1. Why haven't I heard of Prolotherapy?
You likely know someone who has successfully treated with Prolotherapy but like many healing modalities that the media does not bring to the mainstream, it may not have struck you as a treatment you hadn't known about. You may have thought you were hearing about steroid injections or epidurals, trigger point or other types of injections. Dr. C. Everett Koop, one of the former surgeon generals, received Prolotherapy many years ago and has been speaking about its effectiveness and safeness ever since (see his story under Testimonials).
The benefits of Prolotherapy date back 2,500 years when javelin throwers received a lancing treatment after they had a rotator cuff tear. The treatment worked so well, the athletes experienced up to 40% increased strength beyond what they had to the treated area prior to their injuries.
To this day professional sports athletes treat with Prolo. Many of them are reluctant to talk about it because their sport does not allow them to seek modalities of treatment not generally recognized by insurance or standard of care medicine. It's only a matter of time before many more athletes stop letting their profession dictate their choices in health care.
We have effectively used Prolotherapy in the United States for about seven decades. Even so, the actual treatment does not often make the news. For example, the Fox News story (see News & Updates), which features Dr. Douglas and Prolotherapy, states in its narrative that Prolotherapy is a "new treatment".
Medical doctors typically perform surgery, steroid injections, and offer prescription pain killers to their patients with chronic neuromuscular or musculoskeletal related pain. These doctors do not often suggest a referral to a modality outside of their scope of treatment protocols or insurance coverage. If pain continues, psychiatric medication is often the next step after or in addition to the other protocols.
2. Why haven't I heard of PRP?
Platelet Rich Plasma, or PRP is fairly new in musculoskeletal medicine.
The field of dentistry, specifically bone building and healing, surgical applications, reconstruction and regenerative therapy, has been using PRP with great success for 20 years.
In the past 7 years PRP has taken off in orthopedic medicine. Athletes are healing faster, arthritic conditions are being addressed, and surgical healing is enhanced.
The primary benefit of PRP is that one part of the matrix or healing material involved in healing damaged connective tissue is placed in the area rather than recruited to the area by stimulating the body to do so. These specific materials are blood platelets. The other benefit of PRP is that by using one's own blood platelets, which the body quickly replaces, rejection of this matrix material is not an issue, such as occurs in grafts and with the use of foreign cells.
More recently PRP is being used to specifically regenerate healing in a number of other medical disciplines, including Prolotherapy. In Prolotherapy, platelets come to the site of injection to aid in healing. In Prolotherapy with PRP, platelets are placed into the site of injection. This allows for up to 5x the number of platelets at the site. More platelets equals more growth factors.
Prolotherapists generally have an advantage injecting PRP because Prolo doctors are already versed in the therapeutic benefits of helping the body build scaffolding to regenerate connective tissue at the site of injection. The better the Prolotherapist, the better the placement of PRP and the better the body will heal.
3. How do these 2 treatments work?
Both treatments focus on healing joints: ligaments, tendons, and cartilage. These parts of the body use collagen to form connective tissue. Ligaments, tendons, and cartilage heal much less effectively than does musculature. In fact, little if any repair occurs to ligaments, tendons, and cartilage when injured or when under the process of degeneration. Muscle tears happen even while exercising and usually go unnoticed since exercise itself usually stimulates sufficient repair.
A primary difference in the tissues (between muscles and joints) is that there is very little blood flow in the joint itself.
Blood flow to the area is stimulated by Prolotherapy and PRP. This allows for the breakdown of unhealthy tissue and the creation of new, healthy tissue.
4. Do the treatments hurt?
Depending on how severe and extensive your injuries are you will likely experience some pain accordingly. Dr. Douglas' techniques have been considered to be some of the least painful injection techniques our patients have experienced whether they've previously had Prolo or some other type of injection treatments. The injection pain is momentary, during treatment, and patients are able to do all of their basic daily life activities when they leave our office. We do ask our patients to refrain from strenuous activities during the initial stages of healing. There is some local inflammation to the area, this typically lasts 2-4 days, and there is commonly some soreness which lasts a few days. Inflammation is part of the healing process. Ibuprofen, aspirin, arthritis medications, steroids, and other anti-inflammatories are generally contraindicated because they will diminish the local inflammation. Tylenol is suggested instead.
5. How many treatments will I need and how often?
If you have one area to treat, the number of treatments on average is about 4-6 over a 3-4 month period. Number of treatments and injections will vary depending on the area(s) of treatment and the person's ability to heal. Treatment frequency is every 3-6 weeks.
6. How much do treatments cost?
Generally each treatment costs an average of $250-600. The variables have to do with the number of injections, size of area treated, and whether PRP is used. The cost of PRP is higher due to the use of kits needed to spin the blood to obtain the platelets. Also, PRP requires more time to perform. Note: office visits are additional.
7. Does insurance cover treatment costs?
Some insurance policies do cover the cost of an initial office visit, including Medicare. Most insurance companies follow the lead taken by Medicare and do not cover treatments that they have not previously covered. Medicare is attempting to eliminate or keep from paying for all injection therapies including steroid injections. There have been many campaigns to get Medicare to cover Prolotherapy injections. Medicare continues to refuse to cover a number of treatments and procedures whether they have or have not covered them in the past. These decisions are arbitrary and seem to have nothing to do with effectiveness of treatment. For example, steroid injections primarily reduce pain but they also thin the tissue. Prolotherapy does not thin tissue, it increases healthy, thick, supportive tissue while therefore reducing pain.
8. Do treatments help arthritic conditions?
Yes. Prolotherapy and PRP work to tighten looseness in joints. This does two things, it diminishes the wear caused by loose joints (which is why there is arthritic inflammation in the joint) and it causes more tissue to grow and stabilize the joint as a whole. We have seen many successes treating osteoarthritis and some success treating rheumatoid arthritis.
9. What medicines do I need to avoid?
Avoid anti-inflammatories just prior to and during treatment, including steroids. An exception to this is breathing medications. We will need to know all medicines you are taking or have recently taken. Although we do not advise taking ibuprofen and other such anti-inflammatory medicines, diet and supplementation which fight systemic inflammation is beneficial and should not negatively impact localized healing. Acetaminophen (Tylenol) is suggested as an over the counter medicine rather than aspirin or ibuprofen.
10. What type of diet should I be on?
Your body will heal best if you are eating plenty of fresh fruits and vegetables, including raw foods, a variety of organic, hormone free proteins, and a moderate amount of whole grains. For those restricted from high protein diets, there are modifications. Also, eliminate refined sugars, fast foods, fried foods, soda, alcohol, and preferably all caffeinated products. We suggest a wide range of dairy, eggs, meat, chicken and fish. We have treated patients on vegan diets but do not find that our patients heal as well on a strict vegetarian diet. If you are a vegan, please contact our office for further information.
11. Can I continue to get chiropractic adjustments?
Yes, however we prefer that you don't get adjustments to the treated areas for about 2 weeks, perhaps longer in some cases. Optimally we like patients to wait until the area is stable before receiving any adjustments to the treated area.
12. What are the dangers inherent in getting the treatments?
There have been no reported deaths in 70 years of Prolotherapy treatments in the United States. There have not been reports of any serious debilitating repercussions in spite of millions of treatments. There was 1 unrelated fatality in 1959 four months after Prolo treatments and just subsequent to a surgery and there were 3 deaths in 1961 due to the injection being placed into the spinal cord. Injecting into the spinal cord is NOT Prolotherapy.
As to treatments these days - with any treatment that breaks the skin, there is the risk of infection. There is also a risk of breaking a blood vessel, causing a moderate amount of bleeding. Bleeding and infection are rare. Although a small amount of bleeding at the site of injection is normal. Also, some discomfort is normal due to inflammation and the treatment itself. This is experienced mostly as an achiness which doesn't last more than a few days. A vein may be touched by the needle, a lung may be punctured or a nerve penetrated. These are very rare cases and usually resolve without urgent medical care. Over the 60 years Prolotherapy has been used in the United States, it has been found to be one of (if not) the safest treatments in musculoskeletal joint repair. PRP has also shown a safe record for the 20 years it has been used.
13. What if I've been told I need surgery?
Dr. Douglas will offer you a second opinion. In some cases surgery is warranted, in other cases she may advise you to pursue Prolo or PRP treatments either instead of surgery or in addition to surgery. Even bone on bone arthritis can be helped with Prolotherapy. Most of our patients have been able to avoid surgery altogether.
14. What types of injuries do the therapies treat?
Injuries or dysfunctions which effect connective tissue, such as the joints, spine, pelvis, tendons, ligaments, and cartilage are areas of treatment. We have seen improvements in degenerative conditions, auto-immune diseases and debilitating pain and dysfunction in addition to injuries, including repetitive use, sports, chronic, and acute.
The treatments target all joints: shoulders, wrists, elbows, ankles, knees, hips, fingers, thumbs, toes, feet, hands, jaw. These parts of the body are primarily ligament related. Tendons in the heel and foot as well as throughout the body are also areas for treatment. Neck, vertebral disc, sciatica, and other back and spine issues are additional areas of treatment. Cartilage has also been documented to show improvement. With the use of PRP, we also treat some muscle tears (in addition to tears to ligaments, tendons, and cartilage).
15. Am I still a candidate for treatment if I smoke?
The body will heal better if you are a non smoker. Dr. Douglas will evaluate you as a candidate if you do smoke. Patients usually do heal regardless but it's generally more effective for non smokers. Smokers have many and varied nutritional deficits. For example, vitamin C is needed for wound healing but the body leaves little of this vitamin when smoking because vitamin C is used up when the body is under attack from damage due to tar.
16. How long is the treatment effective?
Once the connective tissue heals, it's permanent unless the same area is re-injured. Reports and studies indicate up to 140% improvement in strength prior to injury or arthritis.
17. How effective is the treatment?
We see at least 95% of our patients getting permanent relief; more importantly the vast majority of our patients get significant improvement in function.
18. Do I have to wait to get treated if I recently had an injury?
Typically we suggest waiting until the initial period of healing after an injury has occurred, while the body heals itself. This can take up to 3 months. Prolo and PRP can be used to treat within 2-3 weeks of an injury to boost the body's healing ability. We do not suggest ibuprofen, ice, wrapping or elevation even in the acute stages of injury. The body heals better and more fully with a moderate amount of local inflammation. We also suggest movement, light exercise, activity, massage to surrounding area, acupuncture, infrared, cold laser, and Tylenol. Listen to your body. The key is to allow the body to have blood flow to the area. Without good circulation, the body cannot go about bringing healing materials to the injured area. Attain and maintain blood flow without being excessive.
19. Do I have to be within a certain age range to get treatment?
We've treated patients in their teens up through 90 year olds and have seen positive results. The body heals itself regardless of age. If you receive a wound to your skin and it heals, your ligaments and tendons can also heal.
20. What if I've already had surgery or steroid injections?
In many cases there can still be good results. Since there are many variables, it's best to get an evaluation for your particular case.