T Nation

Prolotherapy for Injuries

[quote]Ray567 wrote:
@Erasmus

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!

[/quote]

  • I can’t give you advice on your first point simply because I don’t know. I would have to dig a little deeper to find an answer. I do know that the dextrose NaCl mix is used successfully. Actually because of the hyperosmolarity any stray bacteria gets killed.

  • Do whatever’s suits your style best. I would also have opted for the buckshot-style if I were in your shoes.

  • What happens when you hit a nerve: PAIN! the chances of neurological damage is low IMO. The worst think I think transient stuff, I really don’t expect long term defects. you are dealing with a needle here, not a scalpel so cutting nerves through is almost impossible.
    Arteries: I wouldn’t start poking around in the big arteries like carotids, femoral, popliteal, brachial,… hehe
    In the wrist you’ve got the radial and ulnar artery you should steer clear of. If you hit them: you’ll maybe get some internal bleeding, no biggie, may even help healing, assuming you stopped your bloodclot medication of course!
    Caution: some patients get dizzy and some even pass out from the treatment. Not because of the pain but because of the vasovagal reaction of the body. Be sure to sit down and pause if you are feeling light headed.

  • extra info: don’t take antiinflammatories (NSAID), use paracetamol instead (does that have the same name in the us?), don’t apply ice use heat instead. After a few days of pain, stiffness, soreness, immediately start rehabbing the wrist. I don’t have a good protocol for you but I bet you can find something on the internet as well.

I think you are brave to attempt this by yourself.
Just for a disclaimer: I’m not a medical doctor, I’m a medical student in my internships. the education i’ve had in prolotherapy is mainly self-taught, also I’ve been taught injection techniques by various “godfathers” in the prolotherapy world. I’ve also worked with a doctor as his assistant who does a lot of cortisone shots so I’ve seen a lot of injections and a lot of what has to be done around it. I promise you that everything that I’ve advised you to do is what I would do myself and is true to the practical reality. The only reason I dare to give you this information is that I think that you are smart enough not to screw it up.

no way you can get dextrose from the internet. it’s crazy you cant buy sugar water without a doctor in this country. i am trying to give them money. thats not such a bad thing is it?
also, if you have dextrose can you increase the concentration by heating it? that is how everything else on this planet works but i have been surprised before

Excellent! Thank you again Erasmus. That’s pretty much all my questions. If I have any more I might PM you in the future, when my account is allowed that. I am ready to do the injections when the shipment arrives. I may just film my first treatment and put it up here to see if you or anybody else has anything to say about. I will use the buckshot style, with some precise injections on the palmar side for a couple specific ligaments outlined in my book. I will follow everything you’ve told me.

@eremesu

The main, cheapest source for the 50% dextrose vials is sold out at the moment. Hospira is having some manufacturing problems. But, there is a string of peptide selling sites, all run by the same people, who stock the dextrose at 8.50 per 50mL vial. It’s not hard to find the specific sites, I don’t want to risk getting banned telling you though. But look at the peptide sites.

Erasmus, that actually brings me to one more thing I wanted to ask you. The dextrose 50% vials I’m getting are labelled as single use. Is it safe to use it and push the fresh needle through that rubber top, and then save it for the next use? And on the next use, clean the top of it 2x with iodine and 2x with alcohol? Or am I risking infection?

Thanks!

[quote]Ray567 wrote:

Erasmus, that actually brings me to one more thing I wanted to ask you. The dextrose 50% vials I’m getting are labelled as single use. Is it safe to use it and push the fresh needle through that rubber top, and then save it for the next use? And on the next use, clean the top of it 2x with iodine and 2x with alcohol? Or am I risking infection?

Thanks!

[/quote]

People in the hospital reuse vials all the time. What a lot of people do is that you leave your suction needle in the vial and just screw your syringe on and of as needed if you’re going to use it at that same moment.
If you are going to use it another day disinfect the top with alcohol. There are some people that say that because there are no bacteriostats in the D50 you shouldn’t reuse it. But i’m not too worried about it. D50 kills of bacteria through it’s hyperosmolarity in the same way that you can use salt to conserve food. If you work in a clean environment and alcohol wipe the membrane I think you are safe.

No problem man, if my help makes you work more safe then I’m happy!

Wow, self prolo, that’s pretty intense.

There are actually doctors who take insurance for the procedure. For some reason, maybe the ease of entry, it seems like many not so skilled or money grubbing doctors have gotten into it or can’t be bothered to bill it correctly. You may want to look around more, try looking for doctors at larger hospital institutions rather than little practices that are more about marketing themselves.

The biggest single factor for a positive outcome is imaging. Simply put, doctors that say they can do it ‘by feel’ are usually full of bs and just do not or cannot make the investment for a proper muskuloskeletal ultrasound machine. I have had both styles, the unguided version like Hauser where he jabs around and injects a ton of fluid, and an ultrasound guided version where the doctor found a small tear in the ligament, brought the needle right to it and injected a little dextrose. The blind jabbing did nothing but cause huge general swelling even with multiple applications. Thank goodness I found the ultrasound guided practitioner where I could feel results after the first injection. Don’t even waste your money on someone who does not have ultrasound guidance (which by the way, is a much cheaper modality for diagnosis than an MRI). They have actually done clinical trials of the accuracy of practitioners using the blind method and it was something ridiculous like over 50% completely missed the injured tissue. These are trained pros, I’m not sure a self application will be any better.

That said, depending on the type of injury, general swelling, even if not a precise application, may help. Do you have an actual diagnosis or MRI of what tissue exactly is injured? What have you tried non-invasively so far?

You may want to look up Biopuncture. It’s kind of a variation of prolo that is more focused on reseting the subcutanous pain nerves rather than hitting the tissue itself. I don’t know how the results are compare to prolo, but just from watching videos of it it seems like a much simpler procedure that can be done by yourself much easier if you are going through with this.

Btw, some prolo practitioners do a nerve block while others just mix some lidocain into the mixture. I don’t know how painful it is without this, so you may think about getting some lidocain with your dextrose.

i have mild jumpers knee right where the tendon connects to the bone under the knee. it is right under the skin so i dont think i need an ultrasound tech to find it

[quote]truth1ness wrote:
Wow, self prolo, that’s pretty intense.

There are actually doctors who take insurance for the procedure. For some reason, maybe the ease of entry, it seems like many not so skilled or money grubbing doctors have gotten into it or can’t be bothered to bill it correctly. You may want to look around more, try looking for doctors at larger hospital institutions rather than little practices that are more about marketing themselves.

The biggest single factor for a positive outcome is imaging. Simply put, doctors that say they can do it ‘by feel’ are usually full of bs and just do not or cannot make the investment for a proper muskuloskeletal ultrasound machine. I have had both styles, the unguided version like Hauser where he jabs around and injects a ton of fluid, and an ultrasound guided version where the doctor found a small tear in the ligament, brought the needle right to it and injected a little dextrose. The blind jabbing did nothing but cause huge general swelling even with multiple applications. Thank goodness I found the ultrasound guided practitioner where I could feel results after the first injection. Don’t even waste your money on someone who does not have ultrasound guidance (which by the way, is a much cheaper modality for diagnosis than an MRI). They have actually done clinical trials of the accuracy of practitioners using the blind method and it was something ridiculous like over 50% completely missed the injured tissue. These are trained pros, I’m not sure a self application will be any better.

That said, depending on the type of injury, general swelling, even if not a precise application, may help. Do you have an actual diagnosis or MRI of what tissue exactly is injured? What have you tried non-invasively so far?

You may want to look up Biopuncture. It’s kind of a variation of prolo that is more focused on reseting the subcutanous pain nerves rather than hitting the tissue itself. I don’t know how the results are compare to prolo, but just from watching videos of it it seems like a much simpler procedure that can be done by yourself much easier if you are going through with this.

Btw, some prolo practitioners do a nerve block while others just mix some lidocain into the mixture. I don’t know how painful it is without this, so you may think about getting some lidocain with your dextrose. [/quote]

I live in Canada and prolotherapy isn’t covered by our standard health care, and the insurance company I’m under doesn’t cover it either. :frowning:

I had an MRI done (which was covered) which revealed a ganglion cyst and “general” ligament laxity and damage. I haven’t lifted in many months. The actual tears have healed up, but the ligaments are showing up looser, thinner, and longer. Also some cartilage damage, nothing too serious though. I will do intra-articular injections in my scapholunate joints to hopefully clear that up. Conservative treatments I’ve tried: physiotherapy, anti-inflammatories, ice, heat, contrast therapy, chiropractic, and bracing.

This is in pretty much my whole wrist (both wrists actually). Widespread pain and aching, too. With physical exam, hypermobility is pretty apparent. These are the reasons why I think the comprehensive buckshot approach would be appropriate for me, and imaging would be unnecessary. To me, it seems like ultrasound would just draw the injection period out. I’m going to be injecting the whole area because I have damage in the whole area.

In your personal comparison of the blind approach and ultrasound-guided approach, were there any other variables? Did the doctors use different prolotherapy solutions, concentrations? Did the blind approach not resolve any pain, but ultrasound did? Any chance you could link me to one of those studies comparing the two? Anything else you can tell me about your prolo experiences would be much much appreciated! :slight_smile:

I know about biopuncture and orthokine injections, but it seems to be more about pain management than fixing the genesis of the problem, which is what prolo is all about. Biopuncture works by inhibiting Interleukin 1 and TNF-alpha, which are cytokines that basically signal for inflammation. So, it is an anti-inflammatory, which as we all know, is the exact opposite of prolo. That’s what I’ve read, I haven’t heard about the nerve-resetting part though. Also, the solutions would be much harder for a guy like me to get a hold of than dextrose.

Subcutaneous prolotherapy is sometimes used in addition to normal prolo, for chronic injuries that have caused nerve damages. I may try that.

And thanks for the tip! I will look into getting lidocaine.

For anyone interested, I will be starting a log of my self-prolotherapy here:

[quote]Ray567 wrote:

[quote]truth1ness wrote:
Wow, self prolo, that’s pretty intense.

There are actually doctors who take insurance for the procedure. For some reason, maybe the ease of entry, it seems like many not so skilled or money grubbing doctors have gotten into it or can’t be bothered to bill it correctly. You may want to look around more, try looking for doctors at larger hospital institutions rather than little practices that are more about marketing themselves.

The biggest single factor for a positive outcome is imaging. Simply put, doctors that say they can do it ‘by feel’ are usually full of bs and just do not or cannot make the investment for a proper muskuloskeletal ultrasound machine. I have had both styles, the unguided version like Hauser where he jabs around and injects a ton of fluid, and an ultrasound guided version where the doctor found a small tear in the ligament, brought the needle right to it and injected a little dextrose. The blind jabbing did nothing but cause huge general swelling even with multiple applications. Thank goodness I found the ultrasound guided practitioner where I could feel results after the first injection. Don’t even waste your money on someone who does not have ultrasound guidance (which by the way, is a much cheaper modality for diagnosis than an MRI). They have actually done clinical trials of the accuracy of practitioners using the blind method and it was something ridiculous like over 50% completely missed the injured tissue. These are trained pros, I’m not sure a self application will be any better.

That said, depending on the type of injury, general swelling, even if not a precise application, may help. Do you have an actual diagnosis or MRI of what tissue exactly is injured? What have you tried non-invasively so far?

You may want to look up Biopuncture. It’s kind of a variation of prolo that is more focused on reseting the subcutanous pain nerves rather than hitting the tissue itself. I don’t know how the results are compare to prolo, but just from watching videos of it it seems like a much simpler procedure that can be done by yourself much easier if you are going through with this.

Btw, some prolo practitioners do a nerve block while others just mix some lidocain into the mixture. I don’t know how painful it is without this, so you may think about getting some lidocain with your dextrose. [/quote]

I live in Canada and prolotherapy isn’t covered by our standard health care, and the insurance company I’m under doesn’t cover it either. :frowning:

I had an MRI done (which was covered) which revealed a ganglion cyst and “general” ligament laxity and damage. I haven’t lifted in many months. The actual tears have healed up, but the ligaments are showing up looser, thinner, and longer. Also some cartilage damage, nothing too serious though. I will do intra-articular injections in my scapholunate joints to hopefully clear that up. Conservative treatments I’ve tried: physiotherapy, anti-inflammatories, ice, heat, contrast therapy, chiropractic, and bracing.

This is in pretty much my whole wrist (both wrists actually). Widespread pain and aching, too. With physical exam, hypermobility is pretty apparent. These are the reasons why I think the comprehensive buckshot approach would be appropriate for me, and imaging would be unnecessary. To me, it seems like ultrasound would just draw the injection period out. I’m going to be injecting the whole area because I have damage in the whole area.

In your personal comparison of the blind approach and ultrasound-guided approach, were there any other variables? Did the doctors use different prolotherapy solutions, concentrations? Did the blind approach not resolve any pain, but ultrasound did? Any chance you could link me to one of those studies comparing the two? Anything else you can tell me about your prolo experiences would be much much appreciated! :slight_smile:

I know about biopuncture and orthokine injections, but it seems to be more about pain management than fixing the genesis of the problem, which is what prolo is all about. Biopuncture works by inhibiting Interleukin 1 and TNF-alpha, which are cytokines that basically signal for inflammation. So, it is an anti-inflammatory, which as we all know, is the exact opposite of prolo. That’s what I’ve read, I haven’t heard about the nerve-resetting part though. Also, the solutions would be much harder for a guy like me to get a hold of than dextrose.

Subcutaneous prolotherapy is sometimes used in addition to normal prolo, for chronic injuries that have caused nerve damages. I may try that.

And thanks for the tip! I will look into getting lidocaine.[/quote]

Here’s two studies that came up on google:


http://www.musculoskeletalnetwork.com/display/article/1145622/1659005

My case was pure laxity, the ligaments were not actually causing any pain. I had my ATFL done, which should be a relatively easy ligament to reach. I did multiple rounds with the non ultrasound doc and he tried progressively stronger doses with little effect.

My guess is for general pain it will be helpful for you because the general area inflammation will get some of the gunk and inflammation out. Getting right into the thinned ligaments to thicken them up will be the tougher part.

Best of luck!

[quote]truth1ness wrote:

Here’s two studies that came up on google:


http://www.musculoskeletalnetwork.com/display/article/1145622/1659005

My case was pure laxity, the ligaments were not actually causing any pain. I had my ATFL done, which should be a relatively easy ligament to reach. I did multiple rounds with the non ultrasound doc and he tried progressively stronger doses with little effect.

My guess is for general pain it will be helpful for you because the general area inflammation will get some of the gunk and inflammation out. Getting right into the thinned ligaments to thicken them up will be the tougher part.

Best of luck![/quote]

Thanks for those. I don’t think it’s enough info to make any definitive conclusions (the skill of the doctor plays a big role IMO) but that is good info. Unfortunately, I don’t really have a means of ultrasound though, so I’ll be relying on palpation guidance

Yea, ultrasound machines are pretty expensive. Maybe a plain ultrasound would be covered by your insurance? You could haggle with the doc to just hold his ultrasound machine while you do the actual prolo operation yourself so he can’t charge you for it. lol

Maybe no lidocain might help with accuracy? I can’t tell because I’ve only had it with. But it seemed to me that once the needle was under the skin you can’t really feel its position very precisely. You feel the metal at the skin and mostly a dull diffuse pain underneath.

[quote]truth1ness wrote:
Yea, ultrasound machines are pretty expensive. Maybe a plain ultrasound would be covered by your insurance? You could haggle with the doc to just hold his ultrasound machine while you do the actual prolo operation yourself so he can’t charge you for it. lol

Maybe no lidocain might help with accuracy? I can’t tell because I’ve only had it with. But it seemed to me that once the needle was under the skin you can’t really feel its position very precisely. You feel the metal at the skin and mostly a dull diffuse pain underneath. [/quote]

LOL I wish! Or there should be rental services for medical equipment, so people like me can perform medical procedures on themselves.

That could help (no lidocaine). I don’t think I’ll be able to acquire it anyway. I found a site that sells 2% 50ml vials of veterinary grade lidocaine, but I don’t know if it would be safe for me. The book I have also explains a bit how to tell if you’re hitting the ligament attachment properly. Also, Erasmus explained to me how to tell when you’ve hit the ligament, as you can feel resistance on the needle, what with lig tissue being so strong.