Prolotherapy Lecture

Part 1
● Introduction to Prolotherapy
● Acute vs. Chronic Pain
● Treating a new injury aggressively
● Narcotic medications and painkillers (the more you take, they more you need)
● Side effects of narcotic medications and pain killers
● Muscle spasms medications
● MRI’s are they accurate for chronic pain?

Part 1 Prolotherapy
● Introduction to Prolotherapy
● Acute vs. Chronic Pain
● Narcotic medications, painkillers
● Muscle spasms medications
● MRI’s are they accurate?

Part 2 Prolotherapy
● Taking away the diagnosis
● More side effects of painkillers
● Dr. Darrow’s wrist injury
● Prolotherapy injections ingredients
● Where are the injections given
● Trigger points
● History of Prolotherapy

Part 3 Prolotherapy
● The 100 day cycle of healing with Prolotherapy
● Bone-on-bone arthritis in the knee
● Number of treatments and number of injections
● Success rate with Prolotherapy
● Dr. Darrow’s own failed shoulder surgery

Part 4 Prolotherapy
● Prolotherapy Research
● Rheumatoid Arthritis example
● Dr. Darrow’s headaches

Part 5 Prolotherapy
● Prolotherapy research
● What is Prolotherapy
● What are in the injections?

Part 6 Prolotherapy
● How does Prolotherapy work

Prolotherapy Links

Who Can Prolotherapy Help?

For one, it helped Dr. Marc Darrow with HIS chronic pain.

Prolotherapy

A chapter from the revised Alternative Medicine, the Definitive Guide, co-written by Marc Darrow, M.D.,J.D.

How Does Prolotherapy Work?

Prolotherapt stimulates the growth of collagen, the material that ligaments, tendons and other connective tissues are made of.

Prolotherapy, Its History

Prolotherapy is the injection of an irritant solution into the joint, or where the ligaments and tendons attach to the bone. These are the areas where pain is often most intense.

The idea of introducing an irritant into an injured joint is far from new.

Scientific Citations for Prolotherapy

Medical references.

What are in the Prolotherapy Injections?

There are a number of different types of injections which have proven to be successful in Prolotherapy. Although they work in different ways, motivating the body to heal itself through a variety of natural responses, the end result is the same: to cure pain by building new tissue and stabilizing the joints.

The Doctor’s Visit

A Prolotherapy physician will physically examine the patient, being careful to gently press on the suspect area causing pain. When the physician’s touch elicits an intense pain spot, known as a trigger points or tender point, this is the spot where Prolotherapy is given.

Side Effects of Prolotherapy
 

 

Where you can read more:

ESPN The Magazine -Placebo Effect

My own story as a skeptic

Read Marc Darrow, M.D’s., own story of how he went from skeptic, to patient, to believer, to practitioner!

Prolotherapy, Trigger Points and Acupuncture

Differences and Simularities

Prolotherapy Institute – Articles and Blogs

Pain Management: Prolotherapy

Treatments & Procedures:
Pain Management: Prolotherapy

An Alternative To Cortisone

As a sports medicine specialist, I see many athletes on the examination table with “hot” inflammation in a joint that is hindering their ability to play their game. In the past, this athlete would have gone to another specialist with the hope of receiving a cortisone injection. Cortisone, they believed, would have them flying off the off the table with an expectation to be back at the game or training immediately. The problem that the medical community and athletes soon found out was that too much of a good thing – cortisone – can lead to a quicker end of the athlete’s ability to participate in sports. For sports medicine specialists, an alternative to cortisone is just as important as being able to administer a cortisone injection. For some specialists that alternative is Prolotherapy.

Cortisone
Cortisone is a naturally occurring steroid in the human body. In the late 1940′s and 1950′s researchers developed ways to produce it synthetically and make it available on a grand scale. Hailed as a miracle drug, it was widely prescribed by physicians for a large array of inflammatory problems and for the athlete, it was considered the gold standard for chronic inflammation, and THE way to get them back on the field as fast as possible.

Too much of a good thing
The rampant, nearly unchecked use of cortisone, started to show its consequences to patients. Physicians and researchers started to issue warnings on the overuse of cortisone injections. As far back as 1969 Researcher Rodney Sweetnam writing in the Journal of Bone and Joint Surgery reported that not only were surgeons noting that prolonged usage of corticosteroids lead to the development of severe vertebral osteoporosis but also ruptured tendons in athletes. Later research points to cortisone accelerating cartilage degeneration in joints.

Alternatives
Athletes have learned through research and their own personal experience that repeated cortisone injections will lead to arthritis, joint degeneration, and other unwanted side-effects. Athletes also want to be healed and returned to to their game as strong as before if possible. This is where the use of Prolotherapy can help reduce inflammation, reduce pain, and as opposed to cortisone, rebuild damaged tissue and strengthen the athletic joint. And Prolotherapy has been proven in studies to do this without the negatives of cortisone.

Chronic injuries in athletes are mostly caused by wear and tear on the connective tissues of the joints. Mainly, the ligaments, which connects bones to bones, and tendons which hold muscles to bones. It is these soft tissues that are the main culprit in joint inflammation, and the ones that receive cortisone injections.

Prolotherapy is a series of injections of simple dextrose (sugar) that stimulates the body to send the cells necessary to repair and strengthen damaged ligaments and tendons. Prolotherapy introduces dextrose into the area so that a mild, controlled inflammation occurs through irritation of the soft tissue. The immune system recognizes this irritation as an injury and is jump started into sending a new wave of immune cell building blocks to heal the wound.

Studies have shown that Prolotherapy can stimulate a 50% increase in mass and a 200 – 400% increase in ligament strength.

At our clinic, Darrow Sports and Wellness Institute, we don’t like to offer cortisone but sometimes, in extreme chronic injury, cortisone, used one time is a very good diagnostic test to see where the pain generator is, and at the same time quiet the pain. The next step is to use Prolotherapy to rejuvenate the tissue and end the pain. Prolotherapy treatments for the athlete are typically given once a week over a 4 – 6 week period.

Prolotherapy and Sleep

If you are not healing, sleeping may have something to do with it.

In treating patients with chronic pain, one of the very first things we do is take a history from the patient of their sleep patterns.

Sometimes a good night’s sleep will get rid of a person’s pain. You ask people with chronic pain “How do you sleep?” and they say, “I don’t sleep.” If you can either teach them how to sleep; teach good sleep hygiene, or maybe use a non-addictive sleep medication or a sleep supplement (because there are a lot of supplements that relax the body and allow people to sleep like magnesium, thorium, and hops) then that will allow them to manage their sleep. There is just a whole array of things to use for sleep and a person is going to feel better. You have strength from the sleep, and neurotransmitters and hormones are replaced in sleep. We feel better.

Sleep is broken up into five different stages, Stages I and II are the “light” sleep phases, Stage III and IV are the deep sleep cycles. Dreaming occurs during Rapid Eye Movement (REM) sleep.

Sleep is an important component in healing. It is during level IV sleep that our body re-energizes and most importantly that the immune system is stimulated. Without deep Stage IV sleep, healing becomes more difficult.

See video on Sleep and Detox

Insomnia and Back Pain
Researchers writing in the Journal of Sleep Research say their “study aimed to provide an estimate of the prevalence of ‘clinical insomnia’ in patients attending a specialist pain clinic and identify factors associated with it.”

“(Questionairre) Scores suggestive of clinical insomnia were noted in 53% of chronic pain patients, when compared with only 3% in pain-free controls. Significant positive correlations with insomnia severity were detected for all six variables of interest (pain intensity, sensory pain ratings, affective pain ratings, general anxiety, general depression and health anxiety).”

Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007 Mar;16(1):85-95.

Pain And Physical Therapy

What is “physical therapy”?
Physical therapy is working with the body to create an increase in range of motion, to create more strength and stability, and also to use modalities like ultrasound or electrical stimulation that’ll actually reduce pain.

In what ways is physical therapy used to manage chronic pain?
Physical therapy is excellent in managing chronic pain, because it helps strengthen areas that are weak. A lot of chronic pain is really just from what I’ll call a disuse atrophy. As people get older, they don’t exercise as much. If they’re injured, they don’t exercise as much. So what happens is the muscles become weaker, the connections to the joint become weaker, and with the instability comes pain.

What is “active” physical therapy?
Active physical therapy is actually having the patient move their own body around. This can be by way of things like a rocker board, which is a round board that’s unstable so a person can stand on that and then can try to gain their balance. That in itself will help strengthen the muscles around the ankles and strengthen up the ligaments. There are also things like Medx therapy, which is a big frame machine which a person sits in. It locks out the pelvis so that when the person flexes and extends, their back muscles will increase in strength and mobility. There are also different ranging motions to increase strength and different strengths in the exercise. Pilates is an example of an active form of physical therapy.

What is “passive” physical therapy?
Passive physical therapy is a therapy where the person doesn’t really have to do anything. They’re pretty much immobile for the most part. Passive physical therapy may be something like ultrasound, which is a deep heat. It may be electrical stimulation, which is often through pads that are placed in an area of inflammation. Passive physical therapy may be something like iontophoresis or phonophoresis, which is when substances are placed on the skin and, electrically or through sound waves, driven deep into the skin to reduce inflammation and pain by use of the device.

Aging and Healing

What about the aging process, of just hurting more after working out or playing tennis. I use to play tennis very often when I was young and nothing hurt the day after if I haven’t played in sometime, everything just hurts. I wonder would Prolotherapy help?

Dr. Darrow: The question about aging is very important, we are made up of 90% collagen which holds a lot of the water in our system, and as we age, the collagen dries out and breaks down and there isn’t as much supportive tissue as there was when we were kids. I remember when I was a kid I got hurt every day. But none of those injuries ever seemed to last, two or three days later I was fine. But what I am finding now in my older years is that when I am injured it stays longer. And sometimes some of these things I had as a kid are coming back.

Because it wasn’t like there was a total recovery of a healing, it was probably a partial healing but there was enough extra tissue around to handle it and there was no pain. At this age, as I notice a few wrinkles on my face, this is also happening to ligaments, tendons, joints are wearing down just like an automobile gives out after a while. We are in a new age now where we are leaning that No Pain, No Gain is not the way to go, because our bodies are pieces of machinery in a sense with a spirit in side of them and we have to protect them and be very judicious about the sports we do as we age because in our older years it is important not to do the same sport more than two days in a row or the same exercise, it is better to let that area heal itself.

Prolotherapy and Tendon Pain

WITH A PARTIAL TENDON TEAR, MANY OPTIONS

SO NOW WHAT?
Surgery is your only option for a complete tendon rupture; nothing else will allow you to eventually resume training. During surgery, the tendon may be stitched back together, the entire tendon may be replaced, or if enough viable tendon is present it may be screwed back into position. the muscle’s strength into musculoskeletal movement by bending and straightening joints. When your tendon is weakened through wear and tear, fraying,or a partial tear, the muscle’s power cannot be fully converted into movement and you lose efficacy in your exercise routine. Speaking of tears, we will also cover a rotator cuff tear in great detail in a future article since a rotator cuff tear deserves a full section devoted to it. A weakened tendon will result in asymmetry. If a tendon in your right elbow is damaged, dumbell curls will give you a great left biceps and a noticeably poor right biceps. Equally, a weak right knee tendon will lead to an atrophied appearance of the right thigh when compared to your left. Trying to even things out by doing more for the weakened side will only backfire, because you will injure the tendon even further. Many bodybuilders try and work through the pain, not understanding the tendon’s function. They unwittingly make the situation worse.” “ Those with partial tendon tears often take anti-inflammatories, pain-killers and cortisone shots, but each of these have a long list of side effects and are especially detrimental to the bodybuilder. Many studies have confirmed these treatments actually rob the tendons, and their partners the ligaments, of tensile strength (the ability to resist tension, stretch and bounce back into place).

Resting the injured joint is one option, but to someone in training this is not reasonable. You could continue to train with the support of a brace, but many studies have been conducted that question whether wearing a brace either enhances your athletic performance or helps heal your injury So far there are no conclusive results, but many researchers disapprove of long-term use of braces.

Those with partial tendon tears often take anti-inflammatories, pain-killers and cortisone shots, but each of these have a long list of side effects and are especially detrimental to the bodybuilder. Many studies have confirmed these treatments actually rob the tendons, and their partners the ligaments, of tensile strength (the ability to resist tension, stretch and bounce back into place).

BACKWARDS MEDICINE: HEALING TENDONS WITH INFLAMMATION
One cause of chronic pain in the tendon is tendinitis, or inflammation of the tendon. Inflammation usually occurs with a chronic, recurring injury like that typically found in overtrainers, who continuously injure a tendon by not allowing the injury to heal. The inflammation can be easily identified by gently pressing on the affected joint until a “positive jump sign” or “pain-trigger”is found. While inflammation can be painful, and despite the billions of advertising dollars spent on turning this natural healing cascade into something evil, it is a necessary component of healing. When an injury occurs, the body’s natural response is to increase circulation to the area and summon the immune system to begin repair. This is what causes the swelling, redness and heat associated with injury. When the healing has progressed enough, the inflammation cycle begins to shut down, evidenced by a decrease in swelling and pain. However, in an injury that is too severe for the body to heal, the inflammation cycle never completely shuts down and chronic low-level inflammation remains. With the exception of a complete rupture, the body’s natural inflammatory response can usually fix a tendon injury, but sometimes the body needs a little help creating a higher level of inflammation.

Prolotherapy and Back Pain Articles

Prolotherapy helped me personally after numerous chronic injuries and a failed surgery. It is a valuable weapon that can help people with chronic pain.

It’s not my herniated disc?
Many people come in with what they are calling a herniated disc problem because they have pain in their back and pain in their leg and they think the disc is responsible.

MRIs and Back Pain
We typically have patients come into our office with stacks of MRIs, CT Scans and x-rays to confirm the label of Degenerative Disc Disease placed on them by other medical professionals. For example, a woman once came into our office. She had in essence become the living, breathing “embodiment,” of the problem that showed up on her film. When she came in, all she could do was talk about her degenerative disc disease.

Sacroiliac Joint
One of the most common causes of low back pain that we see in our office is the pain caused by the sacroiliac joint (SI).

Degenerative Disc Disease
The aging process brings about degenerative changes to our ligaments, tendons, and cartilage through the desiccation (the drying out) of collagen. Degenerative Disc Disease (DDD) refers to this process occurring in the vertebral discs. It just so happens that the vertebral discs suffers through the most dramatic of age-related changes of all connective tissue related to this process.

MedX for back pain
A MedX workout twice a week for several weeks can alleviate back pain and prevent back injuries, and a recent study indicates that the MedX might even prevent back surgery.

Failed Back Surgery
Perhaps the most distressing is “failed back syndrome” — an official-sounding term to describe the pain of those poor patients whose surgical attempts have failed to correct their problem.

Genetic Back Pain?
When you ask me what is the best way to prevent these back pain episodes that you have, the triad of healing in my office is chiropractic to align the spine and then MedX treatment which are big frame machines that were established by Arthur Jones who built Nautilus equipment.

Lower Back Pain
Because the structures of the lower back are very complicated, and the specific symptoms of lower back pain are highly varied, lower back pain is one of the most difficult to diagnose and treat.

Lumbar Stenosis
From Dr. Darrow’s radio show: The caller is a neurologist. “I am a neurologist, I have a lot of patients that have lumbar stenosis with a lot of pain, weakness, and loss of balance. For various reasons, medical problems, they are not good surgical candidates or they do not want surgery.

MedX-Wall Street Journal
An article about the MedX machine that appeared in the Wall Street Journal.

Myths About Back Pain
While sometimes easy to diagnose and treat, back pain can also be very complex. The source of the pain can be due to a single, or multiple causes. Consequently, it can be difficult to diagnose the cause of the pain. Each pain source has a wide variety of treatment options that must be considered, and your treatment may be completely unique from someone else.

Bulging Discs
A caller into the Dr. Marc Darrow Radio Show has aggravated a baseball injury and his herniated discs, Dr. Darrow discusses the spraining of the iliolumbar ligament and the examination and potential use of Prolotherapy.

Radiculopathy Blog
Radicular pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

Radiculopathy
Often I find that the radiating pain is not because of radiculopathy or pinched nerve but because of a ligament that is loose or injured because ligaments refer pain the same way.

Surgical Alternatives
Can Prolotherapy really fix a back problem where surgery cannot?

Types of Back Pain
There are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. The outer rim of the disc can be a source of significant back pain due to its rich nerve supply and tendency towards injury.

During our development, there is a great deal of overlap of nerve supply to all of these structures. This makes it nearly impossible for the brain to distinguish between injury to one structure versus another.

Psychological Factors in Back Pain
There is much to be said for reducing the stress load in one’s life when trying to deal with chronic back pain.

Sciatica
I am having a lot of problems with my L5 disc. Every now and then, and for no reason, I get a tremendous pain in that area, my back freezes up and I can’t do anything or straighten up. I wind up bent over in half, it goes on for several days.

Prolotherapy Rebuilds Cartilage

Removing tissue from your knee through surgical intervention can only make your knee weaker in the long run and prone to arthritis because removal of tissue decreases the shock absorption capabilities built in to protect the knee.

Why remove tissue then? Because some physicians believe that the meniscus, the piece of cartilage between the femur and the tibia, does not have the ability to be repaired, either by regular body repair mechanisms or surgery. So it is shaved, smoothed, or partially removed. Years ago, when a meniscus was injured, the standard protocol was complete removal. Many of these patients were forced to have knee replacement years later because of the severe pain from the meniscus removal.

A recent study, (Reeves KD Hassanein K Randomized prospective double-blind placebo-controlled study of dextrose Prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Hlth Med 2000;6(2):37-46,) showed that Prolotherapy stimulates the growth of articulate cartilage. In a future article we will discuss Prolotherapy treatment in great detail as well.

In this study, people who had knee arthritis, and, who suffered from knee pain for an average of eight years or more, received Prolotherapy treatment over a six month period. Important to note is that 35% of the knees examined for the study had no cartilage remaining in one or more major compartments.

Prolotherapy to the Knee

                                     Before Prolotherapy                                                     After Prolotherapy

                                         Bone-On-Bone                                                       space between bone

                                                           

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