Wednesday, July 25, 2012

Prolotherapy... Good, Bad, Evil????


There are many tools and techniques to choose from in the world of medicine. Recently I’ve been asked about what I thought about prolotherapy…is it good, bad, evil?

Well, let’s go over it…

The first thing you have to realize is that you need to love needles…or at least tolerate them.  Prolotherapy involves injecting dextrose, lidocaine (a common local anesthetic), phenol, glycerine, or cod liver oil extract into a really flimsy, overstretched tendons or ligaments for the purpose of strengthening the suspect tissue to try and relieve musculoskeletal pain.

Prolotherapy sessions are done every three to six weeks, gradually tapering off over time until they are, hopefully, no longer needed.

Like any technique, there is a bit of an “art” to it. So the more experienced the doctor is the better. You don’t want someone to “practice” this on you.

The concept is simple. A joint is forced to move more than it’s designed and its tendons or ligaments become flimsy. However, unlike a muscle, you can’t make tendons and ligaments stronger with resistance training. Instead, the trick is to somehow get them to shrivel up, get shorter and thicker...the body's natural response to direct trauma with a sharp instrument. Kind of like a face lift.

Or you could remove the perpetual cause…but we’ll get to that later.

Basically, prolotherapy injections irritate the heck out of the involved tissue to get it to thicken-up and get stiffer. That’s the goal. Essentially it’s a skillfully applied scar.

Another technique, referred to as “needling”, has a similar objective. Picture a Roman doctor stabbing a hot needle into a gladiators “unstable” shoulder. Today’s less barbaric version of needling is becoming very common to use on horses.  And now that I’m thinking about it Platelet Rich Plasma (PRP) Therapy probably works via the same mechanism, and may have nothing to do with the red blood cells or the growth factor they try to inject.

There’s a good history with this approach. But other than direct injury, why would someone, other than a gladiator, need to give their ligaments and/or tendons a face lift?

Well, like any chain, if there is a rusty link, the adjacent link will move more than it’s designed to, and wear out faster than normal. In this case, the ligaments that are suppose to limit the joints motion, and the tendons that the muscles use to move and stabilize the joint, can get trashed over time, if the joint is forced to compensate for an adjacent “rusted” joint.

If you have any structural abnormality, you will have a bunch of “rusty” joints, all over your body, which will force their neighbors (above, below, other side) to become “flimsy” to one degree or another.

“Flimsy”, hypermobile joints are usually the ones that end up hurting. Naturally, these are the ones that can be candidates for prolotherapy.

But, you have to ask yourself…What’s the sense in doing prolotherapy on a joint that is just going to get loose again anyway? It’s like lubing the loose links and ignoring the rusty ones.

This is how I think.

The PRIMARY conditions, that can lead to a joint-hypermobility, that I focus on correcting, include: Short Leg Syndrome, Compensatory Lumbar Scoliosis and Anterior Head Syndrome… which result in the loss of the normal loading of the vertebrae, resulting in abnormal joint movement, abnormal mechanoreception (joint dysafferentation in general) which is never limited to the spine, because the extremities almost always end up getting caught up in the mix. Especially the lower ones

It’s valuable to understand how things are connected. How a SYSTEM works. How the hip bone is connected to the…

So, for some patients, prolotherapy is a possibility.  It takes advantage of the body's natural reaction to direct trauma, skillfully applied with a needle, hopefully. It's not good, bad or just doesn't make sense if you aren't going to provide the hypermobile joints a better environment, by giving the “flimsy” joints some slack, to reduce or eliminate the primary condition (rusty link).

Of course there is the occasional exception…Some links just can't get unstuck.