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Prolotherapy for Injuries

i have used in the past and it heals by swelling up an injury. anybody else tred that?

I have never tried it but from what I have read it sounds like it would work perfectly. From what I have gleened it tightens up connective tissue like ligaments and tendons. Couldn’t prolotherapy work by just puncturing the injured ligament or tendon multiple times without injecting a solution? because either way the area is going to be irritated and initiate an acute response.

On a sidenote related to prolotherapy… with ligament injuries like strains and sprains e.g. a sprained ankle, why on earth is treatment aimed at reducing inflamation?! Surely if the ligament has a tiny blood supply reduction of inflamation is the worst thing to do becuase doesn’t inflamation flush the area with extra blood so that the ligament can heal?

/ramble

[quote]pgtips wrote:
I have never tried it but from what I have read it sounds like it would work perfectly. From what I have gleened it tightens up connective tissue like ligaments and tendons. Couldn’t prolotherapy work by just puncturing the injured ligament or tendon multiple times without injecting a solution? because either way the area is going to be irritated and initiate an acute response.
[/quote]
Spot on.
But the inflammation is stronger using certain proliferants (dextrose, sodium morrhuate) and thereby attracting more growth factors to the injury site.
Platelet-rich plasma (PRP) is purported to work especially well, since it already contains said growth factors, usually at higher concentrations (and maybe even additional ones - I’m not well versed re PRP).

[quote]pgtips wrote:
On a sidenote related to prolotherapy… with ligament injuries like strains and sprains e.g. a sprained ankle, why on earth is treatment aimed at reducing inflamation?! Surely if the ligament has a tiny blood supply reduction of inflamation is the worst thing to do becuase doesn’t inflamation flush the area with extra blood so that the ligament can heal?
/ramble[/quote]
Again, hit the nail on its head.
Unless post-injury swelling gets debilitating, taking anti-inflammatories (even fish-oil) will hamper healing.

i have heard of positive studies on prolotherapy, but also some negative ones.
it’s too expensive . i have been trying to figure out how to get dextrose and inject it myself. i dont think regular sugar water is the same thing.

[quote]FattyFat wrote:

[quote]pgtips wrote:
I have never tried it but from what I have read it sounds like it would work perfectly. From what I have gleened it tightens up connective tissue like ligaments and tendons. Couldn’t prolotherapy work by just puncturing the injured ligament or tendon multiple times without injecting a solution? because either way the area is going to be irritated and initiate an acute response.
[/quote]
Spot on.
But the inflammation is stronger using certain proliferants (dextrose, sodium morrhuate) and thereby attracting more growth factors to the injury site.
Platelet-rich plasma (PRP) is purported to work especially well, since it already contains said growth factors, usually at higher concentrations (and maybe even additional ones - I’m not well versed re PRP).

[quote]pgtips wrote:
On a sidenote related to prolotherapy… with ligament injuries like strains and sprains e.g. a sprained ankle, why on earth is treatment aimed at reducing inflamation?! Surely if the ligament has a tiny blood supply reduction of inflamation is the worst thing to do becuase doesn’t inflamation flush the area with extra blood so that the ligament can heal?
/ramble[/quote]
Again, hit the nail on its head.
Unless post-injury swelling gets debilitating, taking anti-inflammatories (even fish-oil) will hamper healing.

[/quote]

Hi FattyFat,
You seem pretty knowledgable about prolotherapy, are you in the medical profession?
I also seem to remember from another thread that you live in Belgium right?
The reason that i’m interested is that I’m planning on learning prolotherapy when I graduate medical school and I’ve lived (and still do) near Antwerp for almost 10 years.

[quote]Erasmus wrote:

[quote]FattyFat wrote:

[quote]pgtips wrote:
I have never tried it but from what I have read it sounds like it would work perfectly. From what I have gleened it tightens up connective tissue like ligaments and tendons. Couldn’t prolotherapy work by just puncturing the injured ligament or tendon multiple times without injecting a solution? because either way the area is going to be irritated and initiate an acute response.
[/quote]
Spot on.
But the inflammation is stronger using certain proliferants (dextrose, sodium morrhuate) and thereby attracting more growth factors to the injury site.
Platelet-rich plasma (PRP) is purported to work especially well, since it already contains said growth factors, usually at higher concentrations (and maybe even additional ones - I’m not well versed re PRP).

[quote]pgtips wrote:
On a sidenote related to prolotherapy… with ligament injuries like strains and sprains e.g. a sprained ankle, why on earth is treatment aimed at reducing inflamation?! Surely if the ligament has a tiny blood supply reduction of inflamation is the worst thing to do becuase doesn’t inflamation flush the area with extra blood so that the ligament can heal?
/ramble[/quote]
Again, hit the nail on its head.
Unless post-injury swelling gets debilitating, taking anti-inflammatories (even fish-oil) will hamper healing.

[/quote]

Hi FattyFat,
You seem pretty knowledgable about prolotherapy, are you in the medical profession?
I also seem to remember from another thread that you live in Belgium right?
The reason that i’m interested is that I’m planning on learning prolotherapy when I graduate medical school and I’ve lived (and still do) near Antwerp for almost 10 years.[/quote]

Thanks, but I’m only an educated patient with some experience in the area, meaning I have some useful anatomy and ligament injection knowledge and experience or put differently: I’m feeling confident enough for self-prolotherapy on certain joints, right now.

I’m from Germany and it was hard finding docs who perform prolotherapy, actually.
And even among those practicioners there’s no general consensus on prolotherapy specifics:

  • injection technique
  • proliferants used
  • determining treatment eligibility
  • treatment frequency
  • adjunct therapies
  • limits of prolotherapy (some think it’s only scar tissue lay-down whereas others think that after tissue maturation the patient will have regrown full-quality tissue that’s even stronger than the original one)
  • how sports and rehab fit into the equation

Also, I’m sure the guys tooting their own horns by hawking prolotherapy on the internet and certain publicly accessible video streaming platforms don’t help the cause, either.

A few pointers that might aid you in your search for further resources

  • all practitioners I’ve found so far explicitly specialize in pain management, amongst other services

  • most practitioners that came up in my search also provide neural therapy: I think this is crucial since this field requires good injection skills

  • some practitioners haven’t heard about the term prolotherapy, but offer the same services under the label sclerotherapy (not to be confused with the treatment modality used for ulcers and related stuff)

  • it’s funny, but all of the aformentioned practitioners do have a sports background, some of them still somewhat engaged in their sport of choice

  • in Germany, I know of at least two prolotherapy certification authorities - not all practitioners I’ve met so far are ‘certified’, but I guess those prolo CAs can be quite useful to point you in the right direction, at least

  • Germany’s leading authority on prolotherapy is this guy; I’d contact him if I were you: http://www.eapro.de/Proliferationstherapie/Kontakt-Europaeische-Akademie-Proliferationstherapie.html (I haven’t been at his practice, yet, but from what I’ve heard about him he’s quite good at what he’s doing)

Wow that’s really interesting FattyFat!
Thank you so much for your tips, it sure is hard to find practitioners who do a lot of prolotherapy in Europe, I know of some in the UK, Italy, and now in Germany.
I was at the yearly conference of the American Association of Orthopedic Medicine a few months back, and it blew my mind! I loved it!
I’ve also done a 1 day mini course on neural therapy, and a course and neural prolotherapy.
I’m also practicing neural prolotherapy on family and patients and I’ve had great success so far!
people walk in with a lot of pain, often 8 out of 10 , and walk away pain free! (that lasts from 4 hours to 4 days)
Maybe neural prolotherapy is something for you to try out as well, it’s really easy. PM me if you want more details

I see myself in 5 years as a pain-specialist for the musculoskeletal system. So I’m not interested in cancer pain , …
More like a mix of non-surgical orthopedics and pain management and there is nobody in a 500 km radius around me that does those kind of things that I know of.

I have a slew of chronic wrist and elbow injuries at the moment, and have purchased a guide for prolotherapy (intended to be sold to doctors) over the internet, and sterile water and sterile 50% dextrose which I will mix to about 20% for injection. Wish me luck! :stuck_out_tongue:

Would love to have this done by a skilled doctor, but I simply can’t afford it. You can get 25 vials of 50ml 50% dextrose for $45 off the internet.

[quote]Ray567 wrote:
I have a slew of chronic wrist and elbow injuries at the moment, and have purchased a guide for prolotherapy (intended to be sold to doctors) over the internet, and sterile water and sterile 50% dextrose which I will mix to about 20% for injection. Wish me luck! :stuck_out_tongue:

Would love to have this done by a skilled doctor, but I simply can’t afford it. You can get 25 vials of 50ml 50% dextrose for $45 off the internet.[/quote]

Jesus Christ, good luck. Be careful, eh?

[quote]Ty-fi wrote:

[quote]Ray567 wrote:
I have a slew of chronic wrist and elbow injuries at the moment, and have purchased a guide for prolotherapy (intended to be sold to doctors) over the internet, and sterile water and sterile 50% dextrose which I will mix to about 20% for injection. Wish me luck! :stuck_out_tongue:

Would love to have this done by a skilled doctor, but I simply can’t afford it. You can get 25 vials of 50ml 50% dextrose for $45 off the internet.[/quote]

Jesus Christ, good luck. Be careful, eh?[/quote]

x2

[quote]Ty-fi wrote:

[quote]Ray567 wrote:
I have a slew of chronic wrist and elbow injuries at the moment, and have purchased a guide for prolotherapy (intended to be sold to doctors) over the internet, and sterile water and sterile 50% dextrose which I will mix to about 20% for injection. Wish me luck! :stuck_out_tongue:

Would love to have this done by a skilled doctor, but I simply can’t afford it. You can get 25 vials of 50ml 50% dextrose for $45 off the internet.[/quote]

Jesus Christ, good luck. Be careful, eh?[/quote]

I will be. I’m reviewing elbow and wrist anatomy non-stop to ensure I don’t hit any nerves. The book is also very in-depth as well. I will be using a small needle as well, so even if I do hit a nerve, it won’t be any long-term pain or dysfunction.

Just picked up my iodine!

Hi Ray567,

Good luck!
What is the name of the book?
Be sure to disinfect properly, you really don’t want to be dragging germs into joints. wipe twice with iodine and twice with an alcohol patch.
If you have any questions I can get in touch with docs that practice prolotherapy.
I don’t think you’ll need a local anesthetic, being a man and all.

Good luck again!

@Erasmus
If I could go back, I’d also shoot for becoming a ‘pain-specialist for the musculoskeletal system’.
It’s astonishing how little most orthopedics know or care to treat in terms of restoring joint function and treating myofascial symptoms and causes.
After having picked up a good overview of possible treatment options regarding the above, I can’t help but feel personally insulted as a patient given how many docs - allegedly specialists - hadn’t given a crap about my musculo-skeletal ailments.

I’m interested to learn more about neural prolotherapy and the like. Unfortunately, my PMs aren’t working, but I’ve listed my email address in my hub.

@Ray567
Could you pinpoint the ligaments/tendons in question?
I’ve had wrist prolotherapy and it did a lot for resolving wrist pain I had for a good 5 years.
What’s the name of the book?

Good luck, be careful.

@Erasmus

Yes, that is my main concern with doing this - infection. My understanding is that tendons and ligaments and other structures with low blood flow are sort of “out of range” of the immune system. I will take your advice and wipe it down twice with iodine and twice with alcohol.

Not using a lidocaine or procaine injection, but I have an ethyl chloride spray, and this seems like a good time to whip it out. Lessening pain should help me focus.

In the next couple of days I will get the name and website of the book up on here. I might scan the section on wrists and show it to you, I would love to see your or your prolotherapist colleagues’ opinions on it. If that is a possibility.

Also, any clue where I can get a marker designed for marking injection sites? Can I just use a sharpie, and do the sterilizing wipes afterward? The alcohol might wipe it away though.

@FattyFat

The pain seems to be pretty wide-spread in my wrists, so I’ll be injecting all the ligaments the book guides me to inject. The doctors I’ve gone too just said I had “general” ligament laxity and damage in my wrists. But particularly my scapholunate joints give me trouble. I have a cyst in that spot on my left wrist I will be aspirating a day or two before the prolo.

In the next couple of days I will get the name and website of the book up on here.

continued

@FattyFat

Also, for the elbow, I intend to also take a comprehensive approach. I was diagnosed with tennis elbow, golfer’s elbow, and tricep tendonitis in both. They’re real beat up. Also, I self-diagnosed my elbows with ligament damage, particularly to the annular ligaments, the LCLs, and the UCLs. I will be injecting all the major tendon and ligament attachments in my elbows.

Probably will spread the injections over a couple of days.

[quote]Ray567 wrote:
@Erasmus

Yes, that is my main concern with doing this - infection. My understanding is that tendons and ligaments and other structures with low blood flow are sort of “out of range” of the immune system. I will take your advice and wipe it down twice with iodine and twice with alcohol.

Not using a lidocaine or procaine injection, but I have an ethyl chloride spray, and this seems like a good time to whip it out. Lessening pain should help me focus.

In the next couple of days I will get the name and website of the book up on here. I might scan the section on wrists and show it to you, I would love to see your or your prolotherapist colleagues’ opinions on it. If that is a possibility.

Also, any clue where I can get a marker designed for marking injection sites? Can I just use a sharpie, and do the sterilizing wipes afterward? The alcohol might wipe it away though.

@FattyFat

The pain seems to be pretty wide-spread in my wrists, so I’ll be injecting all the ligaments the book guides me to inject. The doctors I’ve gone too just said I had “general” ligament laxity and damage in my wrists. But particularly my scapholunate joints give me trouble. I have a cyst in that spot on my left wrist I will be aspirating a day or two before the prolo.

In the next couple of days I will get the name and website of the book up on here.
[/quote]

If you use the disinfection protocol and work sterile with your needle I wouldn’t worry too much about it.
Dextrose is a natural antiseptic so it kills any stray germs that you might drag with you with your needle.

For marking I use a simple eyeliner or some kind of skin pencil. WIth eyeliners you don’t run the risk of tattooing yourself if you stick your needle through the marked spot. Also it’s cheap and you probably already have it around the house. I would recommend marking first and wiping second, then injections. Usually eyeliner is made to withstand water and a little soap so I think you will still be able to see the markings. Test it before you do the real thing. If the markings don’t hold, do the disinfections first, mark second and then wipe it again with alcohol.

I’m really curious: are you going to inject yourself only using one hand? or do you have some help from somebody else?

Here is a video from Dr Jon Trister, president of the AAOM, very friendly and super experienced guy, giving injections in the wrist area, note the disinfection protocol he taught me :p, he also mentions that he injects 1 cc (1 ml) per site: I would also do that, another rule of prolotherapy is: you must always touch bone with your needle, meaning that you plan to hit the enthesis . Notice how he pierces the skin first and then starts to move around with his needle: he is palpating with his needle, meaning that he first hits a bony structure and then starts to move around to “feel” around where the bone ends, where the ligaments are,… Ligaments are felt like a resistance to your needle, again I would advice to try to get as close to the enthesis of the ligaments to the bone, so if you hit bone, pull back just a tiny bit and hit it with 1 cc (1 ml).

Here is video of Dr Ross Hauser, another prolotherapist.
You will notice directly that he has a different style of injecting. There are 2 styles, east coast and west coast so to speak. Ross Hauser is more of the school that says: the more injections the better, just hit the whole area !
I think this technique is easier to do for the beginner. I see it as a concentrated sniper shot vs a shotgun with buckshot, you are more likely to hit the desired ligament when doing that. So when in doubt: just inject it.

@Ray567
Also, I’d like you to know that wrist prolotherapy does hurt some, so prepare for some pain.
I have a very high pain tolerance, not only with prolotherapy - but to this day, wrist prolotherapy tends to surprise me and make me gasp.
Luckily, there’s only soreness for up to two or three days, afterwards, no pain.

I’m not saying that to deter you from doing it, actually I applaud you.
Also curious if you’re planning on doing it solo.

[quote]pgtips wrote:

On a sidenote related to prolotherapy… with ligament injuries like strains and sprains e.g. a sprained ankle, why on earth is treatment aimed at reducing inflamation?! Surely if the ligament has a tiny blood supply reduction of inflamation is the worst thing to do becuase doesn’t inflamation flush the area with extra blood so that the ligament can heal?

/ramble[/quote]

Too much of a good thing can be a problem. If comparing ligament injuries to a cut, there’s blood then there’s blood leaking. When you first injure the area there’s more blood then can help sitting in the area. As it sits its not really used, and does more harm then good. This is why they usually want to reduce inflammation the first 48 - 72 hours. After that the aim is get blood to the area. That’s all theory. Studies have shown that reducing inflammation through NSAIDS helps people get back to their job quicker, but not using them helps it heal stronger so it’s your choice.

every place that sells dextrose online seems to require a doctors note.
i was lucky to come across a small bag 10% dextrose being thrown out at the hospital i volunteer at. i only ever see them come in big bags of 5%.
but i was reading about other things to use besides dextrose. i read that prolotherapists sometimes use tannic acid and also glycerin.

@Erasmus

No way! I have seen that video of Dr. Trister performing prolo before, and noticed his disinfection protocol was the same as what you told me! I was wondering if you were the same person :stuck_out_tongue:

And thanks for the tip about the eyeliner. I don’t think I have any, so I will pick some up within the next couple days. At the moment I’m waiting on my shipment of dextrose and isotonic sodium chloride before I can do the injections. I have sterile water vials that I was originally intending to use to dilute the D50, but I’m no longer sure if that will be useful. Correct me if I’m wrong, but the dextrose prolotherapy works by being hypertonic and causing the cells to burst, causing inflammation and, after time, healing. What I’ve read is that prolotherapists who don’t use a compounding pharmacy dilute their dextrose in 0.9% NaCl (or lidocaine solution which I don’t have). The pure sterile water I have would be hypotonic though. If I mix that with the dextrose, would it be less effective? I have 24 10mL vials of sterile water without any additives, bacteriostats, or NaCl. If I can make use of them it would be convenient.

I have heard about the east coast and west coast styles of prolotherapy, and Dr. Hauser’s “comprehensive Hackett-Hemwall prolotherapy” technique. From those videos I see Dr. Trister palpates and identifies the bones of the wrist and, like you said, sort of feels where the bone ends and where the fibro-osseous junction of the ligaments are. Whereas Dr Hauser described his injections as “rows” of injections that cover the whole area. I can see the solution under the skin covering pretty much the whole wrist area.

The buckshot approach seems more appropriate to my wrists considering the widespread damage they have and the duration of the injuries. But my book describes the location and markings of each ligament… Buuut, the book seems to miss certain areas the buckshot approach covers, such as the transverse metacarpal ligaments.

I’m drawn to doing the buckshot, but I am a bit scared of hitting structures like nerves or arteries.
What is the worst that could happen if I inject like that?

I am going to inject myself with one hand. That’s another thing that I suppose limits me from Dr. Trister’s approach. But, with markings, I don’t think I’d need my other hand anyway. All the videos of Dr. Hauser I’ve seen, he only seems to use one hand.

I think my family and friends would think I’m crazy if I asked for help with this. : /

Thank you SO much for all this help you’re giving me!

@FattyFat

Yes, I will prepare for the pain. Again, hopefully the ethyl chloride spray helps. I may be getting a minor unrelated surgery soon, if they give me Vicodins or something, I could use those for the prolo.

Haha thanks for your applause :slight_smile: and I talked to Erasmus just up there on this post about doing it solo.