T Nation

Prolotherapy & Knees

MODS: I’m not sure where to post this; it’d fit in Supp/Nutrition, 35> lifters, Steroids, and maybe GaL; your call.


I’m wondering if anyone has heard of/experienced prolotherapy?

[For those who haven’t, it’s an injection treatment where a solution, usually some kind of irritant is injected into the site of pain to encourage cartilage growth and strengthen connective tissue. The solution is usually a “non-pharmacological and non-irritant” mix.]

I’m considering using it for my chronic knee problems; my hope is that the injections will kick start some new cartilage growth in the area, which allow me to do more exercises for it pain free.

[I’ve suffered from patellar tendinitis for almost 3 years now, and despite arthroscopic surgery on both knees, braces, physio the entire time and non-stop exercises, I still can’t operate at 100%]

It’s still relatively new, so I haven’t been able to find too much information available.

Based on my research, the solution they inject with can vary largely. Often hGH will be added to the irritant solution, and that has had positive results, but it wasn’t very clear on when the hGH would be a good idea or not. I don’t care either way, just want whatever will fix my knees.

I’m 18 (19 in a month) and I’m not sure if the small amount of hGH (if it were used - which is apparently up to the doc) would affect me? I can’t tell if my growth plates are fused, and while I wouldn’t mind being taller, I don’t want to do any damage. Just want working knees.

If anyone has any thoughts/advice on this therapy (with/without the hGH, doesn’t matter to me), it would be greatly appreciated.

My boss has had it done. Has had a few different injections. He seems to like it. I’ll try to get his updated thoughts when I can.

from what I remember, he used primarily sugar injections

Thanks a lot; I’d like to hear how it went for him.

A buddy of mine administers them himself. The process he described sounds a little bit different than what you do, but it’s up the same alley. He swears by them, and offered to do it on me. Unfortunately I didn’t have the balls to do it (in the manner that he described). This guy knows what works too. He’s posting over a 700lb squat at the age of 20, so he’s certainly experienced in this arena.

How does he do it? Is he just using a basic solution? Did he add hGH?

What was unsavory about his method? From what I’ve read, it’s just like an insulin injection needle into the effected area.

Did he have previous knee problems?

Cheers

I’ve had prolotherapy shots for my elbow.

I was given a bunch of solutions, including human growth hormone into various tendons for an elbow problem I was having.

Honestly I can’t say it did much for me. Aggressive soft tissue work seemed to help a lot more.

My 2 cents,

MM

It seems like there have been mixed results among everyone that uses it…

If it had worked, do you have any recommendations about things to ask about/look out for?

To be honest, I would not recommend prolotherapy. Like I said, I had multiple treatments with growth hormone into my elbow and it didn’t help.

I would suggest you pick up Mike Robertsons Bulletproof knees. You need to go beyond the pain site and see WHY your knee is hurting in the first place. It could be movement dysfunction, soft tissue restrictions, muscle imbalances and etc.

If you really insist, find a prolotherapist who is willing to administer the strong stuff. According to my research, you need to hit the injured area with alot of injections per visit.

MM

Thanks. I understand your recommendation against it, but it seems to have worked for some people. Were there any negative side effects to it that you experienced?

From my point of view, since I can get it under insurance, why not try it? I haven’t read of any harm it can do.

I’ve gone through Bulletproof knees, as well as worked with some Olympic physios. I’m almost pain free… but I still wouldn’t trust myself to go back to playing a high level of baseball or other sports. I’ve been working at this for close to 3 years now (I’m about to turn 19).

Either way, I’m still just looking at it as yet another option. I don’t have very many left except to continue my knee exercises (seem to have plateaued); surgery won’t fix me.

I have the same problem. Ive had patellar tendinitis and tendinosis, as well as a tear in the posterior part of the tendon for about 3 years. I’ve done physical therapy and have also had 6 prolotherapy injections with a dextrose solution over a period of 3 months.

Unfortunately, it didn’t work for me. Im still getting extreme stabbing pain and weakness in the tendon with any running, squatting, jumping, walking up and down stairs, basketball, etc. No type of brace or strap works anymore.

After the prolotherapy, I went to the orthopedist and he recommended iontophoresis with dexamethasone, which is administered by a physical therapist. He also told me that surgery has a low success rate for this injury. Have you tried this? I had my first session earlier today, and it feels slightly better. They said it takes two or three treatments to really start to notice a significant difference.

Give the prolotherapy a try if you can get it under insurance. It can work for some people. I haven’t heard of any negative effects from the prolotherapy other than pain and swelling from the injection.

[quote]ryansc wrote:
I have the same problem. Ive had patellar tendinitis and tendinosis, as well as a tear in the posterior part of the tendon for about 3 years. I’ve done physical therapy and have also had 6 prolotherapy injections with a dextrose solution over a period of 3 months.

Unfortunately, it didn’t work for me. Im still getting extreme stabbing pain and weakness in the tendon with any running, squatting, jumping, walking up and down stairs, basketball, etc. No type of brace or strap works anymore.

After the prolotherapy, I went to the orthopedist and he recommended iontophoresis with dexamethasone, which is administered by a physical therapist. He also told me that surgery has a low success rate for this injury. Have you tried this?

I had my first session earlier today, and it feels slightly better. They said it takes two or three treatments to really start to notice a significant difference.

Give the prolotherapy a try if you can get it under insurance. It can work for some people. I haven’t heard of any negative effects from the prolotherapy other than pain and swelling from the injection.[/quote]

Wow, great first post! Thanks!

It seems like our injuries are almost identical. I can only squat with both legs; if I try a single leg squat, it’s almost excruciating. I’ve already had arthroscopic surgery on both; it made it a little better, but in hind sight I wish I hadn’t done it since I don’t think I had really exhausted all the manipulation/exercises I could have done at the time. That was 2 years ago.

I hadn’t heard of iontophoresis treatments before (or of dexamethasone) and just did a quick read. Based on that, it seems like in this application, it would mostly be used to reduce inflammation. How is this different from cortisone? What purpose would the iontophoresis serve?

I’ll discuss both of these options with a doc I’m seeing soon.

It’s such a frustrating injury because every time I feel like its improving, I’ll do something that will make it just as bad as it ever was.

Dexamathasone is a very strong antiinflamatory medicine, much stronger than cortisone. Usually, cortisone is injected, but it’s been shown that injections of steroids directly into tendons can weaken the tendon and lead to rupture. The way iontophoresis works is using a negative charge to repel the negatively charged medication directly into the tendon over a period of 10-20 minutes.

When I was talking to my orthopedist about this, I was worried that this might just be a way to get rid of the acute inflammation and the pain would just come back when the treatments stopped. He assured me that this would work permanently, and that he has had a lot of success with iontophoresis treating this same injury. I will be getting 2 treatments a week over the next 3 weeks, so hopefully this works. It might be my last option before surgery.

I think I have to agree with mr. martian on this one…
You’re wasting your time and money if you’re going to get this injections and not address the root of you’re problems by looking and you’re muscle strength and flexibility imbalances. Then when the injection doesn’t work, people come to the conclusion that it’s a useless shot, however they don’t realize what they’ve simply done is kept reinjuring their said knee.

As for me? Although I’ve never tried prolotherapy, there is one area I have tried and suggest you look in to. It’s called PRP (protein rich plasma), where essentially you have your blood drawn, then centrifuged so all the platelets, proteins, and growth factors are isolated and reinjected back into you knee. I had this done post operatively on my knee (cartilage reconstruction via debridement and microfracture). Although I can’t tell you how much it worked in regenerating cartilage, I can tell you that I had little issues with tendonitis post-op, so it is definitely something to look into.

But first and foremost address your strength and muscle imbalances. Although Cressy and Robertson are both brilliant guys, their DVD Magnificent Mobility does little to address and help alleviate serious issues with muscle strength and flexibility imbalances. I was a college basketball player a few years ago who couldn’t improve his flexibility at ALL. Get a functional movement screen - after I had one was when I finally saw improvements in my flexibility and movement performance (and yes, I had no tendonitis after).

I agree with your assessment, hungryone - except that I have done all of that, for several years now. Read the above posts.

Thanks for the tip about PRP though, I’ll add it to my expanding list now: PRP, prolotherapy, and dexamathasone.

[quote]ryansc wrote:
It’s such a frustrating injury because every time I feel like its improving, I’ll do something that will make it just as bad as it ever was.

Dexamathasone is a very strong antiinflamatory medicine, much stronger than cortisone. Usually, cortisone is injected, but it’s been shown that injections of steroids directly into tendons can weaken the tendon and lead to rupture. The way iontophoresis works is using a negative charge to repel the negatively charged medication directly into the tendon over a period of 10-20 minutes.

When I was talking to my orthopedist about this, I was worried that this might just be a way to get rid of the acute inflammation and the pain would just come back when the treatments stopped. He assured me that this would work permanently, and that he has had a lot of success with iontophoresis treating this same injury. I will be getting 2 treatments a week over the next 3 weeks, so hopefully this works. It might be my last option before surgery.[/quote]

I hope it works for you. I also encourage you to make sure you explore every possible other alternative; as I said, I wish I had waited a little longer for my arthroscopic surgeries, even though they did help a bit. Once you’re cut open, it’ll never be quite the same.

I can also sympathize with you on the sensitivity of this injury. It took me almost two years to get this very mild “swelling” out from one knee. Even now if I do something that feels a little off to either knees, I freak out - go ice/heat asap, stretch for an hour, foam roll it, pop some pills, etc…

Moving back on this thing would probably cause me to just amputate both legs.

Thanks for the info on the dexamathasone, especially the comparison with cortisone. I’ve had one or two shots of cort, and I didn’t really notice much of a difference.

How did your injury start? Was there some trauma?

Mine developed slowly when I was doing multiple high level sports.

Mine came on gradually starting about 5 years ago with basketball and baseball. At that point it wasn’t too bad and I could still perform at 100%, but just got pain afterwards. It just got worse and worse after that. I don’t recall any one specific trauma, just the repetitive trauma of jumping and running.

Baseball here too! I swam competitively before that, but ended up choosing baseball. A year after that, the pain started; I played through it for a season and then I was done.

I probably COULD play at a high level again, but I’m still paranoid about injuring it somehow… and adding another few years onto my ‘sentence’.

Good luck.

[quote]madquarker wrote:
I haven’t read of any harm it can do.[/quote]

That’s what I was thinking too. I got prolotherapy to fix an adductor injury. Doctor assured me I would be fixed. I’m worse off then I was before (pain in new areas). I don’t trust these doctors.

I would be very hesitant about trying this. Like you, I was out of options and considered this. If I could go back, I would have changed my mind. My best advice would be to rest for an entire year and reevaluate. I know that sounds like a long time, but if you give your body enough time to heal.

I hear you; I’m actually a little way through that. I stopped seeing my physio about a year ago since they had run out of new exercises for me to do, so I just kept going at them myself. I got my girlfriend to roll my leg with the pipe, and I foam rolled it of course :slight_smile:

I’ll give it a little longer; I’m definitely not going to jump into anything.

I don’t get how there COULD be any harm done though; it’s just a basic solution, it should be absorbed and carried away, no? Was there something unique about your case?

Hi guys, I ve been suffering from pattela tendinosis for almost 7 years now. Last 2 years I was almost pain free and could play competitive sports but know the pain kicked in really hard and I dont now what to do to make it go away.
My treatment was to stay innactive and tecatherapy, I also worked hard on soft tissue work, but now everuthing is gone and pain is right back up.
Any suggestions on what can we work on with this kind of injuries??