I recently attended a meeting in Kansas City hosted by the American Osteopathic Association of Prolotherapy and Regenerative Medicine. That meeting highlighted some of the recent findings and clinical results using prolotherapy. Particular emphasis was on the experience coupling with PRP (platelet-rich plasma) with Prolotherapy to dramatically enhance clinical results. Also discussed were advanced regenerative injection techniques utilizing stem cell therapy(isolated the patient’s own adipose[fat]cells).
The concept of regenerative medicine, in essence, simple. Injections of substances such as dextrose that can elicit the body’s own normal healing response. This is particularly helpful in connective tissue problems involving areas of chronic laxity, pain or degeneration. Joints such as the neck, shoulder, elbow, knee, hip, ankles, etc. all have the potential to benefit. Even when other treatments have shown little clinical efficacy.
For many years, the common methodology involved simple injection of a hypertonic solution of dextrose injected into the weak connective tissues to create a localized inflammatory response. This subsequently led to better connective tissue healing and an overall diminishment of pain. Often, 24-48 hours following a prolotherapy injection, some patients will notice some mild irritation or swelling.
I was intrigued by several of the case studies and personal anecdotes shared by the presenters at the conference. One lecturer shared his initial introduction to prolotherapy almost 30 years ago when he was a medical student and attended a prolotherapy workshop at an American Osteopathic Medical meeting. At that time, he had an ankle injury that was precluding his overall workout and exercise ability and tolerance. The instructor injected him with prolotherapy. Jokingly, he stated that he felt the next two days were difficult to walk through the conference hall with any degree of comfort. That said, the pain went away and has not returned for 30 years! Quite impressive!
The addition of PRP to enhance regeneration can be dramatic. I was first introduced to the idea some years ago by a local colleague who had a friend who had experienced a biceps tendon rupture. Over the course of a year he had done all conventional therapies afforded to him by sports medicine specialists with no improvement. He did one injection of PRP, and within a few weeks, the pain had completely subsided. About 2 months later he had a repeat MRI, which showed the tendon had completely healed.
Sometime treatments with PRP injections need to be ongoing. However, one injection will often treat the problem. I was particularly intrigued by one of the case studies presented at the meeting of a near total rupture of the ACL in a young, athletically active female. He had noted when this patient came to his office, she had been on crutches for 5 months and was essentially non-ambulatory. She had been advised that the conventional treatment would be surgery, but she and her family did not want to choose that option. He had advised her at the time that despite her request Prolotherapy and PRP probably would not help reconnect the tendons, especially if it was a complete separation. At the patients insistence he opted to give the treatment a trial. Her pain subsided, and function returned after 2-3 treatments. She eventually completed seven total treatments. The followup MRI scan demonstrated a total healing of the ACL ligament. Usually, surgery is the only option. This result is highly encouraging.
When enhanced effects are needed, newer therapies are using a combination of prolotherapy, PRP, and stem cell therapy. The stem cells are autologous. This means they originate from the patient themselves. The body has high reservoirs of stem cells stored in adipose/fat tissue as well as bone marrow. A relatively simple in office procedure can be used to extract a fat sample from the abdominal area. After purifying the patients own stem cells they can be injected into other areas to support normal tissue healing.
– Dr. Guyer
