DARROW
WELLNESS INSTITUTE
Prolotherapy:
Non-Surgical Pain Relief Therapy My
name is Dr. Marc Darrow, M.D. and I can
imagine that if you are visiting this site
you or someone you know, is suffering from
chronic joint pain, and, that you are
interested in learning more about your
options, including Prolotherapy. As a
board-certified physician, I have used
Prolotherapy with thousands of my patients
that struggle with back pain, neck pain,
ankle pain, shoulder pain, knee pain,
headaches and more to help them
avoid surgery and go on to
live pain-free.
If you have questions, simply
contact me
or call my office in Los Angeles, California
(310) 231-7000
A Patient’s
Story
Medial arthrotomy, Lateral arthrotomy, and Two
Arthroscopies – Then Prolotherapy.
Recently we saw a 65 year old male patient with knee
problems. The patient lived an active lifestyle playing
sports, lifting weights, and traveling, unfortunately
this also lead to chronic knee pain.
His past medical history included four procedures on his
right knee: medial arthrotomy, lateral arthrotomy, and
two arthroscopies. He also had surgery on his left knee
to repair a quadriceps rupture.
Read a patient's story
Knee Pain Case History FV is a 48 year old man with a 3 month
history of bilateral knee pain.
The patient was
initially seen by a rheumatologist, and
given a steroid injection which gave him
relief of his pain for 6 months. The pain;
however, would return, and another steroid
injection provided only minimal relief.
Plagued with pain, and searching for
answers, the patient went to see an
orthopedic surgeon who ordered an MRI,
which revealed a right medial
meniscus
tear.
An
Arthroscopy was
recommended; however, FV did not wish to
pursue a surgical treatment. Patient was
therefore given mobic for symptomatic pain
relief, and told to await his eventual need
for a total knee arthroplasty.
Seeking alternative therapies, the patient
came to the Darrow Wellness Institute, after
a referral from a close personal friend and
current patient of Dr. Darrow.
Upon his visit to our office, FV reported
significant and worsening right
knee pain,
described as sharp, and worse with bending
of the knee.
After examination, FV was thought to be an
optimal candidate for treatment with
prolotherapy. He underwent his first
prolotherapy treatment into his right knee
on 4/20/10.
On 4/29/10 patient returned for his second
treatment and reported that the only pain he
experienced had been one day prior to his
visit at the gym, while running.
He reported a 70% improvement after his
first treatment.
On 5/17/2010 patient returned for his third
treatment of his right knee, and reported
complete resolution of his
knee pain.
Ligament Instability and
Revision Total Knee Arthroplasty
Researchers writing in the medical journal
Der Orthopäde examined how loose ligaments played a role in the need for follow
up (revision) knee surgery. Graichen H, Strauch M, Katzhammer T, Zichner L, von Eisenhart-Rothe R.
[Ligament instability in total knee arthroplasty - causal analysis.] Orthopade.
2007 Jun 21;
The researchers examined 135
knee revisions and noted that
-In 32.6 % of
all cases, ligament instability was the primary reason for revision.
-In another 21.6%, ligament instability was identified as a
secondary reason for revision.
They concluded:
Ligament instability is a common reason for revision total knee arthroplasty (TKA).
Prolotherapy as an option
Question: I have a knee
that a couple doctors told that I should have a
knee
replacement surgery. It is pretty swollen
and sore, I sure would like to avoid the knee
surgery.
Dr. Darrow: With this process of
Prolotherapy
there is a very good chance of building up
enough
collagen and
cartilage so that you can
walk around, hopefully pain free after a few
series of injections. Surgery is something, it
seems to me, that is something that should be
the last option.
Golfer's Knee
Question: I am over 50, play a lot of golf and have been
having a problem with my left knee, the pain
comes and goes. I am over 50.
Dr. Darrow: This is typical in older golfers
because when they were younger, they were taught
to keep their feet parallel in their swing and
then roll over the heel of their left foot. It's
not taught like that today because that
technique puts great stress on the knee and
ankle. Today there is more of a theory of
opening up the left foot even to 45 or 90 degree
angle so that during the follow through there is
less stress placed on the left leg.
We use to do something called a “Reverse C,”
where we would throw our heads way back, that
was popular 20-30 years ago, and what that would
do is torque the whole body and golfers would
suffer from terrible back problems, terrible
knee pain, terrible ankle pain, terrible foot
pain.
We teach our patient golfers to open up that
knee and prevent those problems. The nice thing
about Prolotherapy is that it really helps with
knee pain. It takes three four injections and
typically we can help that pain.
Workout Knee
Question: I am 52 and
have
knee pain after working
out. What can I do other than surgery?
Dr. Darrow: At 52 the Collagen in the body
starts breaking down, actually it starts in our
40's and even younger but we start to notice it
in our 40's as we start getting wrinkles around
our eyes and on our faces.
As we see in the skin on our faces, the collagen
in our knees starts to go and as we continue to
work out there is obviously a stress on the
joint.
Most
knee pain that we see is called Chondromalacia patella. Malacia means break
down, condro means cartilage, patella means the
back of the knee bone, which is called the
patella, (and there) is the thickest cartilage
in the body. It starts rubbing the wrong way
against the tract that it slides in and with
repetitive use like running or stair climbing,
things of that nature, any sport really, the
repetitive use just wears out the back of that
knee cap and begins the
arthritis process and
pain.
It is also made worse when you are sitting in a
movie theater or you are in an airplane and
stuck in one place for a long period of time.
Often times people can have a little meniscus
tear, the meniscus is a little cushion inside
the knee. Prolotherapy helps grow back all of
this tissue.
Before you decide on surgery, explore
Prolotherapy, because of all the things
Prolotherapy works on, it works fastest in the
knees.
Exercise or Surgery for
Chronic Patellofemoral Pain Syndrome?
Study says exercise program just as good as
arthroscopy.
Researchers writing in the medical journal BMC Medicine examined the efficacy of
arthroscopy in patients with chronic chronic
patellofemoral pain syndrome. They split 56
patients into two groups. Those receiving knee
arthroscopy and an 8-week home exercise program
and those treated with the 8-week home exercise
program only.
They found that "Both groups showed marked
improvement during the follow-up," but they
added, "In this controlled trial involving
patients with chronic PFPS, the outcome
when arthroscopy was used in addition to a home
exercise program was no better than when the
home exercise program was used alone."
Kettunen JA, Harilainen A, Sandelin J, Schlenzka
D, Seitsalo S, Hietaniemi K, Malmivaara A,
Kujala UM. Knee arthroscopy and exercise versus
exercise only for chronic patellofemoral pain
syndrome: a randomized controlled trial. BMC
Med. 2007 Dec 13;5(1):38
Knee Braces or NSAIDs for
Chronic Patellofemoral Pain Syndrome?
Researchers writing in the medical journal American Family Physican say "there
is little evidence to support the routine use of
knee braces or
non-steroidal anti-inflammatory drugs. Surgery should be considered only after
failure of a comprehensive rehabilitation
program. Educating patients about modification
of risk factors is important in preventing
recurrence."
Dixit S, DiFiori JP, Burton M, Mines B.
Management of patellofemoral pain syndrome. Am
Fam Physician. 2007 Jan 15;75(2):194-202.
Revision Ligamentoplasty of the Anterior Cruciate Ligament
Recent research examined patients who underwent revision
ligamentoplasty of the anterior cruciate ligament (ACL) to
assess the functional outcome after this type of surgery"
Rollier JC, Besse JL,
Lerat JL, Moyen B. [Anterior cruciate ligament revision:
analysis and results from a series of 74 cases.] Rev Chir Orthop
Reparatrice Appar Mot. 2007 Jun;93(4):344-50.
DISCUSSION: The functional outcome (of revision) is not as
good as after first-intention repair, especially if the initial plasty was done with a synthetic ligament and the knee presented
meniscal or cartilage damage.
Do You Recommend Knee Braces? In our practice we stress the following points on the
patient when they request a prescription or recommendation
for a brace understanding that we very rarely recommend the
use of braces.
First, that the brace must never be thought of as a
replacement for a medical treatment.
Second, that the patient must not be allowed to feel a sense
of security that the brace will allow them, by itself, to
return to a normal active life style.
Third, that perhaps with the exception of the Unloader/Osteoarthritis
Brace, and only in certain situations, should a brace ever
be used for any extended length of time.
Fourth, in our opinion, rehabilitation for medically treated
knees must allow for increased movement and circulation to
the knee, two important factors that maybe curtailed with
improperly fitted or extended wear of a brace.
Knee pain in the 55 year old skier
We recently had a 55 year old female patient
come in, she had bilateral
knee pain,
both her knees were very painful for about a
year. She is a very active person, an avid skier
who races during the winter season. It was
following last season she started having the
knee pain.
She first tried to rehabilitate her knees with
physical therapy
and did not get good results.
She had X-rays of the knees which really didn’t
show anything, I just wanted to mention that
X-rays mostly just show the bones, they are not
great at finding soft tissue issues.
She may have needed an
MRI had she gone to
another doctor, but came to our office first.
You have to be very careful if you get an
MRI
because they don’t necessarily show where the
pain is coming from. They give false positives
very often, they may show something that looks
terrible but is not the generator of the pain.
Secondly, we did not get the MRI because it is
very expensive, we wanted to see how the
Prolotherapy worked first.
After the second injection she noticed an
improvement in both her knees and decreased pain
even after climbing step hills.
She had a third Prolotherapy session and she is
doing much better. For knees it is usually the
third or four visits, sometimes one time
depending on the extent.
Do I need to get an MRI of this person to find
out what is going on if she feels great? No, we
don’t need too. We occasionally do it when
someone does not have great results with their
treatment.
Injury To The Meniscus
The meniscus or menisci are the thick, strong
cartilage-like shock absorbers that cushion and
pad the knee between the thigh (femur) and shin
(tibia) bones. Shaped like the letter "C," the
meniscus of each knee provides stability in
carrying the weight of the body or in gliding
through the knee's many range of motions.
Knee Pain
Treatments In Older Adults
Researchers writing in medical journal
Rheumatology (Oxford, England) examined
the way older adults with
knee pain were treated
in primary care. What they found was
"Interventions recommended as core treatment for
knee pain in older adults were underused-in
particular, exercise, weight loss and the
provision of written information. There
appeared to be early reliance on pharmacological
treatments with underuse of non-pharmacological
interventions in early treatment choices."
What the researchers noted:
201 adults were interviewed.
These pateints had each been advised:
1. heat and ice (84%)
2. paracetamol (non-opioid
analgesic) (71%)
3. compound opioid analgesics (59%)
4. non-selective non-steroidal anti-inflammatory
drugs (59%).
"Three core treatments forknee pain(written
information, exercise and weight loss) were
advised to 16%, 46% and 39% of the participants,
respectively."
"Referral to surgery was commonly initiated
before more conservative options had been tried."
Porcheret M,
Jordan K, Jinks C, Croft P; Primary Care
Rheumatology Society. Primary care treatment of
knee pain--a survey in older adults.Rheumatology
(Oxford). 2007 Nov;46(11):1694-700. Epub 2007
Oct 15.
Another Option
A very conservative treatment we specialize in
is Prolotherapy because it works on most knee
problems with excellent results. Prolotherapy is
a simple injection of dextrose and a local
anesthetic, like those used in dentistry work.
What the dextrose does is start a very small
inflammatory response in the body. Inflammation
kicks up the immune system, the immune system
brings up fibroblasts which are small cells that
produce
collagen.
In other words the collagen metabolism spoken of
before is stimulated. A few injections is of
course a lot less invasive than surgery, not to
speak of the rehabilitation effort following
surgery in comparison.
A Multi-Disciplinary
Clinic For Professional and Amateur
Athletes
and Chronic Pain Sufferers
11645 Wilshire Blvd., Suite 120 Los Angeles, CA (310) 231-7000
►Contact
Darrow Wellness Institute via email
Patient's stories herein,
and the language used, is intended to inform and educate. HOWEVER, it
does not imply that you or anyone else will receive the same outcome.
Prolotherapy and other modalities mentioned are medical techniques that
may not be considered mainstream. As with any medical procedure, results
will vary among individuals, and there could be pain or substantial
risks involved. These concerns should be discussed with your health care
provider prior to any treatment so that you have proper informed consent
and understand that there are no guarantees to healing.
Neither
Dr. Darrow, nor any
associate of
DARROW WELLNESS INSTITUTE
offer medical advice on this website. This
information is offered for educational purposes only. Do not act or rely
upon our information without seeking independent professional medical
advice. The transmission of this information does not create a
physician-patient relationship between you and
Dr. Darrow
or any associate of
DARROW WELLNESS INSTITUTE. Neither Dr. Darrow, nor any associate
of
DARROW WELLNESS INSTITUTE
guarantees the accuracy, completeness, usefulness, or
adequacy of any resources, information, apparatus, product, or process
available at or from this transmission. The photos in this Web site
feature models for illustrative purposes and do not depict real
patients.
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