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prolotherapy
A Joint is Only as Strong as its Weakest Ligament
I do not trust my body
Prolotherapy treatment is used to stabilise any joint in the body thereby improving mobility and restoring natural movement to the patient.
The Three Minute Miracle
With over 10,000 injections and 25 years experience under our belt we are confident that within three minutes the referred pain in 98% of the patients will disappear.
No Chemicals - Just Sugar!
Using natural ingredients we encourage the body to repair the damaged ligament, restore instability and allow the patient to return to normal function without pain.
We Diagnose What Most Doctors Don’t Treat, Because We Care
Prolotherapy (Proliferative Therapy), also know as Non-Surgical Ligament and Tendon Reconstruction and Regenerative Joint Injection, is a recognized orthopedic procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the joint is stabilized, pain usually resolves. Traditional approaches with surgery have more risk and may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only act temporarily. The original term used for this therapy was “sclerotherapy”, coined in the 1930’s when this treatment was discovered, and included both joint and vein injections. Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.
the carousel of conditions
FAQ
Frequently Asked Questions
What conditions can be treated by prolotherapy?
Injury scenarios…sports, work, recreation, wear and tear, accidents, and any other situation where abnormal forces are applied to the body and pain results. Virtually all of these situations involve symptomatic, and healable, connective tissue damage, which can include damage to menicsus, labrum, tendons (like the rotator cuff tendons and may others), ligaments (like the ACL, sacroiliac, and many others), fascia and periosteum (like ‘shin splints’). Almost any ongoing muscle malfunction more than six weeks after an initial injury, though felt ‘in the muscle’, and usually associated with tightness of the muscle or spasm, is actually due to nearby tendon or ligament damage. Many sports injuries for which arthroscopic surgery, elbow surgery, and ankle surgery is recommended can be successfully treated without surgery.
Skeletal abnormalities that put additional ‘stress’ on certain Connective Tissue structures (scoliosis, hip socket malformations, etc.) produce symptoms that are almost always arising from connective tissue structures which do not ‘show up’ on imaging. This cause of pain is commonly overlooked during ‘standard’ evaluations.
‘Degenerative’ conditions involving discs, cartilage, and bony structures almost always involve ligament damage and ‘looseness’ as the cause of damage/ ‘degeneration’ of the structures. This ligament damage is generally the cause of ALL of the symptoms that are usually ‘diagnosed’ as being due to the ‘degeneration’. This includes the condition that is generally called ‘osteo-arthritis’, and includes situations termed ‘bone on bone’ based on imaging studies. In almost all of these situations, the connective tissue structures are where the pain is actually coming from, and healing this damage results in excellent long term results.
Any condition with an ‘itis’ as the last four letters. Tendonitis, bursitis, costo-chondritis, epicondylitis, osteo-arthritis, plantar fasciitis, tenosynovitis. Almost any condition which for which people experience transient symptom relief with an anti-inflammatory medication or corticosteroid can be resolved long-term by Prolotherapy treatment. Virtually any condition associated with ongoing or intermittent muscle malfunction—spasm, ‘trigger points’, and tightness, or weakness, loss of range of motion and pain with activity—is being caused by small-fiber, stretch-induced nerve damage in one or more connective tissue structures. If you cannot ‘stay in adjustment’ following Chiropractic care, this is in all likelihood due to healable connective tissue damage. Virtually any painful condition which would be treated with epidural steroid administration, radio-frequency nerve ablation, or physical therapy is also treatable with Prolotherapy with a very high, long-term success rate.
‘Undiagnosed chronic pain’ is often actually caused by the connective tissue damage mechanism described above (read about Connective Tissue Damage and Pain). It is easy, and inexpensive, to determine whether or not unhealed connective tissue damage is playing a role in a patient’s symptoms.
Post-operative pain is commonly arising from connective tissue, and this phenomenon is not usually diagnosed by surgeons or other practitioners. This pain is commonly ‘diagnosed’ as due to ‘scar tissue’, ‘a nerve pinch at another level’, ‘another disc that is symptomatic’, etc. It is certainly worth ruling out unhealed connective tissue damage as the cause of such pain before proceeding with ANY other intervention.
Almost all work-related and trauma-related pain in necks, backs, and joints is caused by healable connective tissue damage.
Almost all ‘postpartum’ back pain and coccyx pain, and pelvic floor dysfunction and pain are arising from connective tissue structures which respond to Prolotherapy with a high success rate.
Many headaches, migraine and other types, can be improved or cured by Prolotherapy, particularly when there is a history of neck trauma or ongoing neck symptoms.
This list is only partial, but will give you some idea of the many ‘faces’ of unhealed connective tissue damage, and the versatility of this treatment in addressing the many possible presentations of this pathology.
What to expect after the first treatment?
Following a Prolotherapy treatment, people experience a wide variety of symptom change, and discomfort from their own healing system. The sensation of aching and fullness from the injections themselves are gone in a few minutes. Some people feel ‘better’ in the days following treatment. Most feel their usual range of symptoms.
When will symptoms improve after the first treatment?
What everyone wants to see, obviously, is ‘improvement’ in symptoms—something changing that is ‘outside’ their usual range of symptoms. In addition to feeling ‘less pain’, or being ‘more active before the pain starts’, this can mean ‘sleeping better’, better range of motion, more strength or stability, fewer referred symptoms or headaches…basically any change that is noted during the month after the first treatment is important to bring to our attention. Most of the new collagen is made during the second two week period after a treatment, so often this is when improvement is noted. It is not uncommon to hear people report feeling better during the first ten days, then having their ‘usual’ symptoms recur during the fourth week, just before seeing us again. This pattern also means that the healing system is ‘triggering’.
What if my "worst symptoms" come back during treatment?
One of the most important things I have learned in treating the thousands of patients we have seen, is that if we can noticeably improve symptoms at any point, we are triggering healing. If we are triggering healing, the symptom fluctuations along the course of treatment do NOT mean that the patient is ‘going backward’, or the the treatment has ‘stopped working’. Instead, tensile strength in these structures will eventually increase to the point that the ‘stretch’ will stop, the nerve damage will heal, the tenderness will resolve, and all other symptoms will resolve. But, until healing is COMPLETED, symptoms can vary widely and ‘upticks’ can be ‘as bad as the patient has ever had’. Envision an individual connective tissue structure that is ‘non-loadbearing’ as that cable that ‘stretches’ under load. The healing system is building wires back into the cable progressively. But, as long as the cable is capable of stretching under load, until the job of strengthening is fully completed, the remaining ‘stretch’ is very capable of yanking on damaged nerve fibers, or damaging new ones, and causing symptoms that are just as bad as the patient has ‘ever felt’. This is annoying to the patient, but it does not mean that the treatment ‘is not working’, and that it ‘will not fix the problem’: it simply means that the patient triggered the ‘strain gauge’ in a few structures, loaded them until they stretched, aggravated some nerves, and paid the price…just like they were doing before treatment started.
What can prolotherapy not treat?
- Actual inflammatory disorders, like rheumatoid arthritis and other ‘collagen- vasular diseases’.
- Nerve damage/injury—stroke, severed or damaged nerve fibers following accident or surgery, or an actual neuropathy. Some numbness and tingling in hands and feet is incorrectly diagnosed as ‘neuropathy’ when it is in fact arising from stretch-induced nerve damage in ligaments and tendons. The nature and distribution of these ‘referred symptoms’ are easy to differentiate from an actual ‘neuropathy’ in the office.
- True ‘sciatica’, which is quite rare and which generally puts people in bed and on narcotics. The nature and distribution pattern of these symptoms can easily distinguish ‘true’ sciatica from referred connective tissue damage symptoms.
- Actual spinal stenosis. Actual spinal stenosis causes problems holding urine or feces, and causes numbness in a ‘stocking’ or ‘pantyhose’ distribution in the lower extremities (the entire foot, or the entire leg, instead of in part of the lower leg and foot, for instance), weakness that causes people to have trouble walking without falling, and muscle atrophy. If the problem is simply pain in the back and scattered symptoms down the leg or legs, then there may well be a connective tissue problem causing ALL of these symptoms.
- Joint damage so severe that, not just the cartilage, but the bones of the joint surface are badly damaged. This is an indication for a joint replacement.
How painful is the treatment?
Does the treatment hurt? Yes. But the problem that brings you to see us also hurts, often a lot. So most people who see us are already ‘handling’ quite a bit of pain and the treatment is not that much ‘worse’. We work very hard to minimize the discomfort and to make the patient as comfortable and as relaxed a possible during the process. We also see an interesting phenomenon in many people: as we inject the ‘spots’ where pain has actually been coming from (which are often different than what people have been ‘told’ is the source of their symptoms—the ‘spot’ is actually in the sacroiliac ligament instead of their ‘diagnosed’ lumber disc, for example), people will say, “There it is, that is THE spot..no one has ever found that before!” While treatment is uncomfortable, it is comforting to know that we can actually find your pain-causing structures…and generally resolve your pain.
Although my first Prolotherapy treatment was, for reasons we can discuss in person, more uncomfortable than most treatments I offer, still it was ‘comforting’ to me to feel the doctor ‘hit the spots’ where my pain had actually been coming from, after finding them on examination. That gave me great confidence that he was on the ‘right track’ with his treatment. People who have been treated by other Prolotherapists generally say that our treatment process is ‘more comfortable’ than their previous experience, in addition to being more thorough. My wife and I have had numerous structures treated with Prolotherapy over the last decade. We live very active lives, and are accumulating birthdays at an alarming rate…. We have paid very careful attention as we have been receiving treatments to adapt our techniques to minimize discomfort. You get to benefit from our extensive experience on ‘the other end of the needle’.
What does a course of prolotherapy treatment look like?
The endpoint of treatment is that a patient can return to full activity, doing the activities that they desire, symptom free. If we can trigger the healing system (which we can ultimately do in around 95% of people), and assuming that there are no other major sources of symptoms (which, even in our very broad and varied patient population, is very rare), then we can generally accomplish this. The endpoint of treatment for any given structure is that it becomes ‘load-bearing’, or ceases stretching abnormally under typical body loads. Therefore, the nerve fibers that had been chronically damaged heal, and cease to produce either tenderness or symptoms. Usually many structures are treated in a given patient. Some of these structures finish healing before others, so toward the end of the treatment course it is not uncommon for the treatment size to contract a bit. How do we know what to treat, and what we do not need to treat, at a given visit? We treat only tender structures. Those that have become non-tender can be left alone. We simply continue until we are finished, and this does not comply with any arbitrary ‘schedule’ or patient expectation. Healing systems produce widely varying amounts of collagen with stimulation—some large amounts leading to quick responses, others smaller amounts, leading to progress that can be ‘moderate’, ‘slow’, or ‘very slow’. If the pace of healing is not optimal, we will usually explore options to stimulate the system more strongly, and perhaps look at the healing system per se more carefully.
We track progress with several questions on the patient follow-up form, and with a follow-up pain and symptom diagram. These are extremely helpful in caring for you, for decision making that allows us to render the best care possible. We would greatly appreciate it if you would take these questions seriously and give the best answer you can. Symptoms fluctuate, we understand…but your ‘guesstimate’ answers are surprisingly helpful to us. The fundamental question at each visit is, ‘more of same’, or ‘change course in some way’.
The issue that is most disconcerting to patients during treatment courses is the occasional ‘bad’ day or week that occurs just when the patient ‘thought they were getting better’. We spend A LOT of time discussing whether or not the treatment is ‘working’ in light of these symptom variations. The issue is not that WE do not know the answer to that question…the problem is that what the patient is ‘feeling’ does not match what they ‘expect’ to feel if the treatment is ‘working’. If a person understands the concept of ‘load bearing’ and ‘non-loadbearing’ structures, and realizes that, at any point, if enough force is applied to any of these structures to ‘trip the strain gauge’ (stretch the structure to the point that damaged nerve fibers are yanked, or further damaged), then symptoms MAY WELL be as ‘bad’ as they have ever felt, even though they are very close to being completely healed. If patients ‘get this’ concept, and understand that this is normal and, frankly, expected as patients become more active as they are feeling ‘better’, then much anxiety can be avoided. A more detailed discussion of symptoms during treatment will follow in a few paragraphs.
Some people have a large array of painful and symptomatic structures. One reason that people from all over the country seek us out is that we get excellent results with ‘larger’ issues. Our treatments are more precise, and can therefore cover more geography (we do not treat structures that do NOT need to be treated, as opposed to many practitioners ‘template’ approach—where they treat the same set of structures in every back, neck, shoulder, etc.), and we have developed ways to get patients through treatments that are ‘larger volume’ treatments, so that we can cumulatively treat a multitude of structures successfully in a finite amount of time. If you have this kind of problem, the discussion about overall treatment strategy will be quite detailed and take into account physical, logistical, and financial issues.
Whether we are treating half the body, or ongoing pain in a single structure, we can give patients a general idea of the length of the process, particularly after seeing the ‘trajectory’ of healing after a few treatments. But pace of healing and magnitude of injury are unique in each patient, and this process simply requires that our patients have patience.
What activities promote healing after prolotherapy?
We do want you using the treated structures, as opposed to keeping them immobile and staying ‘off’ them during a course of treatment. Anything that increases blood flow and activity will, in general, promote healing. This includes moderate activity, massage, heating the area with any form of heat, including infrared treatments and ‘cold laser’ treatments, and may include some Chiropractic treatments (being careful to avoid ‘high velocity’ manipulation!). Physical Therapy may be a useful addition, keeping in mind that the premise of Physical Therapy does NOT recognize the reality of vulnerable connective tissue and connective tissue damage. They focus, instead, on the muscles and muscle function. They try to ‘exercise you out of’ the problem by improving muscle strength, balance, and flexibility. If Physical Therapy makes you feel better, all good. If you ‘walk in, crawl out’, if the ‘treatment’ causes increased pain, then it would reasonably be avoided. These ‘increased pains’ seem not to lead to ‘increased healing’ in our patient population.
Oddly, though, I do not mind if you are a little ‘over active’ and you make your symptoms get worse. This almost never means that you have ‘set yourself back’ in the treatment course. This just tells us that we are ‘not there yet’. The goal of treatment is that you are pain free AT YOUR DESIRED LEVEL OF ACTIVITY, not that you are pain-free sitting on the couch watching Dr. Oz. The only way we know whether your structures are strong enough to handle your life is by using them. We can continue to ‘upsize’ these structures to handle any load, from ultimate frisbee to MLB pitching, from jogging to Olympic level running, from puttering around in the garage to playing linebacker in the NFL. So, we DO want you to gradually increase your activity level as you feel ‘better’ during treatment, just use some common sense in light of what is going on in our structures. This is another place where understanding the actual mechanism of the pain-causing process, and how the treatment ‘works’, helps us craft the best strategy, while maintaining peace of mind. The endpoint of treatment is that, with the desired level of activity, structures are free of tenderness and symptoms. This means that the collagen content of the individual structures is now adequate to ‘hold’ any load applied to the structure without any abnormal ‘stretching’ which would damage the indwelling nerve supply. In plain English, healing is now complete.
Am I developing an infection or other complication?
Complications following Prolotherapy treatment are, fortunately, extremely rare. But any medical intervention is capable of causing a complication. Issues which might occur in the treated area were discussed at the initial visit, and made available in writing. While these events are extremely uncommon, it is important to identify any potential problem as soon as possible. Of course, if there is any ‘unusual’ severe pain, or redness and swelling in a treated area, or fever noted following a treatment, please call the office and let us know. Infections are extremely rare following this treatment, but they are a possibility, and the sooner they are identified and treated, the better. If the ribcage or thorax was treated and there is any trouble breathing noted, call the office immediately and go to the nearest emergency room. If the spinal area was treated and there is a new and severe headache noted, that is worse when upright but which gets better when supine, call the office.
How often are treatments given?
Most people are familiar with the ‘healing cycle’ noted after a major operation. Most people resume ‘full activity’ beginning one month after such a procedure, because this is when the production of collagen molecules, used to heal the wounds, is almost completed. With this ‘healing cycle’, 15% of collagen is made during the first two weeks, 85% during the second two week period following surgery, or injury. Therefore, at one month following a treatment, I can tell what has been accomplished, and what is yet to be accomplished, by treatment. This is why the month interval is generally chosen. Can treatments be given more frequently? Yes. If there is a seven day wait after a treatment, subsequent treatment produces a ‘full’ reaction and a second ‘healing cycle’ that is layered on top of the initial one. If you wait less than seven days following a treatment, the responses ‘blend’ and there is less than a full response to the second treatment. We often have athletes who are preparing for a season, or a competition, or we have people traveling from great distance at great cost, who will get treatments at 7 day intervals. And there is no ill effect from delaying treatment more than a month. Each treatment is a self-contained, independent event, which produces a certain amount of strengthening of structures. One treatment does not ‘depend’ on a former treatment in any way, so there is no clinical problem that results from delaying subsequent treatment. It just takes longer to complete the process.
What if I do not finish the treatment?
One principle has become evident: if healing is not ‘completed’, and if a non-loadbearing (tender) structure remains—even though it is ‘stronger’ and the patient ‘feels better’, what do you think will happen over time? Will continuing to use this ‘vulnerable’ structure lead to re-accumulation of small fiber nerve damage? Will this vulnerable structure be more susceptible to further injury? Will this patient be back on the phone to us at some point saying ‘I thought you said this treatment was supposed to produce ‘lasting results’…? Probably.
What is the cost of prolotherapy
| Area treated (Most common areas listed below. Contact us if you have questions about other areas.) | Cost per Treatment |
| Prolotherapy – Low back | 160€ |
| Prolotherapy – Mid-back | 160€ |
| Prolotherapy – Neck | 200€ |
| Prolotherapy – Knee, Shoulder, or Hip (each) | 120€ |
| Prolotherapy – TMJ (each) | 200€ |
| Prolotherapy – Wrist, Ankle, or Elbow (each) | 120€ |
| Prolotherapy – Pubis | 160€ |
| Prolotherapy – Ischial tuberosity (each) | 160€ |
| Prolotherapy – Foot or Achilles (each) | 120€ |
| Prolotherapy – Pelvic floor | 200 – 1000€ |
| Prolotherapy – Hand (each) | 160€ |
| Prolotherapy – Heel (each) | 120€ |
| Prolotherapy – Toe(s) or Finger(s) (dependent upon the quantity treated) | 120 – 500€ |
| Prolotherapy – Sternoclavicular (each) | 120€ |
| Platelet rich plasma (PRP) (added to the above cost of Prolotherapy) | 200€ |