What is the scientific basis for Prolotherapy?
Is Prolotherapy an “off-label” use of Procaine™ and Glucose?
To what diagnoses is Prolotherapy applicable?
What is the usual Prolotherapy procedure?
- The patient may receive a preparatory skin test for allergy to Procaine™ and other constituents of the proliferant solution.
- The patient may receive a pre-therapeutic dose of a non-anti-inflammatory analgesic.
- The patient may need manual realignment.
- The physician positions the patient, examines, and demarcates the injured ligament—minimal clothing will be moved aside or removed.
- The physician anesthetizes the injection sites.
- The physician will inject the proliferant solution into the injured ligaments or tendons at their bony attachment sites.
Is Prolotherapy painful?
What are the frequency and total number of treatment sessions required?
What are the risks of doing no Prolotherapy?
- No relief of the pain.
- Progressively worsened pain.
- Continued or progressively worsened joint dysfunction, such as decreased range of motion.
- Continued or progressively worsened degeneration of the joints involved with the ligament laxity.
In other words, a chronic ligament or tendon injury is unlikely to get better and it is more likely to get worse.
What are alternatives to Prolotherapy?
- Doing nothing.
- Osteopathic or chiropractic manipulation.
- Physical therapy
- Sacral belt and other temporary splints and braces
- Steroid injections, which may reduce the pain but not give lasting results—may even be injurious.
- Surgical intervention.
What are the risks or complications of Prolotherapy?
- No effect from the treatment
- Immediate pain at the injection site, lasting 100 hours (3-4 days) or more
- Bruising of the general treatment area
- Bleeding at the injection site
- Fainting or dizziness
- Post-therapeutic tendinosis pain flare
- Post-therapeutic muscle spasm
- Similar to risk of surgical intervention, temporary (transient) or permanent injury to cutaneous nerves or muscles at the injection site
- Autonomic nervous system-related skin and sensory changes
- Sensory numbness or pain, aching, or burning sensations, or
- Motor paralysis
- Spinal cord injury during back injections
- Pneumothorax (air on the outside of the lung) during chest injections
- Allergic reaction to one of the components of the proliferant solution. This may be in the form of mild skin reactions or severe anaphylactic shock. Consequently, a careful allergic history needs to be taken and if there is any question, skin testing is advisable and available.
- Death from allergic complications of the treatment.
Is anticoagulation therapy a contraindication to receiving Prolotherapy?
Any patient who is taking any anticoagulation therapy, e.g., heparin, Coumadin (Warfarin), Plavix (Clopidogrel), is not a Prolotherapy candidate. Note: 80 mg of Aspirin a day is acceptable.
Is smoking a contraindication to receiving Prolotherapy?
Are there any nutritional supplements that may help Prolotherapy in its healing effect?
Should the Prolotherapy patient take anti-inflammatory medications for pain relief of established joint pain and post-therapeutic pain?
Anti-inflammatory drugs include:
- Steroidal drugs such as cortisone and prednisone and
- Nonsteroidal drugs such as Advil, Alka Seltzer, Anaprox, Artrotec, Aspirin (acetylsalicylic acid), Bristel, Cataflam, Celebrex, Clinoril, Ecotrin, Excedrin, Feldene, Indocine, Lodine, Motrin (Ibuprofen), Naprosyn, Percodan, Vioxx, any Cox-2 inhibitors, or white willow bark derivatives.
- Note: 80 mg of Aspirin a day for cardiovascular protection is acceptable.
For pain relief following Prolotherapy, the only acceptable analgesic drugs are those that are NOT anti-inflammatory. These include:
- Over-the-counter drugs such as Tylenol (acetaminophen) or
- Prescribed Class II medications, such as codeine (e.g., Tylenol 3) or hydrocordone (e.g., Lorcet or Vicodin) or oxycodone (e.g., Percocet).
You are to follow the dosage directions as prescribed. Do not use additional dosages or medications without Dr. Clark’s personal permission.
Also, DO NOT APPLY ICE, which is anti-inflammatory, at any time during the course of Prolotherapy.
What Post-therapeutic activity is advisable?
Move and exercise the treated joint as much as possible throughout the post-prolotherapeutic healing phase, including normal/routine daily activity movements. However, limit the degree of range of motion and strength exercising to that which is tolerated BEFORE it becomes painful. Let pain limit your movement or degree of stretching. Do not participate in aggressive exercise training or sports activities until agreed upon by Dr. Clark.
DO NOT IMMOBILIZE any treated joint with a sling or restrictive bandage. However, a sacroiliac belt may be appropriate following sacroiliac treatment if the sacroiliac joint is excessively hypermobile and painful.
Following low back and sacroiliac treatments, especially, avoid extreme turning movements, such as performed in Yoga (e.g., Warrior pose).
What post-therapeutic rehabilitative measures should be considered?
- William’s Flexion Exercises—for back pain patients during the course of Prolotherapy
- Physical Therapy
- Rolfing Therapy (Structural Integration)—and
- Pilates Instruction
as rehabilitative therapies to help resolve residual compensatory ligamentous-muscular-myofascial restriction and core muscular weakness problems (e.g., core weakness, short leg aBduction weakness, scoliosis).