, glycerine or phenol.  Often only dextrose and xylocaine are used first and additional medications are added if needed.   The prolotherapy solution is injected into the ligament or tendon where it attaches to the bone.  This causes a localized inflammation in these weak areas, which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself, strengthening and tightening and thereby stabilizing the area.   But most of all helping the person to become a fully functioning individual.  This procedure does not involve the injection of corticosteroids, such as cortisone.  Cortisone is known to decrease inflammation, but will also slow or stop the healing process.   Acute pain may be relieved with cortisone, but repeated use causes a weakening of the tissues and chronic pain develops.

After the procedure, most patients feel fullness and numbness in the areas injected.  Some patients even have reported that all their pain was gone.  This is due to the numbing effect of the local anesthetic Xylocaine, that was part of the material injected and serves as a check or test that the correct areas were injected.  This wears off in about 3 hours, like dental anesthetic and the pain will return.  To prevent this, patients take oral Tylenol or similar medication.  Aspirin and other anti-inflammatories must not be used, as they will cancel out the injections chemically.   That is to say that the above will be counterproductive healing process of soft tissues and ligaments initiated by prolotherapy.  If the pain is bad enough and relief is required, Tylenol with Codiene may be used, as well as natural analgesic such as Bromelain and Magnesium.  The regular use of MSM and Glucosamine Sulphate may also lessen the pain.

Most post-prolotherapy patients fall into one of the following three groups.  In the first, the pain is immediately relieved due to the injection of the numbing medicine into the area of pain.  Then during the next 24 to 48 hours, their pain may return and maybeinitially, more severe.  The pain will gradually decreased in intensity as healing and strengthening occur.  The second group of patients, have little or no pain post injection and the pain stays relieved permanently.  Another group of patients find that their pain is relieved initially but returns after 2-3 weeks, necessitating further injections. 

The number of injections to obtain relief varies considerably from patient to patient and injury to injury.  Some people are relieved totally with one injection whereas others required a series of injections which may total up to 15-20 or more sessions. Generally, several injection sessions are done with most patients. 

   

Exercises

After prolotherapy, patients are encouraged to do regular  light mobility     exercises but not to over stress the areas that have been treated to allow for proper healing and strengthening.  It is important to remember that even if your pain is relieved and structures strengthened, it is possible to re-injure yourself at some time in the future.   Try to take good care of the previously injured body part so as to minimize the risk of re-injury.  Most practitioners recommend careful resumption of activity as tolerated.  This can include normal exercise routines, walking, sports, and other activities.  Physical therapy, massage, chiropractic and other treatment does not usually need to  be stopped and may in fact assist with the overall process.

 

Nutrition

It is also important to remember the diet and lifestyle choices on overall recovery process.   Nutrition deficiencies are epidemic in our modern society and this affects overall health and healing of ligaments and tendons.  Ligaments require proper vitamins,minerals, amino acids, and collagen  formation for repair, and proper diet and nutrition is thus imperative for healing to occur.Similarly, lack of proper hydration will hinder healing and causedligaments to shrink.  It is recommended that you drink at least 6-8 glasses of water per day.

 

Sleep

Lack of sleep is a significant component of chronic pain and chronic pain is a strong factor in sleep disruption.  Chronic pain affects cortisol levels (a response to stress the body perceives-affecting the adrenal glands).   Where cortisol goes up the feeling of restlessness and insomnia occur.  The secretion of cortisol stops when the pain cycle is stopped. Other benefits of deep restful sleep is that it produces growth hormone which is released from the pituitary gland and is anabolic (which means growth as repair).

Hormonal testing to determine your adrenal stress index.  Please consult your physician Dr. Panet.

                        DDI
                       Greats smokies lab

There are many tests to determine your needs. Nutrients, botanical medicines, herbs, amino acids blends, and glandulars can be designed in combination to assist your requirements,

 

Horomones

Healing in prolotherapy requires inflammation and the assistance of the endocrine system which secretes and produces many hormones to help this.  (eg:  cortisal, thyroid, growth hormone, prostaglandius, metatarin, testosterone, etc.)

Hormones decrease with age naturally.  Therefore knowing the present levels is important to determine of your treatment.  Deficient levels may need to be treated by supplementation or support to optomize benefit of treatment.

Exercise/activity increases blood flow thus nutrients to the joints via weight bearing stress therefore good nourishment to the articular cartilage thereby   prolonging joint health, longevity, and mobility.  After ligament or tendon injury, dynamic range of motion exercises like swimming, walking, spinning, (cycling) are essential.  Once stability of the joint occurs secondary to ligament strengthening then a more comprehensive strengthening and static-resistance exercises can begin  along with the flexibility and programme.

 

Limitations of MRI/CAT scans and plain films

*   Ligaments and tendons are poorly imaged and visualized on the studies.

*   Correlation with clinical finding and exam help with diagnosis

*   Many times there is no correlation of pain with imaging studies

*   If relying soley on imaging studies many erroneous surgeries and treatments may be initiated.

Ex:  A study in 1984 by Sam W. Wiesel M.D. (in spine 1984:9:549-551) showed that for people over 40 who had no symptoms of pain.  A 50% of abnormality of their CAT scans exist, including a herniated disc, disc bulges, and spinal stenosis.

So where is their pain coming from!

To properly diagnose the cause of a persons pain a physician must be able to reproduce it through a through understanding of where the pain originates and radiates (ie: organs, nerves, muscles, and ligaments).  Obviously, an x-ray should not be used as the only criterion for determining the cause of pain.  A good history  with a physical, orthopedic, and neurologic  exam,  and palpation of ligamentous structures will help to clearly delineate  a  persons source of pain.

 

Plain film x-ray

Again ligaments are poorly visualized on these imaging studies.  However, indirect signs of instability can be documented by using anatomical land marks and spinal relationshipswithradiological marking techniques.  As well understanding segmented vertebral relationships that are best demonstrated in flexion and extension views.

 


So why don't more people know about prolotherapy?  

  1. Chronic pain is not well understood by most health care professionals and, therefore, is frustrating to treat. Thus the comment, "There is not much you can do about it... you just have to live with it".
  2. Prolotherapy is not taught in medical schools, so doctors are unfamiliar with it.
  3. The technique of prolotherapy requires an in-depth knowledge of anatomy and the skill to place the injections accurately. It takes a great deal of study and training for a physician to become adept at the technique.
  4. The procedure takes up to one hour of clinic time, and most busy clinics cannot afford to take this amount of time for one patient.
  5. Many doctors and patients are looking for a "quick fix", but prolotherapy results do not always occur overnight. Therefore the prolotherapy patient must be committed to the treatment because multiple sessions are often required.
  6. Pharmaceutical companies are not promoting it because there is no money in it for them. Prolotherapy solutions contain common and inexpensive substances. Drug companies cannot obtain exclusive manufacturing rights, so there is no investment potential and thus no profit to be made.
  7. Because there are very few doctors who perform prolotherapy, patients typically just accept the pain or have surgery. While surgery has its place, many patients and doctors are not aware that prolotherapy may relieve their pain and delay or prevent the surgery they thought they needed.
  8. Since prolotherapy is considered by most insurance companies to be "investigational" and "alternative" it is therefore not usually covered.

Prolotherapy is an effective treatment for a multitude of conditions. There is no other treatment that replaces prolotherapy for strengthening weakened ligaments and tendons. Healing occurs slowly but surely, and naturally. Multiple treatments are usually necessary to achieve maximum joint stability and long-lasting relief from pain.

The last paragraph taken from diagnose-me.com


Prolonews

A very informative resource for all conditions that can be treated with prolotherapy

 


Neural Therapy

Neural therapy has become a tradition European healing system focusing on the health of the autonomic nervous system.  Much of the neurophysiological understanding is based on the work of the early physiologists of the last century, especially the school of the Russian genius, Pavlow.  The scientific basis of neural therapy rests on a simple  neurophysiological truth:  injury and illness often result in long-lasting dysfunction of the autonomic nervous system.  The autonomic nervous system controls and regulates or co-regulates most metabolic, immunological, healing, digestive, hormonal, and many other systemic functions.  It controls  such diverse issues as blood flow, pancreatic enzyme and insulin production, and metabolic activity of the liver.  Relatively new is the finding that the neurotransmitters produced in the ganglia and transported to the synapses of the autonomic nervous system are released in the endothelium of blood vessels and activate or inactivate specific portions of the immune system.  Scars can create abnormal signals that affect the autonomic nervous system and its branches for years after an injury or a surgery.  Toxicity can offset an autonomic ganglion.  Unhealed emotional trauma and conflicts can reach the autonomic nervous system via the limbic hypothalamic axis and change the fine or orchestration of impulses flowing in the autonomic  nervous system.  A simple injection of procaine into the exact location where the abnormal impulse starts can restore order in the system and lead to deep healing, often instantly!   It may be an injection into a surgical scar, a ganglion, or a vein.  Commonly the site injected is located far away from the location of the patient’s symptom.

The above taken from Atlas of Neural Therapy by Mathias P. Dosch M.D. second edition.  Forward written Dietrich Klinghardt M.D. PhD.

www.neuraltherapy.com



NEURAL PROLOTHERAPY - NEUROGENIC INFLAMMATION / NEUROPATHIC PAIN

Trauma results in tissue damage and peripheral nerve injury. Where peripheral cutaneous sensory nerves are frictioned or tractioned as they pass through, or over bony architecture or through the fibrous framework of the body, this leaves them vulnerable to injury. When injured the sensocrine nerves of the peripheral nervous system become swollen and tender at there CCI’s or chronic constriction injury sites and along their distributions. When these cutaneous peripheral sensory nerves are injured this leads to neurogenic inflammation and neuropathic pain and repair. It is when this neurogenic inflammation and repair are unbalanced or neural sensitization is greater, that we have the establishment of neurogenic inflammation. When there is sensitization of these peptidergic nociceptors we see allodynia (pain resulting from normally painless stimuli) and hyperalgesia a heightened sense of pain to noxious stimuli.

When these peptidergic cutaneous nerves have been injured they upregulate (increase in numbers) TRPV1, receptors which release two chemicals in particular both of which have know profound effects on the;
  1. Regulation of the immune system.
  2. Affects on the amygdale causing depression.
  3. Up regulation of the HPA stress response leading to exhaustion with prolonged stimulators.
  4. Impaired propriocepsis (delaying antagonistic muscle reflex inhibition.
  5. Tightness in muscles (by increased intramuscular and compartment pressure).
  6. Collagenolysis (degeneration of tendons)
  7. Tissue calcification.
As well as sensitization of other peripheral cutaneous sensocrine nerves. This would help explain the spreading nature and increasing disability associated with a local area of injury.

To summarize:
Low TRPV1, receptor activity results in a trophic effect to support tissue maintenance and renewal. High TRPV1 receptor activity results in neurogenic inflammation and neuropathic pain. But with continued high TRPV1 receptor activity, this results in tissue degeneration and disease.
Neuropathic pain may render individuals unable to work, sleep, and enjoy life. A new and exciting technique in the treatment of neuropathic pain was first discovered and developed by Dr. John Lyftogt MD in New Zealand.
It involves subcutaneous perineural injections of D5W (5% dextrose) or M5W (5%manitol), which acts on sensitized peptidergic sensory nerves in the peripheral nervous system. These injections act as an immediate pain block on these sensitized peripheral sensory nerves which have up regulated or increased numbers of TRPV1, receptors releasing substances P and CGRP (calcitonin gene related product). The pain blocking action of D5W or M5W is hypothesized to affect the slow leak potassium channels. Research is continuing.
Continued treatment has more pronounced affects as the cutaneous nerves of the peripheral nervous system are allowed to achieve full and complete regeneration. This is thought in part to be related to down regulation (or decrease in numbers) of TRPV1 receptors decreasing the release of substance P and CGRP to a normal level, empirically down regulation begins to sustain after three treatments. The reason no anesthetic used to block the pain is that it works on both the sensory and motor components of the nerve. D5W or M5W acts only on the sensocrine nerves with up regulated TRPV1, receptors causing neuropathic pain, therefore this is both diagnostic and therapeutic.
Neuropathic pain is a TRPV1, dependant pain state with the TRPV1, receptors controlling neuropathic pain, neurogenic inflammation, neuro immune modulation, thermal regulation and joint kinesis.
Development of this treatment by Dr. John Lyftogt, MD in New Zealand based on latest developments in the neurosciences and understanding of the neurobiology of the peripheral nervous system.
It appears that D5W, M5W elicits systemic anti-inflammatory and analgesic “sensocrine” function with counter regulatory influence.