Why I Tried Prolotherapy
And Why You Should Too
One of the first patients I treated with prolotherapy told me that the reason she decided to try it was because I had been treated with prolotherapy myself. She was a bubbly woman in her late 40’s who was a fitness instructor with bad knees. She hobbled into my office with the help of her boyfriend, desperate, and not really sure what to do after she was told that she was too young to have a knee replacement and there were no other options. She was having problems at work and needed to modify yoga poses and it was getting harder to teach classes. She had already had several arthroscopic knee surgeries, multiple steroid injections, and a trial of Synvisc injections. None of them worked for very long. She was reluctant to take pain medications, and she was too young to have a knee replacement.
We talked about her options, and she decided to give prolotherapy a try. After her first set of injections she had about 50% relief of her pain and after the 2nd set of injections about 80%. On her last visit she jumped up and down and didn’t need help from her boyfriend to walk. She was scheduled to go on a hiking trip to Hawaii. It was a wonderful feeling to help someone who had been told they had no options. Quite honestly, even I was amazed.
My Story
About 15 years ago, in an episode of distracted bike riding on a beach path, I fell off my bike onto my outstretched arm after losing my balance. A humiliating experience, but also painful. About 10 experienced cyclists in a pack zoomed past me, each asking if I was ok (Are you ok? X 10). No, I was in pain, and yes, I was embarrassed.
For more than a few months I had pain in my left shoulder. I took some ibuprofen and lived with it. I wondered whether I should get some imaging and see a doctor. It was not too bad. Probably in an incomplete rotator cuff tear. My range of motion was still good, despite having some weakness. And like a typical doctor, I got on with my busy life. My shoulder was still a little painful, but tolerable. I am not an athlete and it was my left shoulder. I am right handed. It was mostly better.
An Opportunity
When I went to Honduras to do prolotherapy training, expert injectors offered free treatments, and I thought why not? What better way to learn than to experience it.
After a thorough examination, Milos from Serbia first injected by AC (acromioclavicular) joint. Like any injection, it was a little painful, and then in less than a minute, that nagging pain was gone. Crazy. Gone completely.
The next day I had a little soreness, but I also realized that I had pain in other areas of my shoulder. It was the last day, so I decided to go ahead with a shoulder joint injection and labral injection with the lovely Dr. Carda. Again, the pain was gone, sort of amazing. I would safely say it is 80% better, although I still do have some weakness in my left shoulder. My side plank in yoga still suffers, but it’s a little bit better and when I paddle, my left side is still weak. My pain and function have both improved after one treatment.
Let the Healing Begin
​I had a small amount of discomfort for the first few days. In the next few weeks my shoulder felt more stable. Previously I had pain with internal rotation of my shoulder, so I just avoided it. I was now able move my shoulder into internal rotation without pain. I also felt some aching and the feeling that something “was happening” in my shoulder. I would describe it as some discomfort and an ache. After a few weeks my shoulder was much better, my nagging pain was gone, I had better function and more stability in my joint. It has now been a few years and I’m still doing well.
Looking back
​Early in my medical training I now remember being exposed to prolotherapy and wondering what it was. At that time, I really didn’t appreciate or understand the role alternative or regenerative medicine could play. Just learning the basics of medicine takes a great deal of time and effort. Now many years later, having seen the effects of so many treatments in interventional pain management including various kinds of injections, ablations, devices and stimulators, pain medicine and even surgery, I’m sold. I’m definitely a fan.
Yes, it does work.
If the idea of having a concentrated dextrose (which is a fancy word for glucose or sugar) solution injected into your joint, tendons or ligaments sounds crazy, you are not alone. When I was explaining this to someone recently, they said “can’t you inject something else with it, that sounds like it just wouldn’t work.” I suppose we could do something to make it sexier, but it does in fact work, just the way it is.
I think we are all convinced that medical treatment needs to be invasive to work or that treatment needs to be slightly toxic to produce a result. Our serious issue could only be relieved with surgery or chemotherapy, something serious for a serious problem. After some training and self-reflection, I had to question that idea myself. There are many less serious and less toxic things that can really be helpful and indeed powerful. It is the way we think about medicine.
Dextrose gives your body the food or energy it needs to heal.
We don’t exactly know how prolotherapy works, but there are a few things we do know. The first is that dextrose by nature is safe, we are all eating it every day. The second thing is that we know that it can increase the size of tendons and ligaments. This is based on studies done many years ago on rabbit tendons. Injection of concentrated dextrose showed an impressive 30% increase in tendon size in those studies. The last thing we know is that dextrose modulates pain receptors known as TRVP1. This is considered neuromodulatory (nerve modulating) and explains why people get such rapid relief with injections. As someone who has given many lidocaine injections and other injections, this is not placebo (you should correct your website Cleveland Clinic, it is wrong) or solely the effects of anesthesia; this is the action of dextrose.
To put it simply, dextrose gives the body what it needs to heal. In the words of Dr. Andrew Kochan, renowned prolotherapist and regenerative medicine specialist, who runs the Kochan Pain Treatment Center, “dextrose is like food, it gives the body what it needs to heal.” He also named his clinic specifically “pain treatment” as opposed to “pain management” center, because he feels that this kind of therapy is treatment, not just pain management.
Why I Think You Should Have Prolotherapy
​After studying, experiencing, practicing and interviewing people who practice prolotherapy I think it has wide applications for many musculoskeletal conditions. It is a wonderful treatment option for people who have pain that ranges from mildly annoying to seriously painful and life changing. I have seen prolotherapy work on both ends of the pain spectrum. The most important thing is that the diagnosis is correct and that the condition being treated comes from painful ligaments and tendons that are causing some kind of painful issue. This could be your shoulder, your knee, your foot, your elbow, your neck or your back. Because this kind of pain is not really addressed with conventional medicine, there are many applications for this kind of treatment.
Prolotherapy is Safe
Prolotherapy has been practiced safely for over 75 years and is practiced throughout the world. It is more common in southern Europe, Australia and New Zealand, Taiwan and Korea, Mexico and Argentina, but it practiced worldwide. It involves the injection of 15-25% dextrose into joints or the attachments of tendons and ligaments. Unless you are allergic to corn, or dextrose, or lidocaine, you are probably able to have this kind of treatment. These injections carry no more risk than similar kinds of injections.
Prolotherapy is Regenerative
​Prolotherapy is one of the first regenerative treatments for musculoskeletal pain. This technique was developed before PRP (platelet enriched plasma), which is more well known. These injections help our bodies to heal and to repair themselves, unlike steroid injections.
Prolotherapy is Cost Effective
Prolotherapy is usually less than ½ the cost of PRP injections. PRP or platelet enriched plasma is a more expensive regenerative medicine technique that involves injecting a concentrated solution of a part of your blood that contains important growth factors to promote healing. PRP is a wonderful and effective regenerative medicine technique for musculoskeletal pain. Many people think that PRP may be more effective than prolotherapy, but it is also a little different. Perhaps better for some conditions than others.
Unfortunately, many people are not able to afford treatment with PRP and the cost is out of reach for many people. The second issue is that PRP requires a relatively large blood draw which is off putting for some people. Having seen good results from treatment with prolotherapy, why not try something cheaper and easier first? If that doesn’t work, get treatment with PRP.
Prolotherapy Gives You More Options
So many people are told that they have no options after failing to improve with PT, steroid injections or other fancier treatment like radiofrequency ablation or even surgery. I have seen many people have a variety of procedures including stimulators and even pain pumps, who still do not have relief of pain. Many of these things do work to some degree and provide some relief, and they are useful and helpful treatments.
That being said, prolotherapy gives you the option to treat different sources of pain and the opportunity to strengthen joints, tendons, and ligaments. This is typically not addressed by conventional medical treatment. It is not covered by insurance but is less expensive than PRP.
Prolotherapy is treatment, not management.
This means that after a series of treatments, typically at least two or three or more depending on your condition, but maybe one or two, you should be better for a much longer period of time. It should be a year or more, not weeks or months.
Risks Benefits and Alternatives, Downsides?
In medicine we are often asked to discuss the risks, benefits and alternatives.
Risks of prolotherapy are not greater than other similar injections. What we are injecting is also safe, it’s dextrose or sugar and lidocaine. As with any injection, infection, bleeding, bruising and nerve injury are possible.
Benefits – yes, there are many benefits. It can give your body the ability heal. In my opinion, most of the time people do have at least some benefit. If you do not, maybe the source of pain is different or we are not getting the right area or structure. But I also think too many expect to be cured immediately and that is simply not how any kind of healing works.
Alternatives- most people have already tried physical therapy and are looking into other options. The other common options are steroid injections, which have increasingly been shown to have destructive effects on cartilage in the body. There are also many other alternative treatments such as chiropractic treatment, acupuncture, and laser therapy that can be helpful. PRP is as similar, perhaps more effective, but more expensive option.
Covered by Insurance? No
The last downside is that it is not covered by insurance. There is one state (Wisconsin?) in which prolotherapy is covered by insurance.
I know people are strapped for cash now. I know it is difficult. But I can tell you that people spend money on all kinds of things including getting their nails done and retail therapy. If you think about the benefit of being able to improve your ability to walk and also about the possibility of prevent further degeneration of your body it might be worth it, especially if you have significant pain. If you are looking for possibilities, I think it is a good option to consider. You could try it before PRP, you could try it to shore up an aching body part, you could try it to relieve some pain if you want to put off surgery for a year or so. You could try it if you were told that you had no other options.
Yes, I think you should try prolotherapy.
I have seen it work, felt it work and I feel that it is a good option for musculoskeletal pain that is caused by tendonous and ligamentous weakness. I think this is an often-overlooked source of pain for many people and that can actually be treated with prolotherapy and regenerative medicine. Therapy and exercise are still essential and important for recovery, so there is no replacement for it.
The key is to see a doctor and to have an examination to see what’s actually causing your pain. Prolotherapy and regenerative medicine can work for people with simple musculoskeletal pain that isn’t going away with conventional treatment and PT to people who have serious medical problems and are not candidates for surgery or have had surgery and are still having pain.
Try It. You might find that your pain and function have improved much more than you expected it ever would.