PROLOTHERAPY
What is prolotherapy?
Prolotherapy is a regenerative injection therapy to treat chronic pain related to ligaments, tendons and joints.
Why is it performed?
Ligaments and tendons are made up of connective tissue. Their function is to stabilize joints and attach muscles to bones. It is therefore essential that ligaments and tendons remain healthy.
Because ligaments and tendons are hypovascular tissues that are poorly supplied with blood, the body’s own ability to repair the tissues may be limited. In addition, although they are semi-elastic tissues that are very resistant to traction, they can be injured and weakened by problems in the biomechanics of the body or overuse (typical in athletes).
Some of the causes or problems to receive prolotherapy are:
- Achilles Tendinosis
- Patellar tendinosis or quadriceps tendinosis
- Trochanteric bursitis
- Epicondylosis or tennis elbow
- Epicondylosis or golfer’s elbow
- Rotator cuff tendinosis
- Tendinosis of the supraspinatus tendon
- Chronic ankle and knee sprains
- Partial ligament ruptures
- Pubalgia (adductor or abdominal tendinosis)
- Rheumatoid arthritis
- Arthrosis
- Knee osteoarthritis or ganarthrosis
- Osteoarthritis of the hip or coxarthrosis
- Plantar fasciitis
- Lumbalgia, cervicalgia and dorsalgia
- Headaches of musculo-tendinous-ligamentary origin
- Sacroiliac dysfunction
What does it consist of?
Prolotherapy consists of injecting regenerative solutions into chronically painful or weakened tendons or ligaments. These injected substances have an irritant effect that induces a local inflammatory process, which increases the blood flow in the area and attracts various cells that repair the tendons or ligaments that have been injected. Thus, with the injection of irritating substances a natural inflammatory process is triggered, with the consequent stimulation of fibroblasts, which leads to the production of collagen fibers and the repair of injected ligaments, tendons and joints.
After the injection the patient may notice an increase in pain, as a consequence of the inflammation generated in the injected area. This is normal and the pain will disappear after a few days.
The substances used for prolotherapy are mainly hypertronic dextrose (a totally natural sugar) and sodium morrhuate. Platelet-rich plasma, which is obtained from the patient himself minutes before application, is also used. The latter is a product with many regenerative capacities in muscles, tendons, ligaments and articular cartilage.
It is interesting to note the difference between prolotherapy and corticosteroid infiltration:
- Hypertonic dextrose has no anti-inflammatory effect. What it does is to stimulate a local inflammatory reaction in a controlled manner, to repair and strengthen tendons, ligaments and joint cartilage.
- Corticosteroids, on the other hand, have a strong anti-inflammatory effect but can have a negative effect by weakening tendons, ligaments and articular cartilage.
- Although the initial effects of corticosteroid infiltration are very good, with rapid pain relief, the long-term effects are negative for joint stability and joint health.
- Hypertonic dextrose seeks to cure the patient and not only to momentarily reduce pain, as occurs with corticosteroids.
Preparation for prolotherapy
Prior to the application of prolotherapy it is necessary to make a thorough study of the problems suffered by the patient. Thus, a good clinical and imaging diagnosis of the cause of the pain should be made. It is also necessary to know the exact location where the substance is to be placed, which is why it is sometimes necessary to do so with ultrasound guidance.
It is also important to bear in mind that, together with prolotherapy, it is necessary to correct the biomechanical factors that induced the damage to the joint, tendon or ligament: overweight, bad posture, poor sports performance, postural imbalances, etc.
Care after the intervention
As mentioned above, it is possible that after the intervention the patient may notice an increase in pain, due to inflammation in the injected region. The pain is normal and usually disappears after a few days. However, patients are usually advised to stop taking anti-inflammatory drugs after prolotherapy. The specialist will recommend non-anti-inflammatory analgesics to which the patient can resort in case of pain.