Prolotherapy is a popular yet controversial injection therapy used widely in sports medicine and recently more in general practice, that involves the injection of a dextrose solution. Yes that’s right, sugar injected into the body to help treat a variety of ligament, tendon, muscle and joint pains. However despite lots passionate anecdotal evidence for its benefits, such as speeding up healing, quicker return to sport, and the ability to reduce chronic joint and ligament laxity, there is actually little robust research that supports it use, and even less on its long-term effects.
I have personally witnessed its growing popularity and widespread use in professional sport and in general practice, and I have even referred patients for these injections. But I have to question my motives for this, and in this article we will look at what are the benefits, the risks, the research and the future for prolotherapy?
When is prolotherapy used?
Prolotherapy can be traced back about a hundred years when doctors used to give irritants to help heal many things. But its modern use has really been going since the 1950’s. It was first called ‘sclerotherapy’ as it was thought to be a scar forming therapy, and has been growing in popularity, for the treatment of acute ligament injuries, where the ligament has undergone a mechanical failure leading to laxity but not rupture, these are commonly seen in sports with the ankle and the knee ligaments being the most commonly injured areas.
Ligament laxity after a injury can be present for a long time afterwards and in some cases can be permanent leading to chronic joint instability and cause long-term pain and loss of function. This often prevents a returning to activity long after the original injury has healed. So having a treatment that could speed up the healing rate, but also reduce ligament and joint laxity seems a very attractive prospect to any medical professional, especially those working in sport, where the speed of an injured player returning to play is often the main measure of your success.
So what does prolotherapy do?
Prolotherapy acts as a local irritant and so creates an increased inflammatory response, this increases protein synthesis and collagen formation and so increased cell proliferation. Prolotherapy is also thought to increase the infiltration of leukocyte (white blood cells) and macrophages (debris removers) as well as increase platelet-derived growth factor (PDGF) and interleukin-1β (IL-1β) (chemical building blocks) and so help improve a ligaments strength, mass, thickness and a trend toward an increase in cell number, glycosaminoglycan (protien), and water content. (source, source , source)
How is prolotherapy administered?
Injections of the irritant in solution are given in and around the injured ligament, joint or muscle over a course of a few weeks to a few months. The number, dosage and concentration of the solution used is not well described or explained. Many clinicians seem use their judgement and intuition dependent on the severity and size of the injury and the amount of laxity present. One of the major limitations of prolotherapy research is the lack of consensus or standardisation of dosages or protocols to administer the injections.
Three solutions are commonly used in prolotherapy D-glucose (dextrose), phenol-glucose-glycerin (P2G), and sodium morrhuate. D-glucose is thought to be the safest solution but with conflicting evidence on its effects, with studies showing increase cell proliferation (source) but others showing cell apoptosis (cell death) (source). P2G is thought to create a stronger inflammatory response, but phenol has been found to be toxic to some human cells (source) and can also block peripheral nerves in humans (source). Sodium Morrhuate is a an extract of cod liver oil and found to be toxic to red blood cells (source). All the prolotherapy injections I have seen used have been D-glucose, which seems not only to to be the safest with regards to toxicity, but also has the most conflicting effects.
How does prolotherapy feel?
Well the first thing to mention is that prolotherapy is painful, more so in some areas than others, I have seen grown sports men and women have injections in their lateral ankle ligaments, knee MCL’s and LCL’s, lumbar facet joints, SIJ’s, and even one poor soul having is symphisis pubis injected… three times… ouch! They ALL complained of increased pain and discomfort during, and after these injections.
Thats not really surprising as the irritant nature of the solution causes a local inflammation which obviously can cause pain and discomfort, in my experience this lasts anywhere from 24 hours, up to a week afterwards. Patients are advised to rest and take analgesia as required, but obviously not anti-inflammatory medications as this counter effects the work of the injections, they are also advised not to do any vigorous exercise or have any manual therapy during this reactive inflammatory stage. Once the pain and inflammation is settled the ligament or joint is reassessed for laxity and pain and either re injected or the rehab can begin
Are there any adverse effects to prolotherapy.
In the scant literature and in my clinical experience there are no significant side effects apart for a post injection flare of pain and some tenderness around the injection site. Rabago et al. 2010 did find some very rare effects such as allergic reactions and nerve damage but none classed as serious.
However I would like to add something here, about possible long-term detrimental side effect that prolotherapy may cause. It is purely anecdotal and based only on a single case, but it was observed in conjunction with a very senior and well-respected sports orthopaedic surgeon who regularly operates on many high-profile and professional sports men and women.
It was observed that during an operation on a chronic MCL injury in a professional footballer that had previously had four prolotherapy injections over two years ago, that the ligaments collagen structure was unusual and had changed. It was noted to be comprised mainly of soft stringy collagen, Type III, opposed to the normal stiffer more rigid collagen Type I. The orthopaedic surgeon doing the surgery also commented that this is not the first time he has witnessed this unusual collagen make up with other athletes who have had prolotherapy injections around ligaments, and then needed surgery.
The surgeon explained that he thought these prolotherapy injections may indeed help with protein synthesis and collagen formation, but he believes its of this softer less dense Type III collagen which is formed rapidly and quickly after the injections, which for a stabilising ligament isn’t the best type. He went on to explain that he thought this excessive Type III collagen produced by prolotherapy injections may well actually prevent the formation of normal Type I collagen from being laid down with normal natural healing mechanisms, and so could caused potential long term deficits.
Does prolotherapy work?
Well in my experience and from my own anecdotal evidence…
YES… and NO?
YES… There does seem to be a speedier rate of healing for acute ligament injuries, and ligament laxity does seem to improve very quickly. I have personally seen very lax MCL’s and ATFL ligaments with clear joint gapping on testing, have three to four of these injections over a 4-6 week period and the laxity reduces remarkably quickly and in some cases go completely. I have also seen players return to play a lot quicker than I would expect after ligament injuries, I would say around 30-40% quicker, so a six-week injury is back in four, not majorly important in general sport but a massive bonus in professional sport.
NO… However for those that I have seen go for prolotherapy for conditions such as chronic muscle, tendon or joint pains I would have to say I saw no major benefit. These injections for low back pain, possible facet joint pain and other joint issues such as osteitis pubis I would say didn’t achieve much?
But what about the research????
Well as mentioned there isn’t that much out there and most research has been done on animal models. Jenson et al. 2008 found that rat MCL’s did show ligament thickening after prolotherapy but no difference in its strength or any reduction in joint laxity.
Jenson et al. 2008 again in a different study found that prolotherpay did produce an increased inflammatory response in rats that could assist in cell proliferation, but this was not significantly different from injections of saline solution or just needle stick trauma.
Kim et al. 2011 showed prolotherapy helped reduce chronic SIJ pain better than corticosteriod injections but it was a small study and its results cannot be generalised to the wider population
Cusi et al. 2010 again showed good results in SIJ pain but again cannot be generalised as only individual case studies and no control group
A systematic review done by Dagenais et al. 2007 showed conflicting effects and no effect of prolotherpay when used alone in the treatment of low back pain
And finally another systematic review by Rabago et al. 2005 found limited results for use of prolotherapy in sport related soft tissue injuries and further high quality research with non injection controls is needed
Would I recommend prolotherapy???
Hmmm tricky one… possibly YES and definitely NO… confused… so am I
Possibly YES… in professional sport I think it has a role to play in getting an injured player back quicker with minimal risk. But this has to be used wisely, I think it should only be used for acute ligament injuries that show clear laxity, not just the strains. I also think the player should be fully informed of the lack or research and possible side effects, ie it will hurt like a bugger afterwards, and the possible effect it can have on the ligament in the long-term as mentioned earlier.
In my experience most athletes wont give a toss about the long term effects, most are focused on getting back as soon as they can. This is the ethical dilemma many healthcare professionals have, a duty to weigh up the pro’s and cons’s of an intervention, verses the desires, beliefs and expectations of a patient, and this can be extremely difficult in a professional sports environment.
And definitely NO… I don’t think there is any role for prolotherapy, at the moment, in general musculoskeletal medicine and other non professional sports therapy until the evidence and research can show greater clearer benefits of these injections and prove that there is little to no detrimental long-term side effects to the ligaments and joints injected.
What do you think, have you come across prolotherapy and would you use it or have you used it and what results did it get you.
Thanks for reading and as always enjoy your sport
Cheers
Adam
Have you seen salt water instead of sugar water used? I know the solution is just the irritant that triggers the body to do the work but since everything affects everything perhaps it could have a small affect.
Hi Mark
No I haven’t seen or heard of salt instead of dextrose being used, I know salt saline injections are used in studies to temp induce pain but not sure about fibrosing effects, either way we just don’t know the long term outcome of getting the body to lay down collegen quicker than it wants?
But thank you for your question
Cheers
Adam
While reading another article I found mention of a salt solution.
http://online.wsj.com/news/articles/SB10001424052702304410504575560214236534310
There is a Dr involoved in elite golf & other high profile sports whose entire practice is built on manips & these injections. He does a lot of, what he calls,interspinous ligt injections, in older (over 50) professional golfers & adds “stability” exercises to their programs post injection. There have been a few good results initially ie keeping players in play during the tournament sesaon. However, these players rarely continue with their exercise programs in the winter and do endless hours of short game practice etc so the symptoms return.
I have watched him assess the vertebral stability & identify ligt laxity & strongly advice on the need for daily exercises post injection. However, a year on & the players have the same issues slowly returning. In my humble opinion, although there is a short term response with a decrease in pain – correct exercise & breaking up the practice routine & correct “postural” awareness would alleviate the issue just as well & with a more long term response. However, players looking for a quick fix, have found one with this treatment option
For now, I will keep the option on my “possible options list” but my criteria to choose it would be extremely specific & way down the list. For me it comes across as a quick fix. If it sounds too good to be true……
Great overview on Prolo, any thoughts on Prolo for meniscus repair, using platelets or other combination?
Hi Alan
I’ve only ever come across papers and clinicans using prolo for soft tissue, not for cartilage problems, and platelet or PRP injections are another subject completely with very sketchy evidence
Thanks
Adam
Thanks again for all the great information. So the dilemma rages on. Meniscus repair seems like a misnomer. Prolo, platlets and stem cells seem a bit ahead of there time, but the knee-pain is not going away. What best for the 50 year-old athlete that is looking to train? And what are the long-term implications?
It depends on so many factors, type size and location of the tear, your functional ability and pain levels, any progress made, and expectations for the future ie what type and frequency of sport you want to play, best seek as many professional opinions as possible before deciding, do not rule out surgery though, it can help
my doctor just recommended prolotherapy to treat the symptoms i got, ever since i had a whiplash injury on my neck as a teenager. It seemed like a low risk/high reward treatment, but now after reading your article i am not so sure anymore. if it’s true , that the ligaments can change for the worst long term, than the whole treatment would pretty much miss it’s point and probably backfire in a couple of years. your opinion on this would really help me out.
Hi Chris
I’ve never heard or come across any cases of prolo being used for whiplash so I can’t comment
However it doesn’t seem the best option to me, but without seeing and assessing you it’s impossible for me to assess full
Regards
Adam
I have been getting treatment for labral tears to my hips & I must say that one hip is about completely healed. The other which is more severe has made drastic improvements including not waking up in pain from my sleep as was a usual occurrence before. People travel from all over the world to the Dr. I’m blessed to be treated by. Dr. Hauser from oak park Illinois. I would definitely look into it if I were you. Pray about it..
I am well passed 60 and play competitive 4.5 level tennis. I have had prolo by Dr. Hauser on my wrist and left knee. It has helped me a lot to keep playing. I need to get a refresher every 8 to 12 months; but thats the price and its worth paying.
My mother avoided knee replacements thru prolo. Anything is better than surgery that removes the cartiledge/shock absorber. Until the medical community comes up with a repair, rather than a removal; I’m staying with prolo.
Make sure your prolo doc is a good one. This could partially account for mixed results.
Kam E
Hi Kam, prolo into knee joints is very dubious practice, I’m glad it has helped you but I would argue it’s not for the reasons you think, prolo doesn’t prevent or reduce true joint degeneration, are you sure you haven’t had hyaluronic acid injections not prolo?
Silas, glad to hear of your success. I, too,have hip labrum tears and have begun PRP prolo treatments with Dr Hauser. I have previously been unsuccessfully treated with PT and a cortisone injection. The surgeon I saw encouraged me to try anything to become symptom free to hopefully avoid surgery since it is a complicated surgery within an awful recovery. I am only 2 weeks post on my first set of injections so it’s still too early to tell if it will work. I am, however, hopeful. How many treatments did you have to experience relief?
Check out http://www.prolotheraphynashville.com my wife was told she needed total hip replacement…she could not walk up a flight of stairs because of the pain and limited range of motion. 7 treatments later shes using the stair machine at the gym with no pain. Dr Johnson has a 80 % cure rate and >90 % with reduced pain…#1….It definitely works, #2…its very painful and # 3…insurance will not pay for it.
Hi Kevin
I would suggest that the original diagnosis of a hip replacement for arthritis was incorrect then for your wife’s hip pain, there is no physiological reason why/how prolotherapy injections help a arthritic hip. I would assume your wife’s hip was sore due to soft tissue problems possibly labral or tendon and the injections help this, not the hip joint. All in all I’m glad your wife is feeling better I just hope you didn’t have to pay to much for 7 injections, also please remember the healing ability of time and rest could also account for your wife’s miraculous recovery
Regards
Adam
It sounds as it is.
Hey Adam,
Can you share your opinion on using prolotherapy to correct laxity in shoulder ligaments? I’m having trouble finding anyone with reliable data / firsthand experience with prolo for an unstable shoulder.
Thank you,
Rich
Hi Rich
I have heard of it being used in laxity of the shoulder but not personally seen it used so I really can’t comment
As I say in my post there is some anecdotal evidence that these injections help lax ligaments but the hard evidence is lacking and there is some theories that they may cause log term issues with tissue quality
Hope that helps
All the best
Adam
Get it, but get it with prp as well.. Im getting them both in comprehensive treatment for my hips & getting results.
Just to follow up…I decided to have the prolotherapy on my left shoulder, which had gotten so loose I was having subluxations in my sleep. I had 3 sets of injections about 3 to 5 weeks apart. The shots have significantly tightened my joint. I have actually started PT to regain range of motion. I do not know if these results are typical, but if you have chronic shoulder instability, I would highly recommend finding a qualified physician with experience to treat you. It worked for me and my shoulder was very unstable (surgery was recommended). I also did all the therapy / strengthening exercises religiously and it was still unstable. As far as the shots affecting the quality of your ligaments, my understanding is prolo creates scar tissue which is what tightens the ligament. Scar tissue is only 70 to 80 percent as strong as regular tissue (so I’m told) so I would agree there are drawbacks. If your ligaments are loose or torn, they are already compromised, so I feel the risk vs. reward is worth it. Surgery is not guaranteed to work or be without complications. It seems individual experiences with prolotherapy vary widely. My experience with prolo to correct chronic multi-directional instability has been successful. As far as I know, the solution was a 15% dextrose / lidocaine mix. I believe the doctor doing the shots is one of the biggest factors for success. I hope this information is helpful.
So hard to make a decision,
It’s hard to find out which is the right choice…
I really need your help,
I sprained my ankle 45 days ago and I have rested since then up until till today…
My ankle still hearts and I feel that there is more than just a small sprain going on…
I need this ankle ligament back.
Would you do Prolotherapy it if you were in such situation?
please give me a Yes, or a No.
Thanks alot for your great article.
Hi Pooya
No don’t have Prolotherapy for a first time sprained ankle, if you have rested for 45 days that is far too long, you need to see a physio to guide you through some rehab to get it going again and this will help your pain and function
Regards
Adam
There is a doctor using stem cells harvested from your own body fat for the injection instead of the dextrose solution. Any thoughts?
I haven’t heard of this and so can comment, but it sounds highly experimental so I would check credentials and there research and make sure it isn’t just a money making scam
Regards
Adam
If you would, go to prolotherapy.command take a look, I would very much appreciate it. I have a friend that is doing those treatments right now and she is swearing by them. Much of the published papers on this are written by this same doctor. I appreciate you time! Mia
That should have read prolotherapy.com Darned auto correct.
Yes, I’m looking at prolotherapy options currently for “patellofemoral pain syndrom,” which is fancy-speak for “your knees hurt and we’re not totally sure why, so stop running.” I’ve done PT exercises for 9 months, I”ve had some success and some setbacks but now am in a low state where even mild cycling or light jogging (< 10 minutes) causes aches and pains a few hours later. The doctor on that site is certainly given over to the technique, but he also appears to make all his income from it. A local doctor who administers prolotherapy and other techniques too, recommended (together with a knee surgeon and my sports chiro) to try cortisone shots first. Maybe it's significant that this was his recommendation, given that he isn't relying on selling prolo to make his money?
I wouldn't be considering needles at all if I hadn't already been through 9 months of attempted rehab, and also had MRI's showing some cartilage wear but no other signs of damage.
My daughter has a labrum tear in her shoulder caused by releasing the top hand on her bat (softball player), which led to a partial shoulder dislocation. In your opinion is prolotherapy a legitimate option? Surgery vs. prolotherapy? Surgery vs. therapy (which is what the doctor first advocated). My daughter has three years of elgibility remaining in college and wants the course that will allow her to play NEXT spring (perhaps fall ball) but will be the best option for the long term for a young person. Thank you for any advice you may offer.
Hi Steve
Thanks for your message, I understand the difficult decision sometimes when there is an injury but also a desire to keep competing, my first advice is to always try and think long term, not just for a short term fix, even if it does mean a change of plans sometimes.
To answer your specific question I’ve never heard or come across Prolotherapy being used for shoulder labral tears, in my opinion the fibrosis or scar tissue that the prolo injections are thought to produce is a completely different tissue type from that needed for a structure like the labrum with is more cartilaginous in nature, so I don’t think if a prolo injection near the labrum did fix the tear which is very debatable in the first place that it would do it well enough to be of any use.
I hope this helps a bit
Kind regards
Adam
Dr. … Thank you for your response. What about PRP in the treatment of a torn labrum? I initially asked about prolotherapy but not PRP. And, as you suggested my concern is the ‘big picture’ while my daughter of course is only ‘peeking’ beyond this and the next softball season. For clarification, what is the difference between PRP and prolo?
Hello there, I suppose you would not recommend prolotherapy for sacroiliac joint sprain? I was injured 18 months ago and all other conservative methods have failed.
Hi Patti, no I would not recommend it as no evidence it does anything in lumbar or sacroiliac issues, also I’m unsure what a sprained sacroiliac joint is, I’ve never heard of that diagnosis, it seems unlikely, how and who diagnosed this?
Regards
Adam
Adam & Patti: I’ve had 4 rounds of lumbo-sacral dextrose prolo in 11/2012 for a burning pain in my lt. SI jt. I’ve been MRI’d and know that I have L4-L5-S1 spondylosis/arthr degen. I had 2 cort inj in the SI region (office shot) and then had 2 cort inj INTO the SI joint via fluoroscopy in 7/2012. The relief was only temporary. The fluoro image the dr. shot while placing the needle showed arthritic changes so I knew I had a pain generator at that site. I also have stiffness and nerve pinching in the lumbar spine. After the cortisone injections I discovered and studied prolotherapy and decided to see a dr. who does it here in Dallas, Tx. I had the typical series of injections into all the lumbo sacral ligaments on both sides and into both SI joints. I was hoping for at least to relieve the burning pain in my lt. SI joint but didn’t expect much improvement in my lumbar. After 3 months post-op, the lt. SI pain resolved! The lumbar just got tighter and now I believe I have stenotic-related nerve pinching. Bottom line here is that arthritic/degenerative changes cause some very elusive pains that seem to move around. I will have to say that prolotherapy in my lt. SI joint was successful. I would like to see some variations of prolotherapy developed to combat arthritic changes/degeneration and related symptoms.
My daughter had PRP for costochondritis and rib ligament injuries (she’s a D1 rower). With PRP and some rest she is back to rowing and back to pre injury shape and performance. I think it helped.
Hi Susan thanks for your comment, I’m glad your daughter is better, however my ever so skeptical mind says did the injection do anything or was it the rest, simple answer is we will never know, but glad she is well, regards Adam
Would you recommend prolotherapy for Hallux rigidus and bone spurs in big toe?
No I can’t see any role for prolotherapy here
I dont even understand the purpose of this forum. People continue to ask you if prolotherapy might be helpful to them & u shoot down the idea. I think prolotherapy can work. But if all u do is bash it, why not leave it at that. It’s beating a dead horse for you to keep knocking it.
I am a blessed person. I am 71 years old, and I’ve been playing basketball now for 50 years. However, I now have a tear in my meniscus in my right knee. The orthopedist says it’s just the beginning of degeneration. However, I have soreness and cannot play basketball. I’m wondering if Prolo therapy can help it. Or is arthroscopic surgery a better choice? I still have the passion to play the game, and would like to do so if I can. Thank you
Hello, I have a sublex sternovicular joint. (Right side clavicle partially out of socket under my chin, connected to sternum). Not acute, not sure how exactly it has happened, been complaining about pain for months till just found out why. I am in pt and having closed reduction therapy. She has suggested these prolotherapy shots saying we have almost platoed what she can do for me. I have constant pain and limited mobility of my right arm due to the sublet joint.
Any advise on these shots for this? They do not sound appealing to me but I don’t know what other options I have at this point?
Bummed and curious,
Lisa
Hi Lisa
Sorry to hear of your issue, yes I have seen Prolotherapy injections used in the sternoclavicular joint for subluxation only once thou and it did help, as I say in my post the issue is we are unsure what the long term effects maybe, but we are unsure of this for a lot of things in medicine!
All the best
Adam
I’m 56 and have arthritic degeneration of both SC joints. Just taking off a shirt can light up the intense pain if the movement is enough to “catch” the collarbone sitting wrong in the joint. My ortho dr. says the cartilage has degenerated in both. My rt jt was first about 6+ years ago and he injected cortisone. That calmed it down very well for a few years and then I was back for another about 3 years ago. My left jt. then showed the same symptoms but seemed more painful and it sticks out w/ a pointed bump and hurts like the devil. It has been shot twice w/ cortisone in the past 4 years and is back to hurting and it grinds or pops when I make the wrong movement. Last summer I decided to have dextrose prolotherapy in both SC jts. since I’d had it in my lumbosacral area 11/2012. The rt. joint was asymptomatic and the prolo did not harm and may have “strengthened” the joint capsule because I have no complaints. The left jt. however responded very negatively. It was bad when I had the prolo and seemed to get worse. I peeled off a t-shirt one day and the joint popped and felt like I broke my collarbone! I went back to the dr. and demanded a cortisone shot. That was july 2013. The swelling went down and the popping/grinding stopped. But now the symptoms are back for the past 3 months. Measuring the symptoms now vs. last summer I’d say they are not as bad since having the cort inj after the prolo. Presently I’m in a holding pattern where the pain and subluxations are manageable. He also gave me some Voltaren topical gel 2x daily but it doesn’t seem to work. Summary: I think prolo for this joint is hit or miss. Since mine is arthritic, I’m not sure what works and what doesn’t. I seem to have spots of arthritis in various joints all over my bod that flare up for a few weeks or months and then subsides. I exercise and stretch to help support the areas as much as possible. If you’re willing to part with $1,000+/-, you could try prolo in the SC joints but improvement is basically 50/50. I know that cortisone works 100% for 6 months up to 2 years. It just depends!
Hello Adam,
I have been diagnosed with lumbopelvic instability after my pregnancy. I have been doing physiotherapy, and as long I as I do my daily stretches my pain is reduced, if I go a day without then the pain is back full blown. My doctor has recommended that I do prolotherapy. Do you think that this would actually help me? My Doctor is convinced that it could work, I will be doing 3 more months of physio and then making a decision on whether to do prolotherapy.
Thank you
Sam
Hi Sam, I have had a two of my patients have Prolotherapy for pelvic pain post partum, one it help, the other it didn’t, not a very helpful reply I know, if we look at the research this is also inconclusive, again not helpful for you, the only advise I can give here is that risks from Prolotherapy are low, although long term effects are unknown and benefits can be highly individual
I hope this helps a little
Regards
Adam
Hi Adam,
I have had prolo injections 3 times for SI joint instability. Is it common to feel burning pain for weeks after? Also, not sure it works like I was told it would. My SI joint continues to ‘pop out’ for lack of a better term and causes me great pain and immobility. Just wondering what your thoughts are.
Thank you,
Rebecca
Hi Rebecca
Yes, prolotherapy does feel sore and painful for a few days maybe a week after as it acts as an irritant, its designed to promote healing by stimulating cellular activity which can be sore, this should have been explained to you by those conducting the injections! If you are feeling SIJ ‘popping out’ sensations first I will say that its not pooping out, this is extremly unlikely, instead the sensations are more than likely due to some laxity of the ligaments and muscles around the SIJ, so i would suggest you see a physio for some exercises to strengthen these up.
Hope that helps
Regards
Adam
Tonight I saw a Tv show on prolotherapy. I am 62 and my Dr immediately said I need an operation. I have a problem in the outter meniscus on my left knee. I have also developed a Baker cyst. After reading your article, I learned “it.is.not.as.sweet.as.it.sounds”. The therapy is not for me. What do you recommend? My knee feels weak and sometimes I feel as if something pulls me behind the knee but there is no real pain.
I’m sorry Sara but without seeing you in person I can’t give specific advice
Yes I have had the injections and it worked for me ligaments in lower back! I have had steroid injections acupuncture physio scans ect and the injections in ligaments is the ONLY thing to give me pain relieve ! I am going back for second injection next week as slight pain coming back but I have only had one injection and think more is needed but as far as I’m concerned it’s worth it pain free at last 🙂
Hi, I fell back in Feb. and was told that I just sprained my ankle. Two months later my ankle was still swollen and I was having sharp pain when I would walk. After a MRI was done I was told that I have two completely torn ligaments and a “bruised bone”. Do you think PROLO would help the ligaments heal or should I stick with the plan of surgery? Thanks
Hi Jan
Im afraid if your ligaments are completely torn then Prolotherapy, or any other won’t help them repair, however physio can strengthen the other parts of the ankle and so help compensate for an ankle that has ruptured ligaments, failing that then I’m afraid if the ankle is unstable it may require surgery, I would advise u seek a Physio to assess you in person
Regards
Adam
Hi Adam,
20ish months ago I ‘almost’ took a fall down the stairs and caught myself with my right hand and twisted around but …stopped myself from falling down the 8 remaining concrete steps to a concrete landing. Docs initially didn’t do anything except to ‘rest’ it (it clearly wasn’t broken…we are USAF this was a large military hospital) and finally in March 2013 they took x-rays. X-rays were normal but showed lateral epicondyle enthesopathy. THAT being said the pain has been all medial – to the point that even shaking someone’s hand puts me on my knees with pain. So ..we’ve done – physical therapy – (made it much worse once modality exercises began). I am active -I work from home on a computer (which I know makes it worse..as background my LEFT arm was crushed in 1992 and had to have 2 surgeries for it – once was ulnar nerve release and the 2nd was transposition – so I’ve kinda been there done that and been back again!) I also work out regularly – which I’ve had to alter due to now both arms essentially. I can do cardio but upper body strengthening is out. I also am a horse owner so riding and grooming always irritates it.
All that being said we’ve done PT – I have a TENS unit – I’ve done 3 steroid injections – the last one significantly ended up spiking my blood pressure for a couple weeks and changed some blood work values (kidney values for one) and of course I take vicodin when I need to. BUT HATE IT. I have tried Voltaren (sp) gel – you name it and I’ve likely done it. So after the last steroid injection I said no more – and we’ve moved to another much larger military installation and the specialist I saw today wants to try Prolo – because I do NOT want surgery if at all possible. (Dextrose) I’m now on the fence. Not looking forward to the pain afterwards – and not sure it will work but willing to try anything at this point.
So – I’m hoping against hope if I do it – that it actually helps to some degree. But your ‘thoughts’ and experience in it isn’t making me feel oh so hopeful! I will keep you posted if that is ok! I just feel lost and unsure what to do next!
Hi Kat, sorry to hear you feel lost and sorry if my article has created some confusion, all the experience i have had with prolotherapy is in the lower limb so i cant comment on the upper limb, it sounds like you have a ligament laxity issue that the doctors want to try and use prolotherapy for and i have seen good resilts for this but as I said only in the leg
I hope you get a solution sorted
Cheers
Adam
A huge SHOUT out for the great information and insight that you continue to share!!! Now a question…I have been dealing with medial epicondylitis for 10 months (golfers elbow for al those…). I have been stretching and have done home PT consistently throughout, I even succumbed to a cortisone shot about 5 months ago (which helped until recently). Any thoughts on prolo or other therapies to kick-start the healing process on ME or other degenerative tendon issues?
Hi Allan thanks for the shout out!!!
With a medial epicondylitis or any other tendinopathy i would first try a progressive regime of loading the tendon to generate the required forces to stimulate the mechanotransduction needed for cellular regeneration before you start looking at steroid or prolo injections and dont stretch a tendinopathy it doesnt help, load it, load it and then load it some more!!!
What do you mean by loading the tendon? ??
I am dealing with high hamstring tendonitis (pain in the butt) for several years off and on depending on exercise routine (thank you cross fit for repetitive squats etc…) I’m sure turning 50 did not help and thanks to a desk job and long commute by car daily I am in pain, mostly while driving (sitting).
So two doctors and 1 injection to my butt of steroids later still no answers or relief.
MRI shows a L4L5 Left herniation w severe stenosis but the doc says not related to right side butt pain. MRI says there is mucinod degeneration and some fluid in the ischical tuberosity…anyway neither one of the doctors I went to seemed to think that was a issue.
They both just suggested it could be tendonitis said to do PT. I did and it was waste of money. I notice the therapy was similar to yoga so i’ve started that and pilates. Some relief but still have severe pain at least once a week. So Now I was looking into prolotherapy, plama or stemcell injections.
I don’t know what else to do 🙁
Really great informative site. Its good to see all the interaction. MY son of 18 plays football at a competitive amateur level. He injured his ankle towards the end of last season and had problems withs pain. A good physio friend did a comprehensive assessment. He did not know which ankle it was by was able to diagnose the damaged one and said there was a lot of movement and believed the ligaments were damaged. He recommended the sugar injections. He is in private practice but was a sports physio for a prof football team and his son is on a prof contract, so I guess he has come across a lot of use of it. I am in the health business, involved with evidence based practice implementation. So when I could not find the RCTs and thats its not on the NHS I was curious.
what are the alternatives?
Hi Dean
When it comes to alternatives for prolo or scelerosis injections there arent any. If the ligaments are lax then you could wait and see if an issue, do standard physio focusing on strength, control,and balance etc
It is widely used within football as I mention in my blog but as you have found out there is little in the way of evidence
Cheers
Adam
Hi Adam
I have played football for about 25 yr and after damaging my ankle ligaments in my younger yrs I’ve had lots of probs with the ankle . I went over on it again a few week back and seen my physio last week he has suggested this treatment as he says my ligaments have been damaged that much over the yrs there is lots of play in the ankle now and very little stability . Will this treatment help get the ligament tighted around the ankle and therefore get some stability back to stop this prob reoccurring ?
regards stephen .
Hi Stephen
I have seen and managed many pro and amateur football players who have had unstable ankles and some have had Prolotherapy some not.
Would I say the prolotherapy helped? Yes! I guess I would say that for ankle ligaments, is it the only way? No! Ive had many who didn’t have it manage quite well, if it did take them longer to get there
Simple answer is there is no simple answer, these injections do seem to cause scaring around the ankle so help stiffen it up and help stability but you still need the rehab too, it wont do it alome, and the other thing to consider is the injections are bloody expensive and you normally need 3-6 of them, make sure anyone recommending you isn’t getting a cut
Cheers
Adam
Hi Adam,
I desperately need your advice! I suffer from a collateral ligament tear of the index finger (confirmed through muskuloskelatal ultrasound) due to an injury that happened a year ago. Surgery to repair the ligament was recommended since it did not heal on its on but I am look into alternative options (prolotherapy, cold laser, etc.) . Do you think prolotherapy would help cure it altogether and repair the torn ligament? If not, what would you recommend?
Thank you.
Hi KT
If the ligament is completely ruptured then no prolotherapy cannot repair it, prolotherapy only works via sclerosis, thats the process of forming scar tissue by acting as an irritant in area, but as my blog states how good that scar tissue is and how long it lasts is not known.
With regards to what I would suggest I’m afraid it would be unethical of me to give advice online without meeting, examining and discussing it with you in person.
Kind regards
Adam
Hi Adam,
I’ve snowboarded from 1988 to 2003, then I tore my ACL and MCL and was told I’d never ride again, which put an end to my snowboarding for 11 years. I’ve now started again with the help of a second opinion and a Bregs Fusion brace. What I’m wondering is could this help repair the ACL/MCL and reduce swelling after riding? I do have ACL laxity.
Even the possibility of improvement is enough for me to get the injections.
Hi Dave
No brace will ever repair a torn ligament, only reconstructive surgery will do that. Nor will they reduce inflammation.
Im not aware of that specific brace, but many braces do aid people with torn ligaments of the knee continue to function and play sports and do activity they love doing
All the best
Adam
I had a tone of prolotherapy so far, i can assure you that dextrose does not work, and did only temporary benefit for me, i injured myself in the lower back and went to a chiro that finished the job injuring me in the neck and causing my hips to pop. Sodium morrhuate also did help but everything needed to be done again the month later.
By working with my physician we agreed to try whole blood therapy and so far everything is holding amazing, i had issues with my D3D4 and is now solid no more movement there. The lower back does not bother me anymore sacro illiac region is amazing. I still have treatments for the hip ligaments and tendinopathy caused again by that chiro but so far i can get back into weight training, not heavy training but still it as given me my life back.
I also think i depends on the time before being treated, i been injured for 10 years and saw many incompetent fools that adjusted me so the damage was there.
Hi Yannick,
I injured my neck and shoulders working out about 3 years ago. I have had xrays/mris done and nothing comes up– doctors don’t know what is wrong. Tried physical therapy and got minimal relief. Just got my first prolotherapy dextrose injection and I’m hoping it works. My Dr. also talked about the blood therapy treatment. How many times did you need this treatment before it worked?
Hi, I am a professional musician (drummer.) I broke my wrist as a kid and have had a problem with wrist stability and in the last couple of years I have been experiencing elbow pain. I went to a doctor and got some x-rays and he said I have arthritis in my elbow and tendon laxity in my wrist and elbow. Would prolo help increase the stability of my wrist and help with the laxity? Also what would you suggest for joint pain?
Yes as I said I have seen prolotherapy used to help lax ligaments, sometimes it works, sometimes it doesn’t. That pretty much what the research says as well
With regards to pain comtrol, I am afraid I cannot comment as I am a physio not a doctor
I have had hypermobility of my joints with a lot of joint pain since I was 9, I am 43 now. I just did my first round of six sessions in my upper spine, hips, si joint, wrist and ankle. Now I am starting on round 2 of my other ankle, my other wrist/fingers and my knees. I can feel strengthening happening in the places it has been done. It is hopefully going to bring me back my life. I do not know what the long term effects will be though but currently I have found some relief.
Hi , I’ve been recommended by a sports physician to try Prolotherapy or autologous platelet rich plasma into my partial tear common extensor elbow injury.
Not sure which to go for .any tips please
Don’t go for either, no evidence of benefit in research, instead follow a progressive loading program to promote mechanotransduction and cellular healing
I had ACL reconstructions in both knees. It seems that as time goes by my reconstructed ligaments have loosened up and I have some instability in my knees, especially when I play sports. Do you think a prolotherapy could tightened the reconstructed ligaments?
I am unaware of any evidence on its use for ACL laxity, nor have I seen or heard its use here
Adam, several people have asked you, and now I am, what is loading and I am hoping will explain? Also I just took Prolo for ankles, knees wrists and neck: all with stretched ligaments. The pain has been unbearable and I can’t even hold a iPhone or keys or drive. The shots of sugar helped with the pain so far.
Loading is what it says, loading the tissue, joint, the body.
Movement, exercise this is loading!
Adam,
I hope that you still read your responses to this article.
Full disclosure that I am a health researcher, I have Ehlers Danlos Syndrome (but took 14 years to be diagnosed and most people with this disorder are undiagnosed), so when I started being treated for “pain” and “injury” with prolotherapy 7 years ago I was regarded as someone without a connective tissue disorder. I was someone who needed multiple surgeries actually before I discovered prolotherapy due to problems in my connective tissues (spiral fracture of the ankle), but I had a multitude of sports injuries. The procedures worked so well they brought me back from the brink of palliative care and near death because they could not treat me and my entire spine and ribcage had de-threaded, and my body was falling apart. I healed so much that when my doctor passed and I struggled to find a new doctor, I found there were no good prolotherapy support groups, and I started one – one for patients to help them find safe, good prolotherapy doctors and another group for practitioners, researchers, and inquisitive people to
Someone posts your article as the big “naysayer” article every 5-6 months or so in one of our groups, and we always have a long discussion. Over time as I’ve gained knowledge my thoughts on this article have remained skeptical about its merit because of basic scientific principles, but have evolved more over time as I’ve done more medical-related reviews of research, more health research, and spent more time in the regenerative medicine community. When someone posted it yet again and I responded to them about my issues with this article, I decided it was finally time to respond here directly instead of just in the group.
First, I will just say, that I think it is good for any provider to remain skeptical of anything with which he is not familiar – that is good practice. However, when put in the place of making recommendations or dissuading people from something, I think the onus is on us as professionals to learn all we can to make the most informed decisions to be sure our judgement is sound. For example, even though I run regenerative medicine support groups to help people get safe care, the very first things I caution people about are that this is not a decision to be made lightly, that it is not for everyone depending on their problem, and I make sure to especially inform them about all known contra-indications. I feel it is my responsibility to do so.
When I read your article I see some somewhat irresponsible comments from a scientific, scientific method, and simple logic standpoint.
The biggest thing that scares most of my patients in group is your “observation” in one patient that the collagen is spongy type 3, and not the good hard type 1 collagen. Although you do not say this directly, there is this fearful implication that prolotherapy causes people to have type 3 collagen INSTEAD of normal type 1 collagen.
I am going to outline a few major problems with your claim and argument:
1) The problem with your claim here is of course taking an N of 1 and even if you also add the anecdotal experiences of one surgeon which should also be highly suspect. This is a problem because it cannot be applied across the whole population as any scientist would know, but even if it could, it leads us to…
2) Which of course is sampling error. We know from both recent studies and professional wisdom who is more likely to get injured (hypermobile or EDS people who don’t produce normal collagen), so they are going to be more highly represented in sports injuries, regular injuries, etc. We already know which people are most likely to end up failing traditional therapies, end up resorting to what are expensive and “experimental” (I use that tongue in cheek because prolotherapy is well past the research threshold of being experimental if you read AAOM’s statement and research review, it just means that insurance is not paying for it), but again this will be people who are hypermobile and those who don’t produce normal collagen that will be over-represented in prolotherapy. And we know who will be most likely to have to end up in surgery or who might not heal properly from any therapies – (as an aside if you ever take more interest in our group, that may be due to not waiting long enough, exacerbation of injury, or improper treatment, too, because of the lack of insurance and regulation bad doctors can do prolotherapy without proper training or assessment just as often as great ones) – but again, people with abnormal collagen and hypermobility. So you do not say100% of patients have this after prolotherapy, just some, which would be completely in line with the idea that someone with abnormal collagen could get prolotherapy, produce their abnormal collagen and it would be spongier than a healthy person. And that this type of person would be over-represented in this type of failed surgery. This is consistent with our findings in our prolotherapy group that around 30-50% (or more suspected) are in the support group seeking prolotherapy have a connective tissue disorder, which is far higher than the general population.
2) You did not mention the time frames of how long the surgeries occurred after the prolotherapy for every patient – were they within a year? Shorter, longer? We know that most regenerative medicine works by proliferating type 3 collagen first (the spongy) then that has to harden before it turns into type 1 collagen. If it’s prolotherapy it takes 3 weeks to start getting just the initial type 3, quite a bit longer for it to turn into type 1. It’s why the doctors say that “it keeps working for up to 6 months or even a year” – it’s because it continues to proliferate some more type 3 and the type 3 is continuing to turn into type 1. And that’s just for prolo. PRP the time frames are even longer. 8 weeks until proliferation peaks. So is this surgery well over a year or two after? If not, then who knows if the tissues were done converting into type 1 yet even if they were totally healthy individuals.
3) And this is my biggest one concern with the article of all, the way you misrepresent it as though it is something “scary” that is happening, that seems to imply that these patients have spongy type 3 collagen INSTEAD of healthy type 1 collagen that they should otherwise have. This is a massive logical fallacy. This is insinuating that prolotherapy works by DESTROYING the healthy type 1 collagen you already have and then REPLACING it with that terrible soft type 3. Dead wrong. Cortisone destroys, injury destroys, lack of blood destroys your soft tissues — prolotherapy does the opposite – proliferating brand spanking new tissue on top of what is already there.
Whatever healthy tissue you had left (if any) with type 1 collagen is still there, it has not gone away or transformed into type 3, you just would have formed more type 3 on top of it. The type 3 may not be as strong as the type 1 yet… but this is not a weakest link scenario were the ligaments or tendons are only as strong as the weakest strand of collagen – it is not a chain – it is strands on top of one another. And if you’ve ever bundled fibers into rope, you would know that the thicker the fibers sure, but also the number of fibers can mean even more to the integrity of the rope. Every bit of tissue helps. My guess is that if you take the same person regardless of whether they have a connective tissue disorder or bad injury who had nothing done? They wouldn’t have that spongy type 3. But they also wouldn’t have this healthy type 1 like you are implying. They would have shredded up non-healing starved tissue. It might be hanging by a thread. So you may want to actually compare injured tissue without prolotherapy to injured tissue after prolotherapy – you would probably find that although not spongy, the injured tissue looks much, much worse after a long time without proper blood flow and oxygenation at the site.
And it’s this error that disturbs me most of all, because it means there is a fundamental misunderstanding of the concept of thickening and bolstering a weakened tissue.
As my prolotherapy doctor says whenever someone brings up the idea of “but, but… some people say that collagen formed might not be the BEST collagen right away! So you shouldn’t get prolotherapy!” And they repeat that logical fallacy a lot in EDS and connective tissue disorders because we do often have dysfunctional collagen, but even in people with injuries their collagen proliferation stops, and they cannot heal and it can remain utterly stagnant. He says, “So do they think it’s better to have no collagen?”
So it is possible these people you and your surgeon friend saw are still healing and will eventually have that fancy type 1 collagen, or possible that they have a disorder and they will never have it, but either way the procedure is not making their base, underlying collagen they already have weaker or deteriorating it or making it go away or exchanging “strong” collagen for “weak” collagen. It is just supporting what the person already has, whether weak or strong, with more of something. It is making that rope thicker. And when someone has a chronic injury, sometimes that is the most important thing.
For some people that may be the best outcome they will ever have, but it will be better than sitting with a torn ligament / tendon or injury that will never heal. And it’s pretty odd to perpetuate that myth. So I hope you will take the time to read this and do some more research on how prolotherapy works. I do very much encourage lively debates, but I want to make sure the proper information gets out there and that people understand it.
Now I will say, I think it is unfortunate that it seems from my experiences that prolotherapy seems to fail more often not because of lack of the prolotherapy working, but due to misdiagnosis and poor assessment by the doctors. And sadly some people do not find out until it is too late – until they’ve already had surgery and the ship has sailed. My hope is that we can get better standards and best practices out there so that people can all get the help they need.
I have been fortunate though, that I live in an area where all of my doctors are very supportive as is my PT, and she actually coordinates care and work and strengthening programs with my prolo doctor. In tandem they’ve brought some very disabled people back from the brink and given them their lives back again. I think that together professionals have the opportunity to learn from one another and can affect very positive change.
Wow… A long long long comment, with some very clear biases and plenty of inaccuracies and logical fallacies of your own.
I could waste my time trying to debate this further with you but I have a feeling it will get neither of us anywhere so I wont
Regards
Adam
Adam,
I appreciate that you were willing to post my reply, and that you left it up. I am disappointed by your response.
And yes my post is long, because your article was long, and the issues are complicated and require sophistication to explain them, so I’d rather actually address them with the sophistication required than just posting a “tweet” response that has no sophistication and does not address the serious issues and resort to flippant or glib accusations or insults.
You mention “some very clear biases” — why would you bother saying that? I fully disclosed and openly admitted my conflicts of interest and bias. I admitted the perspective I was coming from. I disclosed why I was posting and coming from that perspective. A good researcher admits his or her biases – because full disclosure is the point. None of us are objective. What would be the point of pointing that out to me in such a condescending and insulting way? I brought up my concerns about your post, based upon its widespread posting for people being “afraid” of prolotherapy because of your claims. I think this is a legitimate concern for me to raise from the prolotherapy community. I thought it would be great for you to have a chance to respond. You have a bias, I have a bias — we both have biases — that is a given. This is not about name-calling or bashing people over it — it is simply a fact. It is how human beings, and different fields work. Surgical vs. medical. PT vs. chiropractics. Orthopedics vs. regenerative medicine. Western vs. eastern medicine. Naturapathic vs. conventional drug therapies. Sometimes they debate, sometimes they find common ground. It is only through admitting their biases, though, and having reasonable discussions that they find common ground. Talking about bias is not about name-calling. It is about acknowledging the perspective from which one comes and how it colors how they see problems – the old adage “if all you have is a hammer everything looks like a nail” comes from this. It is not an insult – it is a necessary admission and it is why it was my very first disclosure. Why you feel the need to hurt that back as if it were an insult I simply don’t understand.
“Plenty o inaccuracies and logical fallacies of your own” – please elaborate – again, I said that I love a lively debate and encourage people being challenged, especially when science requires it. It requires hypotheses, competing hypotheses – it requires logic, but also clear evidence. It requires there to also be interpretation though, and that interpretation always comes from a bias. It means that those interpretations can and must be challenged. If left unchallenged, we’re left as mindless drones.
So of course, if your only response is to insult me and disengage, that is your prerogative, but I believe I came up with some incredibly genuine and fully articulated concerns.
If you want to dismiss them, that is fine, but all it tells me is that you do not have a sophisticated and thought out response to real concerns. My intention was not to insult you – it was a concern about the entire premise of your article. I would hope you would take that seriously. And I’m very dismayed that you do not, and think it’s just about not getting any of us anywhere — my hope was progress. Understanding. Dialogue.
When you simply are dismissive and run away from intellectual challenge, then you’re correct, you do get nowhere.
Ok, with some trepidation that it will get nowhere and that I am wasting my time, lets try this again.
First remember that this is a blog article, where I post my own opinions and views using some of the evidence base to support them. And if you care to check you will see that this blog is one I did over THREE years ago.
It is not a scientific paper, nor a literature review or meta analysis, and so should not be held up as one, and I don’t nor should anyone. I clearly state a number of times in this blog that the comments I make are anecdotal and based on my own experience. I did look at the research when I wrote this BLOG and I will stand by my comments that the evidence base on prolotherapy is scare, scant, and is grossly biased… most being funded by the companies that produce the injectate.
You can also see that I dont rule out the use of prolotherapy based on my understanding of the research and my own expereince, I say it MAY have a role, in SOME, in SOME circumstances.
I apologize if you thought my reply was flippant or glib, but please understand that I have no real interest in any long drawn out debates online, which in my experience only end up in miscommunication, argument and then ad homs, logically fallacies and lots of rhetoric.
I usually dont post any comments on this blog anymore due to time passed since I wrote it and the fact I havent had chance to look at any more of the research. However I posted your comment as I found it interesting for a number of reasons, first was the shear length and verbosity of it which interested me. It really does seem that you doth protest to much, which in my experience either means this blog challenging a dubious practice has affected you either personally or professionally.
Next is your velvet coated attempts to belittle my views and opinions first with an appeal to authority as a health care researcher (first logical fallacy), and then your ad hom attacks (second logically fallacy) that I an unprofessional and being irresponsible and harmful by stating my concern over the use of prolotherapy, which is clearly ridiculous, as how can anyone be harmed by NOT having prolotherapy. Finally I found it really interesting that you claim to be a researcher in this field and that you disagree with views and opinions that prolotherapy is evidence based and supported, yet you failed to provide ANY evidence or research to back this up, in these long drawn out comments, rather you wish to discuss my tone and the scientific method, a classic diversionary tactic.
Also I am a little unsure again what your background exactly is, and why you are so passionate about this one little blog post. You mention you are a healthcare researcher who has looked at prolotherapy. If so I would be keen to know if any funding or support you receive for your research is from company that supply or manufacture prolotherapy products.
If you really are an independent healthcare researcher and you truly do work in the area of prolotherapy, then again I am surprised you haven’t added any research or trials in your comments. Give me something to debate and discuss around prolotherapy that I havent seen, show me something that has changed in three years since I wrote this blog, and then we can begin.
With regards to me being insulted or taking your comment personally, please understand I do not. Having done this blog for a number of years and posting many controversial topics that go against many outdated and dubious practices, that are driven by profit rather than patient care, I am well used to personal attacks, ad hom’s, threats etc from those who see my challenging the status quo threatening, I even wrote another blog on it here https://thesportsphysio.wordpress.com/2015/09/20/youre-offended-well-thats-your-own-fault/
So I will state once more, if you really want to debate the evidence behind prolotherapy please supply me with some unbiased, well controlled, blinded trials, rather than diversionary attempts to discuss my dismissive tone or professionalism, if you agree to follow Crokers rules http://wiki.lesswrong.com/wiki/Crocker's_rules then we can begin.
Regards
Adam
We must be using two different languages. When I am referring to prolotherapy, I am referring to dextrose prolotherapy. What type of prolotherapy are you referring to that has people profiting from prolotherapy / prolotherapy products that are “manufactured”? Prolotherapy is saline mixed with dextrose. Neither are patented. Every patient with whom I’ve spoken has doctors who hand prepare their own solutions at varying levels depending on the level of proliferant needed depending on the procedure.
Each uses some standard form of pain relief that they prescribe or use. Again, standard. Lidocaine, ropivicaine, etc. Again, added by the doctor. Standard clinics stock saline, dextrose, and local anesthetic. Pharmaceutical companies and other companies do not make a profit off of “preparing” these things since doctors do these themselves. No drug companies manufacture “prolotherapy”. No doctors sell pre-packaged “prolotherapy solutions” that I’ve ever heard of. This just seems to be your own misunderstanding of the process and the proliferant solution. The other thing they use are syringes. Again, things that most clinics stock. So unless you are claiming that doctors have some sort of weird relationship with the mass saline, glucose, and syringe lobby in their states, it seems an odd claim.
Most of the well-respected researchers in the area are professor researchers and MD / DOs at teaching hospitals and adjuncts at non-profit universities and university hospitals. Again, no dextrose, saline, syringe group is paying them to combine their products into this. It has been done for over 60 years.
I could post hundreds of old studies, animal studies that explain how it works to proliferate different types of collagen, but you seem to dislike long posts, so I’ll just post this non-profit professional association research summary from Dean K. Reeves who is from Kansas:
http://www.aaomed.org/Research-Summary-Update
But again, David Rabago from the University of Wisconsin is also another well-respected non-profit researcher. Jeffrey Patterson was until he passed away in 2014.
One of the main arguments for prolotherapy and the reason why many insurance companies are starting to cover it is actually its low cost (when the insurance companies are not partnered with a drug lobby, anyway) – because the materials are only a couple dollars per patient, if that, for the materials when the doctor prepares it all. The numbing agent if used (lidocaine) being the only “expensive” agent, but in bulk and in such low doses not costly at all.
And if one were opposed to prolotherapy, one would theoretically on that basis also have to be opposed to all other allowed injections (steroids, trigger points) and IVs due to the conflict of interest in “manufacturing”- which include all the exact same ingredients and costs. Saline, dextrose, numbing, use of a syringe, logically, wouldn’t they? I mean, if that’s the problem? The ingredients?
But they’re all standard medical ingredients that all clinics and hospitals carry. Standard. So I really do not see how anyone could be making any extra profit. Doctors who do prolotherapy get paid for their training and time, the same way that doctors who regularly do pain control trigger point injections aren’t just average joe’s on the street giving those (although prolotherapy takes far more training of the body structure) – and where I live they charge very little because they want it to be affordable and available.
Harm, in my definition, comes in the form of misinformation. I believe in informed consent as an important tenet of all medicine. So if as a professional you are implying to patients that a procedure can actively change their type I collagen into type III collagen, then it is providing them with misinformation about the procedure. Therefore you are depriving them of informed consent.
I agree with you about telling them to be cautious. I do that with every patient. However, I am very careful about telling patients the limits of the knowledge – what is known in the research and what is not known in the research. I am careful about telling them what a procedure is capable of doing (through the limits of both logic and science), and what we do not know it can do. Telling a patient that a procedure can maybe turn their strong collagen into weak collagen is a logical fallacy. It is misinformation. And misinformation can harm patients in being able to make informed, self-determined decisions.
There are side effects, limits of the research, and issues that prolotherapy cannot heal. I agree with telling patients that and being cautious, but the main premise of my post was to not give patients misinformation. I think that is important. And I believe misinformation can cause harm. Even if it is insinuated, not said directly, or unintentional misinformation on “just a blog”.
“Simple, practical, honest advice” your blog says. Not all things are that simple, and sometimes we can make misunderstandings happen. I think they’re important to address.
The ‘cost’ of prolotherapy that I refer too is not just from the materials or products used, but more so from the consultation fees. I have heard of patients spending £1000’s on courses of these injections that are ‘needed’ to be done often, and top ups. Its this practice with all injection therapy, not just prolo that in my experience is rife and rampant.
For example, and yes I was working in professional sport so costs are skewed, but the ‘specialist consultant’ we referred our players too for prolotherpy would be charged £950 + tax per injection, and it was always a minimum of three injections needed once a week regardless of the condition. That’s the cost I am referring too.
I asked for randomized controlled evidence that prolotherapy has any clinically meaningful effects over placebo, or no treatment, and you send me a power point presentation, which although is very good and does point to some trials, it doesn’t prove any evidence of effectiveness. And yes before you say it. I am aware that there are issues with EBM and what constitutes effectiveness, but with out it we would be still blood letting and drilling holes in skulls.
You keep stating that in this blog I actively imply that prolotherapy changes their collagen from type 1 to type 3. This is incorrect and a straw man argument. I clearly state that these views are during a in conversation I have with an orthopaedic surgeon who was rummaging around in a ligament injected 4 x with prolotherapy that he believed prolo had adversely effected. Again I will state this is clearly stated as an anecdotal story in a conversation, not as fact, there is NO harm that I can be accused of.
Again just because its a negative comment, blog, story about prolotherapy seems to be your biggest gripe. Well I’m afraid thats tough, there needs to be balance and if this highlights some of the issues and concerns about prolotherapy, than in my opinion that is good.
You only have to read a few of the other comments here to see that many are promised much with prolo and it delivers little, but also some that report good effects.
You accuse me of making misunderstandings happen, when I am actually only presenting my opinions on my blog, which the only issue I can really see in all of your objections is due to the fact they conflict with your own.
Actually your post 100% explained what the problem is – if you’re only working with professional athletes and only with exploitative prolotherapy “doctors? practitioners?” and they’re charging those outrageous fees without doing comprehensive assessment and prolotherapy, then it actually explains your post to me 100% – far more than any scientific debate ever could.
I do not ever work with professional athletes who are being exploited – they’d never get away with it here.
I work in an area where it’s being done by osteopaths helping people with non-healing soft tissue injuries. So being from the states – they’re charging ~$200-300 with no extra fees not for 3 injections, but for literally dozens or hundreds of injections depending on the area and need. Sometimes performing completely free as part of a training program (“I’m training residents on this today, if you want to be my subject we’ll treat your entire ribcage and pelvis for free”).
That is what happens when prolotherapy is done by non-profit doctors at teaching hospitals rather than by “sports” professionals who are jumping on a fad without being trained. Which is why my group spends a lot of time educating people on what constitutes good assessment, protocol, and patient-centered care. And what doesn’t.
The doctors you mention? Would be on our blacklist for exploitation.
So as I said, it explains your jaded nature.
As for the premise of your “buyer beware, it will make collagen bad” – if your argument is that a surgeon told you it makes collagen soft and spongy and it was just his fault and you’re just repeating his argument, that scares me even more. Or it should, but to be honest does not surprise me. I see far too many surgeons making such errors. It is a shame. But I have met some good ones, too. In our area (the teaching hospital areas), our surgeons work side by side with regenerative medicine doctors, and learn how to assess when regenerative medicine is the better option and when to turn a referred patient over to their colleague first. I have been impressed by how much more frequently that it’s been happening these days.
And the part that will probably shock people the most — in our area the main HMOs (managed care insurance – which is not nationalized like most rational countries to keep costs down, but instead often gouge patients for health care costs regardless) are challenging our FDA and have decided that there is more than enough evidence that it is effective, but moreover that they’re seeing better outcomes, and it is loads cheaper – which is partly why not only are patients not at all getting gouged (they aren’t paying a dime for it), they’re getting supported to try something safer and more cost effective (of course any insurance company’s actual priority) than surgery.
So… yeah, we just come from two very different experiences. Thanks for the clarification. It was enlightening. Cheers.
Its not just professional athletes, usually with more money than sense, that are being exploited with prolotherapy, PRP, cortisone or any other ‘regenerative’ injection therapy that is said to speed up or help healing. In fact its more the general public I see this nonsense and rubbish being promoted and sold to.
Again your straw man argument that you think I am saying in this blog “buyer beware due to making your collagen bad” is really tiresome.
My blog uses a case study of the adverse effects of prolotherapy seen on the ligament of a professional footballer that was made by a very skilled, well respected and highly acclaimed surgeon, not a back street quack, and of course it scares you?
It scares you to hear any negative reports on prolotherapy, it scares you to think anything other positive and happy reports on a treatment you ‘believe’ works rather than looking at the evidence, which is scarce, scant and flawed, but as at least you admit, you are biased towards it.
I wonder if you would you be so scared and spend so long writing comments if I wrote a report of how good prolotherapy was.
Now can I tell you what scares me more in your comment, and what I suspected right from the start of this ‘debate’ you started hidden behind your claims of disappointment and scientific debate.
Thats your use of “non-healing soft tissue injuries”
What makes you think soft tissue injuries don’t heal for the majority. Only in extreme very rare cases of severe biological and genetic abnormalities will people “not heal”
Persistent pain is common, but persistent pain is not an indicator of “non healing”
This is my biggest reason for my “jaded nature” towards this kind of rubbish and comments like yours that promote as helping heal and fixing pain. Pain is complex, pain is NOT just due to issues with the tissues. You cant just fix pain by injecting the crap out of everything and anything and you can leave my ribs alone thank you very much.
When the ‘regenerative’ medical profession (what ever the hell that is) realise this and stop trying to rush or correct structure in those with persistent pain the world will be a better place
A few things – all misinformation scares me, and yes, I write the same things to doctors who say “Prolotherapy can cure ANYTHING!” or who tout prolozone as the new wonderful thing that has been “proven to cure” different things – there is no such evidence. All misinformation scares me, especially when it is coming from supposedly respected professionals. I tell all of the people with whom I consult to RUN. Dr. Hauser in the U.S. is a doctor who runs a prolotherapy clinic in Chicago – probably one of the most famous doctors for prolotherapy. He also runs his own non-peer-reviewed journal that misrepresents itself as peer-reviewed. I abhor it, because it does more harm than good with fraudulent reporting at times and with the kind of quackery you talk about.
I noticed you mentioned cortisone in your argument about “regenerative therapy” – cortisone is most certainly NOT regenerative. It damages soft tissues.
I work with a lot of orthopedic surgeons. I see them make these errors constantly. I saw one tell a patient that hyaluronic acid caused the side effects that cortisone causes so they couldn’t do it again. It was complete nonsense.
You are also misinformed about the prevalence of connective tissue disorders. Rodney Grahamm, respected doctor in the UK even, says they are in 10-20% of the population. A lot of people who have difficulty healing after they hit adulthood. And they are more likely to be injured in sports or accidents due to having weakened tissues. Thus over-represented in sports medicine, orthopedics, and EDs, as well as rehab. That you think pain is normal and not a big deal might be your own bias. It may be that you are missing an underlying soft tissue problem and writing it off.
And again, you’re saying that having more type 3 collagen is an “adverse event” – again, this may be a misunderstanding of how the procedure works. Especially in people with CTDs, but even in normal people, it is normal to develop type 3 collagen. So not sure why you are referring it to an adverse event now.
And I realized I completely let you get away with it in the last post because I was trying to be civil – but you did a switch on your stance about profit motives in prolotherapy. You said all the doctors were making profits from the medicine, from the related products – and when I corrected that, then you ignored it and said they get paid to consult and make a profit off that? When you flip the argument and change it midstream that’s a disingenuous approach to the debate. It would be like me saying that PTs cannot be trusted because they get paid for their work, or surgeons cannot be trusted to do the surgery because they profit off of doing the surgery.
Of COURSE they get paid for their work. They’re doctors, aren’t they? In what world do you live in where doctors and other medical providers have to work for free? And if they don’t then they’re automatically exploiting and profiting off of the drugs and related products — no, not letting that one slide.
You can use that argument when you start doing all your PT for free. And even then you cannot, because it’s ludicrous.
I grow tired of your circular reasoning and use of so many logical fallacys such as appeals to authority, straw men and begging the question blah blah blah
As I feared right from the start these debates go nowhere, even one hidden behind the clock of civil scientific reasoning, this is a perfect example, but to yet again answer your accusations one FINAL time
First remember this is a blog, not a journal article, it should be read by all, including you, as my views and opinions and yes it’s opinionated, so what, deal with it!
I know cortisone isn’t the same as prolo, I merely used it to demonstrate my point about healthcare professionals profiteering and ripping people off with these treatments!
The point I make about clinicians charging for services IS exactly the point I am making, no switching stance or tact as you accuse!
Many clinicians often sell sickness that needs monitoring with more consults, more scans etc that cost patients unnecessary expenses, they then sell cures such as prolotherapy etc that needs, in your own words literally 100’s of injections!
This is a massive problem in all countries when healthcare is a business rather than a profession. Of course people’s time and expertise needs to be paid for, including mine, but I work to discharge patients as soon as I can, I work to see patients as little as I can, I want patients to manage themselves, not rely on others.
And the reason I am dubious and skeptical about this and all kinds of treatment is they don’t do this, they rob the patients of their agency and locus of control, handing it to the clinician, they don’t give the patient the power ownership, agency and knowledge to manage themselves.
The over reliance on ‘fix me’ is horrendous in all areas of medicine and healthcare and is perpetuated and generated by treatments such as prolotherapy.
Now to your personal issue and I suspect grievance to this blog, that of Hypermobility and EDS. Of course it does affect people, of course people need diagnosis and explanations but working with hypermobility often many many can and do self manage for life with simple advice and guidance, not repeat consults and certainly not with injections that merely be placebo and may have long term side effects to collagen quality
Yes I will say it again there maybe be long term side effects! Unless you can prove otherwise I have seen enough and read enough on this topic to not be fully reassured, I have questions, so should others!
Next your clearly incorrect erroneous and frankly insulting comment that I think pain is normal and not a big deal is the most annoying to me!
I NEVER SAID THIS.
Pain is very very real for everyone, pain is what ever some one feels it is!
But, pain is not nociception, pain is not just due to structural issues with joints, tissues or nerves. Pain is so much more complex that this and I suggest you learn more on managing pain than managing physiology
Finally this has gone on long enough, I WILL not be posting anymore of your comments.
This you may feels is not fair, but tough, is my blog so I reserve the right to have the final word and this is it, deal with it!
Yes, I was also wondering about his Comment:”Companies that produce the injectate”. The author definitely switched his thoughts on how the profits are managed. From “injectates” to then turning that into doctors charging too much for the service!
Very confusing, coming from someone who takes so much time to be a professional blogger. This is why it is impossible to have the type of conversation you seem to want. (He did warn you.)
I also understand the desire, at times, to defend prolotherapy, as many people do complain about the expense. I live in the Los Angeles area, my Dr. (Andrew Kochan) is one of thee top in this field….he knows every millimeter of the body, much more than your everyday intern, its really been amazing. Not many people can handle a needle like he does. Anyway, everything is expensive these days..yoga, pilates…to name a few. Alternative healing methods are also expensive, just like health food! If you ever get interesting stuff on prolotherapy, please let me know. Ive been dong it for 15 years. Thanks.
I had patients bring up this concern and then one sent me this blog.
I felt dismayed by the sentiment, and thought about addressing it, but then when I saw this last comment (above), the serious and genuine concerns raised by this person, and your glib response, I felt compelled to say something.
This is very unprofessional, and I hope you will do more research before you actually harm patients with your practice and unfounded advice. The research does not support what you say, and the young woman above has voiced extremely reasonable and serious concerns.
You seem to be taking it personally rather than learning. In patient-centered care (which we do where I live), we would never be this arrogant. We listen and try to learn and respond rather than being so reactive and flippant about concerns.
Yet again as I have just stated in my response to Sheilah, how can this BLOG post harm anyone? How can recommending that people think twice and be wary of an injection therapy that has little robust, unbiased evidence, be harmful? How is it unprofessional to question anything?
If you read the BLOG again you will see I state CLEARLY these views and opinions are based on my EXPERIENCE and ANECDOTE. If you are concerned that a patient brought this in to ask you questions about prolotherapy then I would ask you to question yourself why is this? IS it you dont like to be questioned? Is it that it caused you some dissonance? Or is it just the annoyance that someone is asking awkward questions around prolotherapy?
The fact you say the research does not support my own views yet do not provide any to back up your comment speaks volumes to me. The fact you choose to focus on my perceived flippant and reactive reply is a classic diversionary tactic to change the point at issue.
As I am aware prolotherapy has little evidence to support it use, and unless you can provide me with any to the contrary I will keep saying as much.
Regards
Adam
Doctors in Wisconsin, Kansas, Ontario all at public universities – all it takes is a quick search on pubmed. I think your claim above that they are somehow profiting is odd / ludicrous since prolotherapy is all made from hand by agents found in just about any standard clinic or hospital. Dextrose, saline. I cannot imagine how anyone could make a profit when they mix these themselves very easily – even you as a non-doctor could order these all online very cheaply and mix them yourself (although I do not recommend it). In fact, while I have seen non-peer reviewed research (which should be ignored), all of the peer-reviewed research is non-profit and there’s not a single dextrose prolotherapy study I can think of that has been done by a drug company since there’s nothing to patent. That’s simply an ignorant claim.
Spreading ignorance can harm patients if you are claiming to be an expert, and if you are lying to them. If you are lying to them about how much you know, about the risks, and about how a procedure works. Patients need the full information, and accurate information to make a decision. I am careful not to advise patients and to tell them truthfully when I cannot give them full informed consent and I send them to an expert.
Your post is about whether or not you “recommend” something, which it is apparent you have no business making a recommendation about either way because of your lack of understanding of the basic science or the research. If you’re going to make recommendations, publicly or privately, this is on you, not others, as a health professional.
Do consultants not charge or profit for their time or skill in administering these injections then, usually often, usually repeatedly? I have seen consultants charge £1000’s and patients (and pro sportsmen and women) spend significant amounts of money on these, with little evidence of superior effect, this is my biggest gripe with the increasing popularity of prolo, just like PRP a few years back, and look how that turned out… Prolo is no different.
This blog is not only about if I recommend prolo, its more than that, its my personal experience and opinions on it, this is clear for all readers to see.
And last I checked I am free to post my own views, opinions and recommendations, on my own blog based on my understanding, experience and interpretation of the evidence, on any subject. Readers can make their own minds up
I am sorry that your own experience has left you with the notion that prolotherapy is not effective. Perhaps this is due to the doctors that you know, and again, the lack of research available. Not everyone is good at administering these injections. They need to be point perfect by a physiatrist who knows the intricacies of
the human body and how it is related to one another. There are not that many prolotherapists around.
A steady hand and a very educated doctor is a must. I know there are many prolotherapists who have not done their patients much good. But when you get one that does, you see and feel the difference. I feel fortunate to have discovered my doctor.
I had a cervical fusion..everyone is fusion happy these days as well, and the surgeon nicked one of the nerves, leaving me with permanent nerve damage. So, researched enough or not, mistakes are constantly being made in the medical world. We all have to make up our own minds and keep learning.
Hi Adam,
I underwent a series of prolotherapy injections about 4 years ago due to persistent left SIJ/back pain which was present for about 10 years or so. I am a physiotherapist with an extensive orthopaedic and pain science background.
I tried everything in my power for a very long period of time to improve the situation but the pain persisted and was affecting my ADL’s and leisure activities more and more. I delayed trying the injections for quite some time because I had heard they were painful. Anyways, I finally decided to give it a go and found there was a significant improvement in pain and function after the injections. I know that the treatment is questionable and the mechanism of improvement is likely multi-faceted but I am glad I did it. Interestingly, I’m just now starting to have a few problems again. Although I would consider repeat injections in the future, it would have to be much worse than it is now due to the considerable effect it had on the weight of my wallet.
Sincerely,
Aaron Johnson
P.S. I really enjoy your blogs and feel you are a much needed breath of fresh air in the MSK physio world. Keep up the great work.
Hi Aaron
Thanks for a well reasoned, rationale and balanced comment… you have restored my faith in people on the internet… for a while ;o)
Also flattery will get you everywhere!!!
You make a good point, and one I mention in this blog about these prolotherapy injections, they help some people, some of the time. Why, how etc as you say isn’t fully understood, nor has it been investigated well. However, if prolotherapy is used wisely, rationally and not costing a fortune then the argument could be made, wheres the harm? I get that!
However, before we all say this e do need more research exactly on that issue. The harm maybe as I have discussed a increase in Type III collagen over Type I, is this detrimental or even an issue, I don’t know, it was for the case I described with the footballer and his MCL, it and he was never the same again, now was that the due to the injury he had, the prolotherapy, the surgery, the rehab after, who knows, but it does leave some interesting questions to be answered.
Thanks again
Adam
Hi Adam,
I personally like Prolotherapy and professionally have seen effective and ineffective results. Anecdotally More effective than ineffective.
I only have two issues with your article and it’s the impact the anecdotal surgeons perspective has on the weight of your article ; it leaves the reader believing the anecdotal message is fact- when it’s actually part of the lack of evidence.
In summary the article should finish with more evidence needed.
My other issue is with the idea that Prolotherapy increases the speed of healing.
I ‘think’ it prolongs the inflammatory phase and lays down collagen but healing still needs to move through the phases and requires stress to guide the collagen – will stress applied at the right stage produce better collagen?
All in all your opinion is a reasoned opinion, but your influence can create other physios to ‘close’ their minds to useful adjuncts.
I’ve seen prolotherapy save a rugby players career when we had rehabbed him for months; I’ve also seen it do nothing on other people.
My conclusion is : a useful adjunct to help in the treatment plan of a client I’m taking from bad to as good as I can possibly make them.
More evidence required for me to use it all the time and more evidence required for me to stop using it all together.
Cheers
Matt
Hi Matt
Thanks for taking the time to comment. I appreciate your views on my blog, and believe me I have no intention for, nor did I think my opinions or anecdotal accounts could or would be viewed as fact!
Just as you I have seen prolotherapy do some remarkable things, but the words of a highly respected surgeon who was rummaging and wading through the mush that was a professional footballers MCL still ring in my ears.
Prolotherapy screws up ligaments, yes its n=1, yes there may have been other factors for the mushy MCL, but in the absence of any good robust long term studies that show this isn’t a risk, I wont be advising anyone has prolotherapy, unless their professional sporting career depends on it and they have exhausted all other options first!
Kind regards
Adam
Hi Adam,
Clearly your observation of prolotherapy as not having a definitive answer on it’s effectiveness, is being reiterated in the above posts – the variability in evidence is being shown in the variability of opinions.
In terms of the degrees of passion shown in the above posts, I would argue that the topic is not interesting enough, definitive enough or exclusive enough, to truly warrant the above comments.
As a physio in Australia, prolotherapy is probably not as widely used as in the UK or US, however, my experience with it has been a bit up and down like yourself. It shouldn’t consume too much clinical time because it’s bigger picture net worth, and interest, is quite small.
My only comment would be that within this post, and this is something that you don’t normally do, is that you’ve convoluted self-observational evidence with research papers. Don’t get me wrong, you should be able to do this, however, some people that are reading your blogs cannot make the distinction between the two. Subsequently, this leads to you getting grilled on quality of evidence, professional requirements/doing no harm etc. This is a lack of understanding by others. However, it does take up valuable blog reading/information displaying space.
Your format of mixing your own clinical opinion and current research is working great on twitter; because there is limited space for response. You’re also not the physio of those that chastise you, in this format, you just have a blog. The great majority proportion of recovery for patients comes from their own self-management. So if someone is taking what you say from blogs verbatim and applying it to their own health-care, they aren’t getting better anyway.
Hi and thanks for your comments.
And you make a fair point about use of anecdote mixed with my review of the literature and it may confuse people
However, I still argue that as a blog and not a peer reviewed journal that NOBODY should read this (or any other blog for that matter) thinking the information it contains is fact. To do so is just ridiculous. Blogs are opinions of the writer or writers they don’t follow the usual rules or rigour of scientific research (heck most journal papers don’t do this either) and so all readers should take this into account and read everything with a critical eye!
Thanks again
I have had prolotherapy and PRP many times with pretty good results. However, last week I had a prolo injection in my foot for plantar fasciitis and the next day a vein running from my foot to my knee was very painful and inflamed. I thought it was muscular so ignored it. Two days later a vein from the back of my knee to my groin was swollen, painful and red. I went to the emergency room and they found that I have a blood clot. I am now taking a double dose of Xarelto and hoping that the clot does not travel to my lungs.
I assume that the prolo sugar solution should not get into a major blood vessel because it will cause inflammation and now I conclude, clotting. I do not see any similar problems reported on the web but doctors should be aware of this possibility .
I also got a clot following prolo. Was a shot in my foot for morton’s neuroma. Clot is superficial in saphenous vein and about 8″ long. Too long to dissolve. Still residual swelling 3 months later
Hi adam,
I hope you see this message and I apologize for posting this on such an old blog of yours, but I have a question you may be able to help me with.
I suffer from a back injury or more specially a rib injury in my back where it attached to the spine. It is around the tenth rib and the rib always cracks and pops and I always have pain in that area. I can crack and pop the rib by just pulling air into my body or by flexing my abs a specific way. The pain is only on the left side of my back right where the rib attaches to the spine. I have tried everything I know of and I refuse to take pain meds so I am running out of options. I am an athlete and it is affecting my quality of life everyday. Have you ever seen anything like this? Is there any specific way to rehab this? Is there any info you can give me or direction you can point me in? I have had this for the better or 7 years with the popping and cracking only happening the last three years. It is getting worse every year and sitting in a chair reviewing paperwork kills my back or rib after a few hours of it. If I bend over and touch my toes, I feel popping in the thoracic area of my spine including the rib.
I’ve tried chiropractics, physio, prolotherapy, stretching, weight lifting, bed rest, and pretty much everything other than surgery. Most doctors still don’t know what exactly it is, but I have been told by some it could be ligament or soft tissue laxity that cause the rib to move, thus causing inflammation and chronic pain.
A lot of random information, I know, but I hope you have some insight on this. Thank you for your time, I really appreciate it!
Hi Alex
First there is no way I can give you specific advice via email/blog comments, but I will say that there is no way you could specifically rehab what you describe.
The fact you have had this for 7 years means that there is unlikely to be any significant mechanical issue going on here. The persistent pain and discomfort you feel will be due to a whole host of other factors that need to be addressed with a healthcare professional in person, one who understands modern pain science and biopsychosocial aspects of musculoskeletal issues
My very simplistic advise would be to continue with general activity and exercise as usual and gradually try to expose your whole system to more and more as tolerated. Also find some activity that aggravates a little and do this, and again build up your tolerance to this over time.
Finally try to reduce the attention and vigilance you give to this issue, try to put the thoughts of joints popping and clicking out of your head, most of the time they are nothing to be concerned about
Regards
Adam
When you say there is unlikely any significant mechicanical issue going on, what do you mean exactly? Are you implying that this could potentially just be in my head? I’m not offended by that notion, just genuinely curious. I have had bone scans and MRI’s. The bone scan confirmed large amounts of inflammation in that area and on the MRI two discs were degenerating in that area, but nothing too major, appparaently. Nothing mentioned about the rib specifically in the reports, but that is where I feel the pain and where all most snapping and popping takes place. I haven’t restricted my activities too much, because surprisingly enough activity doesn’t bother it too much if I’m careful, but sitting at a desk or slouching for too long can wreck my back. I was curious if I had some sort of thoracic joint dysfunction or slipping rib sydrome or something. Just not sure where to go wit this. Do I get more diagnostics done to help pin point the issue or do I try and ignore the pain and just continue life. Do I stretch, get more prolo, do physio or just try and get all of these thoughts out of my head? Sorry for the long winded post, but this is very important to me. Thank you very much for the quick reply and hopefully you can reply to this too with any advice you feel could help or if you have any questions, please don’t hesitate to ask. Thanks again!
Hi Alex, no I’m not saying this is all in your head, rather that persistent pains still felt long after injurys and issues should have healed and settled are normally governed by central nervous system issues!
Also don’t take scans or others diagnosis and recommendations in isolation and as to what to do next, that’s not for me to advise you on blog comments without seeing and assessing you fully!
Regards
Adam
Hi Adam,
I have a quick question on prolotherapy if you don’t mind. A few years ago I injured my proximal tibiofibular joint playing American football. It wasn’t fully dislocated, but I suspect I subluxed it at the time. Although it doesn’t prevent me from doing anything, it periodically gives me some trouble, and “clunks” sometimes in a deep squat position.
I have done a fair amount of research on prolotherapy, and agree with your assertions that it isn’t a cure all for any musculoskeletal issue, as some of the doctors would like you to believe. But your experience with it and ligament laxity prompted me to look into it further for my tib fib joint.
So firstly, do you think that this issue would be a decent reason to give prolotherapy a shot (no pun intended)?
Secondly, due to the proximity of the peroneal nerve in this area, should I be worried about any sort of nerve damage with the injection?
Thanks for your time
Hi Keenan
Any injection around a nerve has risks, but a good skilled practitioner aware of anatomy should be able to avoid them!
Is prolotherapy worth it in your case, well there is no clear answer here and there are pros/cons risks/benefits. It has to be based on lots of factors and in afraid I could not say either way!
Cheers
Adam
Hi Adam,
I am a high school athlete. I play tennis but I have been struggling with shoulder instability for the past 2 years. I have popped my shoulder out of place 9 times most of which has been over the past five months as my instability has gotten worse. I have done intensive physical therapy, I have taken time off, I have seen a chiropractor, and nothing seems to be helping. My trainers have suggested that we find a more long term solution for my instability. One option being surgery, another option mentioned was prolotherapy. Do you think prolotherapy could potentially help me? Do you think surgery is my only option? Do you think I could wear a brace while playing and continue with PT until after my senior season (October 2016) or do you feel like something needs to be done now? I understand you may not be qualified to answer some of my questions especially via comment on a blog but I am asking for your OPINION (I understand this is a blog and that it is your opinion) and any advice would greatly be appreciated. Thank You!
Hi CW
My opinion is no prolotherapy wont help significantly with a recurrent dislocation shoulder. The evidence and my opinion is that the younger you are the more times your shoulder has dislocated the more likely you will need surgery.
I would advise an MR arthrogram to check for any structural defects from your dislocations
Regards
Adam
too many incompetent doctors peform prolotherapy thats why im not surprised it doesnt work for so many people, first it has to be comprehensive,secondly the injections need to be precise using ultrasound and fluoroscopy,thirdly it should be stem cell using bone marrow in combination with PRP. thats the most effective way to make it work!
Agree with the comment about too many doctors use prolotherapy
But disagree with everything else you say. There is now good robust and unbiased evidence to show PRP has no effect in improving healing of anything. Asd for stem cells I am not aware of much unbiased research that shows much effect either.
Hi Adam,
I am currently undergoing prolotherapy injections in my C2C3 neck vertebrae. I was in a vehicle accident in 2013 and have had ongoing health issues since. My physiotherapist has assessed that I have “a consistent block in left extention at C2C3.” I have had 6 prolo sessions and see no significant results. My doctor feels I need 9 more to know for sure. (15 all together). In fact the tingling sensations in hands seem worse and burning on back of hands and right arm is worse. This past weekend I called 911 as my right side face, arm, side of body and outer right leg went numb & tingly. They did CTC scan ..EKG..blood work. All came back normal. After recent assessment by my physio he feels I have trigeminal issues happening. ( the burning face..right side mainly..around right eye. .right ear & forehead & chin ) they r not ruling out the very slight possibility that I had a TIA mini stroke..possibly in my sleep. Which he felt may not have been revealed in the CTC scan. He said we will keep an eye on your symptoms ( play a waiting game) and in the mean time feels that it is safe to Continue with my prolotherapy injections. I need him on my side, as he believes me and knows my symptoms are real, as my doctor (I believe) is starting to feel that it is in my head, that I am turning into a hypochondriac. But I am scared and am worried that the prolotherapy has caused this issue with my trigeminal facial nerve and or the TIA. My physiotherapist strongly believes in prolo and feels it has absolutely no bearing on the other issues. I don’t know what the heck to do. If I refuse to go, and my physiotherapist is not happy and let’s me go so to speak, as his patient.. feel I may be in quite a delema! !
Sincerely, Christina
I’m sorry to hear of your problems Christina, but I am afraid I can not give you any sound rationale advice via a blog!
I don’t know if you have giving up on prolo or not, but I started prolo 2/2016 in my neck as while. there is nothing regenerative about prolo; it delivered me to chronic, debilitating pain because I became so inflamed. I kept listening to the prolotherapist that I needed more prolo to help with my ever increasing pain/new symptoms, not realizing that my body had gone off the rails with inflammation. I finally spoke to my PCP and he said to “stop the madness” and don’t go again. I am still in a high degree of pain and will be seeing a pain specialist in a couple of days to see what can be done for the inflammation so I can get back to work. (I haven’t worked since March). I would listen to yourself and not your physiotherapist, it’s your body, not the physiogherapist’s.
Christina,
I just received my first series of shots also to treat my neck from a car accident. He must have poked my herniated disc because intense pain shot down my leg at the time. But the following day i started noticing a burning sensation on the top of my forearms and now spreading to the tops of my hands. Clothing hurts by touching it. Im curious what you ended up deciding on doing, and how your symptoms are now. Is the burning/tingling temporary? If so how long did it last? I had one mild session to see how my body responded, but he recommended 5 more sessions on different areas of the neck. Not sure if I should continue, if the cost and pain out weigh the results or not.
Fingers crossed,
Abby
I just had my 4th Prolo treatment over 8 weeks for a 63 year old knee that gets over 90 days of downhill skiing annually. I was barely walking after last season. The improvement has been remarkable, I am now able to get back to my brisk walking routine and increase my heart rate to the needed levels for short bursts. I heard about Prolo from a friend who had great results. Of coarse the issues are different for everyone, for me at this point as a very sceptical participant I am impressed. I will try and report again in another few months.
Christina, Michelle, Abby…
Just my opinion based upon my experiences:
I had a work-related shoulder injury (torn rotator cuff) in April 2013. Workman’s Comp sent me to a DO for Prolotherapy treatment. With my perfect 20/20 hindsight I would now refuse Prolotheray. For me, it would have been FAR better to have just had the surgery as there would have been far LESS residual damage! The Prolotherapy has caused MORE damage than the initial injury due to buildup of scar-tissue at the injection sites.
For my first Prolo session, the DO gave me 17 injections…then I returned every two weeks (from April – Sept) for the next set of injections (typically 9-12 each session). Three years later, I’m still dealing with scar-tissue buildup (around the injection sites) and have to have a physiotherapist and a massage therapist to help break it down…otherwise, my shoulder locks-up.
Pure torture…I would NEVER recommend Prolotherapy…but, for some people it MIGHT have some success.
But for those who must try Prolotherapy…”good luck”…and be SURE to “listen” to your body.
That is so awful that happened to you Sara! I also had a torn rotator cuff in my shoulder, so I know how painful it is! I was told I had to have surgery for it from a top surgeon in NYC who operates on professional athletes (mostly baseball players). I opted for Prolotherapy instead. I was in so much pain that I was in tears every night (that is how badly it hurt). I had a total of I believe 4 or 5 treatments, BUT, over a period of 6-7 months. Prolo I have found works over time. It needs time between treatments to actually work. I think that is a big part of it.
My torn rotator was over 7 years ago, and my shoulder has not hurt at all since. It is as though nothing ever happened!!! I also do gymnastics, so I put it under the most extreme tests. I am in my 40’s too, so it isn’t because I’m a teenager. 🙂 I swear by Prolo for these reasons.
A few years ago, I also had Prolo on both of my elbows for tennis elbow. Unfortunately, the doctor who did the injections in my shoulder, passed away, so I had to find another doctor who could do Prolo on my elbows. This doctor told me I would need a total of 3 treatments. She told me to come back after 2 weeks for my 2nd session. I knew better than that, so I left the office without a follow up appointment. I never needed any more treatments, and haven’t had any pain in either or my elbows since. That was about 4 or 5 years ago. Although the treatment also worked on my elbows, I stopped referring that particular doctor to my friends because I didn’t like that she was also telling my friends to come back for follow up appointments after only 2 weeks. Anyway, I guess it doesn’t work for everyone, but I have had amazing success with it and tell everyone about it!!! Doctors don’t make the big bucks doing Prolo like they do for surgery, so I’m convinced this is why more people don’t know about it.
It could also be that the Prolo did nothing and you got better due to natural history with those time frames
That goes both ways. Dr Stuat McGill said the same thing about back surgery in “The Back Mechanic”. A lot of people get better after surgery just because of the rest.
I had it done for Ostitus Pubis and it worked amazing! I’ve also read a lot of scientific articles that said it was beneficial. So there is some scientific evidence. It was gone in 7 sessions after 2 years of pain. I’ve had really good luck with it but I have a great doctor and he finds the right spots. If you don’t find the right spots I have found there is little benefit