At some point or another, even the least athletic among us is likely to sprain an ankle or strain something in the back. Injury to the body’s connective tissue — the ligaments and tendons that literally hold us together — is very common. The problem is that once injured, connective tissue tends to get injured again, often because it didn’t heal completely the first time. The result is ligaments and tendons that are weaker or lax, with fibers that may fail like a tattered rope, one strand at a time. Complicating matters further is that osteoarthritis often sets in after injury, limiting movement and further increasing discomfort.
Physical therapy is usually helpful of course. Though surgery can be an option, it is invasive, expensive and usually is followed by painful recovery, rehabilitation and activity restriction for months. Also it doesn’t always work. Though not exactly new, a technique called prolotherapy is growing in popularity. Less invasive and less expensive, proponents say it heals the damaged tissue, making it strong once again. The technique, also known as regenerative injection therapy (RIT) is typically performed by medical doctors called physiatrists who specialize in rehabilitation medicine or by other physicians who specialize in sports medicine or chronic pain.
I spoke with K. Dean Reeves, MD, clinical associate professor of physical medicine and rehabilitation at the University of Kansas School of Medicine, a specialist in this technique. Dr. Reeves explained how prolotherapy works. Doctors intentionally induce inflammation by injecting a mildly irritating substance (usually dextrose, a sugar solution) into the tissue. This brings growth factors that create collagen to the site of the injury to strengthen the weakened ligaments and tendons. Interestingly, this important final step to the healing process may be hampered by use of pain killing medicines, such as NSAIDs, as well as by inadequate nutrition and prolonged icing, so following post-treatment instructions is important.
MANAGING BACK PAIN BETTER
Back pain is a frequent reason people have prolotherapy. Dr. Reeves says that many believe their back pain was caused by a degenerated disk or the sciatic nerve. In fact, chronic back pain is often the result of a series of minor injuries over the years to one or more of the many ligaments and tendons that surround the spine, for example around the sacrum or lumbar spine. To treat back pain with prolotherapy, therefore, the physician will typically inject the solution into every ligament or tendon that is painful to pressure as well as those that support that structure. By treating the entire field, the doctor is likely to set healing in motion for all damaged tissue in the area. Prolotherapy is somewhat painful, though. The procedure can be done under local anesthesia for smaller areas, while for larger areas conscious sedation, such as is typically used in a colonoscopy, may be given to make the procedure comfortable. The pain usually lasts just a few days and can be managed as advised by your doctor.
Prolotherapy can also be used to treat osteoarthritis. The goal is for the injection of dextrose solution to trigger the inflammatory response to eventually generate enough collagen to heal tendons and ligaments, which stabilizes joints. This in turn allows the bones to glide within the joint rather than rub against each other, thereby reducing arthritic pain.
Dr. Reeves says that if all potentially painful areas are treated with prolotherapy, it generally takes just two procedures to see if it is working. At that point some people still experiencing discomfort will go on to have a third, and others will quit. The frequency of treatments varies from weekly to every three months but many practitioners prefer to do them two months apart to allow time for full healing.
DOES IT WORK?
In his experience, Dr. Reeves finds that prolotherapy results in a complete cure in 30% to 40% of patients, for those with current or old injuries that have failed to respond to other methods of treatment, with another 40% showing at least some improvement. Dr. Reeves has one caveat about an old injury — in patients who have experienced pain for months or years, the nerves that transmit the sensation can begin to malfunction, becoming oversensitive. In this case, fixing the injured tissue doesn’t necessarily resolve the pain. Consequently, Dr. Reeves urges people to consider prolotherapy sooner rather than later so an injury is treated before pain becomes chronic.
Prolotherapy may not be appropriate for patients on blood thinners, depending on the size and location of the injury being treated.
Dr. Reeves says most people with a cartilage or joint injury are candidates for prolotherapy, though it works best for people who are healthy and eat nutritiously. Also, Daily Health News contributing medical editor Andrew L. Rubman, ND, cautions that in order to be successful, prolotherapy depends on having the inflammation-induced growth factors form healthy new tissue, for which certain nutritional supplements can be helpful.
Naturopathic physicians (NDs) are also trained in prolotherapy — but the only states that allow them to practice it are AZ, CA, OR and WA. However, you can add naturopathic advice by having your ND work in collaboration with the doctor administering prolotherapy, to prescribe supplements to support growth of new tissue.
BASIC FIRST AID… REVISED
Dr. Reeves raised an interesting point regarding how we treat injuries, in general. People often take NSAID painkillers such as Motrin and Advil to ease pain and swelling when they’ve been hurt. However, soothing the discomfort this way can impede the body’s natural inflammatory response, which is intended to help heal the injury.
Therefore, even though it goes against conventional wisdom, Dr. Reeves says it is better to take acetaminophen (Tylenol) after an injury — it works by blocking the perception of pain, not stopping the natural inflammatory process. Also effective is proper use of ice and heat — using ice only when the area is hot, red and painful, and then followed quickly with heat. Facilitating the body’s ability to heal itself the right way from the start means you will be much less likely to need other interventions — such as prolotherapy — down the road.

Source(s): ??K. Dean Reeves, MD, clinical associate professor of physical medicine and rehabilitation at the University of Kansas School of Medicine, Kansas City.

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