Inflammation is a good thing – it helps our tissues to heal and repair. When we injure or cut ourselves, we need the inflammatory and wound healing process to bring growth factors and elements of tissue repair to the site of injury via increased blood flow to the area. This helps to generate new connective tissue. Over time, the collagen connective tissue remodels itself to form a more stable, healed tissue.
The problem is that inflammation can be prolonged or increased and gets out of control resulting in chronic pain or autoimmune diseases. Autoimmunity is inflammation that is overactive and out of control.
Prolotherapy is short-form for “proliferative therapy”. This type of injection therapy is used for damage and injuries to tendons, ligaments, and joint capsules. It involves injecting dextrose with an analgesic solution (most commonly, procaine) to help promote the proliferation of the connective tissue in the tendons, ligaments, and cartilage/connective tissue within joint capsules. This helps to add stability to the joint. The proliferation happens due to dextrose stimulating a controlled inflammatory response which instigates the tissue repair process by bringing platelet-derived growth factors to the site of injection. These growth factors help create the collagen connective tissue framework. Over time, this framework remodels itself and becomes stronger.
The more injections, the more opportunity for the connective tissue to develop better tensile strength. Sometimes, multiple prolotherapy treatments are required and you can think of each prolotherapy treatment as “adding a layer of super glue” onto the injured site. Multiple treatments increase the tensile strength and make the joint, ligament, or tendon stronger.
Please note however these injection therapies do not address the root cause and are a therapy to help rebuild strength in your joints, tendons, and ligaments so you can perform activities of daily living that you once used to. It is recommended to limit stress on the affected area for a few weeks after the injection treatments and gradually return to your regular activity level.
If you are susceptible to chronic injuries or delayed healing from injuries, there may be an imbalance at the physiological level that should be addressed such as autoimmune diseases, chronic inflammatory conditions, hormonal imbalances, and, poor digestive health. A more in-depth naturopathic initial visit can help to identify these areas.
Neural therapy is great for helping to break up scars that can be creating pain. This can be used for cosmetic scars however should be refrained from surgical scars. Depending on the circumstance, breaking up a surgical scar can cause more damage.
Neural prolotherapy is a prolotherapy technique that uses a lower dose of dextrose and is used to help with neurogenic pain and inflammation “nerve pain”. The reason for using a lower dose of dextrose is because the goal is not to proliferate and grow new tissue but rather to stop the pain-producing signals from the nerves (reduce the amount of Substance P). This reduces inflammation in the nerves.
Trigger Point Injections
Trigger point injections use procaine (an analgesic) along with vitamin B12, magnesium, or other therapeutic injectable solutions to help relieve trigger points in muscles. These are great for athletes or anyone involved in any form of physical activity and have developed tight muscles or notices ‘knots’ in their muscles which creates pain as the muscle is unable to relax completely. Trigger points can be identified through palpation of your muscles and identifying areas of pain that feel harder than normal.
Conditions That Benefit From Prolotherapy
Partial meniscal tears
Shoulder pain / Frozen shoulder
Partial ligament tears or sprains
Partial tendon tears or strains
Medial tibial stress syndrome (shin splints)
Weak ligaments/ligament laxity
Rotator cuff injuries
Foot and ankle pain
Treatments are typically once every 3-4 weeks and 4-6 treatments are usually recommended for prolonged injuries. Most individuals will experience pain relief after the first few treatments but some may not experience relief until the 5th treatment. For an acute situation, one or two treatments may be sufficient.
Post-Injection Treatment Recommendations
Chiropractic treatments are recommended prior to the injection to help with joint mobilization.
Massage therapy is recommended after the injection to help with moving the fluid around the affected area.
It is advisable to not take any anti-inflammatories (Advil, ibuprofen, Curcumin, Turmeric, Aspirin, Boswellia etc) for 2-3 days prior to your prolotherapy treatment and 2-3 days after. This allows for the controlled inflammatory response needed for tissue repair to take place. If you are wanting to take something for pain, Tylenol is okay.
Absolute contraindications are:
An allergy to analgesics (procaine, lidocaine)
Surgical implants in the area
If you are curious to know if these injections are right for you, contact Dr. Shah.
Cortisone injections vs Prolotherapy
Cortisone injections: These involve injecting a corticosteroid into the joint or area of pain which helps with short-term pain relief. Corticosteroids work by stopping the inflammatory process by suppressing the immune system. Less inflammation leads to less pain in the area. This is why corticosteroids are given to people that have received transplants – to suppress their immune system so it doesn’t act and reject the transplanted organ.
Since the inflammatory process is needed for healing of the injured tissue, suppressing the inflammation can result in weaker tissue over time. Another important thing to note is that cortisone injections can increase the amount of cortisol in the body and high cortisol (just like when you are always stressed) can affect your blood sugar, other hormones, cholesterol levels, and blood pressure plus contribute to weight gain. For this reason, cortisone injections are usually restricted to 3-4 injections per year.
Prolotherapy: the dextrose triggers a controlled inflammatory response which helps attract immune cells and growth factors to the injured tissue to help it heal. The procaine in the injection helps to act as an analgesic to reduce the pain sensation. Injections can be provided every 3-4 weeks until the tissue heals. Even though the dextrose is sugar, it has not been shown to affect blood sugar levels and prolotherapy can benefit those with diabetes as well.
If a chronic injury is not improving with prolotherapy, this is a sign to look deeper at what else is going on with the rest of your body!
While prolotherapy is contraindicated in pregnancy because there is not enough research to show how the solutions injected impact the developing fetus, joint and back pain along with increased susceptibility to strains and sprains is common in pregnancy. This is especially so in the 3rd trimester as relaxin increases to help relax the pelvic ligaments to prepare for the fetus getting bigger and childbirth. Unfortunately, relaxin is not specific to the pelvis and will weaken other ligaments as well which can increase the tendency to more sprains, strains, and other injuries.
Prolotherapy treatments post-partum once breastfeeding is not as frequent or has been finished can help strengthen the ligaments and joints again.
Hydrolyzed collagen supplements and vitamin C are key to help build connective tissue as hydrolyzed collagen contains the amino acids necessary for synthesizing collagen and vitamin C helps cross-link the amino acids together. Adding a prolotherapy treatment to this supplement regime for arthritis and injuries can add a little kick to the regeneration process and help with faster healing.