PROLOTHERAPY: NON-SURGICAL JOINT RECONSTRUCTION


Originally Written by: Aubrey, Jean, M.D.

Dr. Aubrey is medical director of the West Nipissing Pain Clinic and Orthopedic Medicine Centre in Sturgeon Falls, Ontario, and past president of the Canadian Association of Orthopedic Medicine. Dr. Aubrey specializes in non-surgical reconstructive techniques for joints called prolotherapy. and he has integrated this technique with many other treatment modalities such as acupuncture and neural therapy. Prolotherapy is a preventative treatment which may help you to avoid back surgery, knee surgery, hip replacements and other orthopedic surgeries. Prolotherapy involves the injection of a natural solution into the joint which stimulates the repair of ligaments and eliminates pain.

WHAT IS PROLOTHERAPY?

Prolotherapy or sclerotherapy is an inflammatory therapy which involves the injection of a known irritant, usually glucose or sodium morrhuate, into a ligament, tendon or joint. This will cause irritation of that joint for the purpose of improving the tensile strength of ligaments. We produce inflammation in order to stimulate the formation of fibrous connective tissue which will bring about healing of that ligament or deficient structure. Prolotherapy was originally evolved by Dr. George Hackett, M.D., in Kenton, Ohio, back in the 1940s and 50s, although you can trace its origins back to the ancient Greeks. You will find references to it in medical literature under various names including sclerotherapy, prolotherapy, or proliferant therapy. More recently, it has been called non-surgical joint reconstruction, coined by Dr. William Faber, D.O., from the Milwaukee Pain Clinic, Milwaukee, Ohio. These terms are used interchangeably. It has been around for a long time and we have tested it, and know the results are reliable. I have used this treatment personally for about 15 years.

WHEN DO YOU USE IT? Prolotherapy is used for any condition in which you have joint instability, or ligament relaxation which is basically the same thing as chronic ligament strain. Everyone knows what acute ligament strain is. This happens when you sprain an ankle, and the ankle swells up and is painful. Chronic ligament strain is a little different, because it involves weakened ligaments which have relaxed and stretched, and can’t support the joints. They are worn down and weakened, and this causes joint instability and a whole cascade of problems which starts from one joint and spreads to the next and produces dysfunction in one joint after another in a chain of events. We also use sclerotherapy for varicose veins and spider veins and other vascular problems. It is used in orthodox medicine for sclerosing veins in alcoholics. It used to be used for hernia repair without surgery. We still use it for hemorrhoids. However, the major use is for ligament strain, ligament relaxation and acute and chronic pain syndromes.

WHAT DO LIGAMENTS DO?

Ligaments stabilize joints. They are the fibrous tissue which connects one bone to another across the joint, guides the motion of the joint, and restricts excessive motion. So you don’t want slack ligaments.

WHAT KINDS OF SCLEROSANTS (PROLIFERANTS) DO WE USE?

We have lots of them. Probably the main one is sugar (glucose, not table sugar). We use it in various concentrations depending on the location. Sometimes we use glycerine. Other irritants that are used are P2G which is phenol-based with glycerine and glucose. We used to use a lot of phenol, but we don’t now because a lot of people are allergic to phenol-like compounds. Plasma QU is another good one, which is quinine and urea. Ground pumice, as well, is used. Sodium morrhuate (distilled from cod liver oil) is another, a very potent sclerosant. In the 1950s, zinc sulfate used to be used, but it is very irritating.

WHERE DO WE INJECT IT?

We inject it in the place where the ligament anchors to the bone, or in the main body of the ligaments. We have a rule that we always touch bone when we inject. That way it makes the procedure very safe.

HOW DOES IT WORK?

We inject the sclerosant in order to stimulate the production of collagen. The sclerosant produces inflammation, which produces a cellular reaction; cellular debris is formed, and the debris attracts white blood cells to the site. In the early inflammatory phase for the first few days, granulocytes are brought in. These attract inflammatory substances toward the site of injury, and enzymes are secreted to clean it up, and hormones and growth hormones are brought in. About ten days later, granulation tissue starts to form because fibroblasts move into the wound and start to heal by laying down collagen, and this forms the basis of the ligament. The collagen goes on to produce tendons and ligaments. So this whole cascade eventually produces ligaments, not just fibrous tissue, but ligaments. This phase will go on for some time. Inflammation is a natural process that your body has evolved over millions of years to repair it. If you don’t have inflammation, you do not have repair. Be aware that when you use anti-inflammatory agents, you can control pain, but you also stop repair.

SIDE EFFECTS OF SCLEROSANTS

There is pain at the injection site which will last sometimes a few hours or sometimes a couple of days. It depends on the sclerosant we use. Morrhuate will produce more pain for a lot longer than glucose. Initially, the injections are combined with local anaesthetics because even glucose injected by itself is not pleasant.

POST-INJECTION INSTRUCTIONS

Usually after a few days it all settles down and you are on the road to rebuilding the ligament support. You must not use aspirin or anti-inflammatory medications (like non-steroidal anti-inflammatory agents). It doesn’t make much sense to use an anti-inflammatory when you are undergoing an inflammatory treatment. You can use Tylenol with codeine if you need it. We do not recommend using ice on the area, just heat and movement. The sclerosing agents must be used in conjunction with exercise, so that your body will determine where to lay down the ligaments in response to the stresses and strains it undergoes.

CONTRAINDICATIONS

We have to make an assessment of levels of toxicity and your nutritional status. This includes the presence of chronic Candidiasis, or use of cigarettes or aspirins. You should stop using these things at least a month or two before we begin treatment.

HOW DO YOU DIAGNOSE LIGAMENT LAXITY?

The prime symptom of ligament laxity is that pain is increased with rest and relieved with movement. In the morning, or if you sit down for any length of time, the pain is worse, and you feel stiff and sore, and can’t move. Then after a while when you are mobile, you feel better. Because of the pain, there is fatigue. The second symptom is that there is recurrence of symptoms. If you go to see a chiropractor, relief may last for a few days, but it comes back again. When it recurs, that usually means that the ligaments have been compromised and they are not holding. We do a physical examination and go through two diagnostic processes, one of stressing and the other of evaluating trigger points:

1. STRESSING All of the ligaments have a way that you can stress them specifically by pushing down on them in the appropriate manner in order to see if the stress produces the symptoms and elicits pain.

2. FINDING OUT WHERE THE TRIGGER POINTS ARE You can stick needles into trigger points and observe how pain irradiates from them. If you stick a needle into an injured ligament, it will send pain down in the distribution of referral for that ligament. In this way, we can determine which ligaments are affected. For instance, the iliolumbar ligament will give you pain to the top of the buttocks, down the side of the leg, and as well to the front and the inside of the leg. If the patient relays that symptomatology, you know his iliolumbar ligament is affected. The ligaments will send pain down the limb, but they will spare the back of the large joints. However, an irradiation of pain from a sciatic nerve impingement will send pain through the large joints all the way down the leg, including the knee and the ankle. So that is another way you can tell the difference. We also examine spinal motion to see which part of which intervertebral disc is moving and how much movement you are getting.

WHAT IS THE CAUSE OF LIGAMENT RELAXATION?

Most of the time ligament relaxation is caused by a sheering injury of some kind, horizontal forces like car accidents, the to and fro motion of whiplash (flexion-extension) injury, falling off ladders, falling down stairs, shovelling, vacuuming, lifting and twisting, repetitive movements, an injury from an unaccustomed task, primary degeneration like arthritis, and some people are just born sort of loose jointed. Pregnancy can slacken ligaments; hormones released during pregnancy like estrogens, progesterones and relaxins will go on to produce relaxing of the ligamental structures in the pelvis to allow the baby to come out. Many women do not recover from this, and will start to complain of back pain. I will also direct your attention to birth control pills which can slacken the ligaments because they simulate pregnancy. Many operations will slacken ligaments; despite the fact they really tie them up again, they don’t heal as well. Ligament relaxation is also caused by sports injuries. Very few sports injuries are muscular, but a lot of them are to the supportive and connective tissue. If a muscle has been sprained, find the joint or the ligament that is causing it to be tight, because the minute you fix that, the muscle will relax again. Actual muscle injuries are very infrequent. We see a lot of injuries from roller blade accidents. Roller blading is actually quite a good form of exercise because it is the only exercise I know to improve thoracolumbar syndrome problems.

Another cause is poor nutrition. People who smoke don’t tend to heal. They do not heal ligaments well because they exhaust a lot of their vitamin C. To make ligaments, and collagen specifically, you absolutely need lots of vitamin C, as well as other nutrients. You need to be nutritionally well prepared, and detoxified to allow the metabolic process to produce collagen.

We will find ligament relaxation in most chronic and acute musculoskeletal disorders, lumbar disc problems, lumbar strains, sacroiliac problems, cervical disc disease, pulled muscles, arthritis in the knees and hips and spondylolisthesis. Ankylosing spondylitis is an auto-immune problem, but the pain and dysfunction respond beautifully to prolotherapy. All of these things are frequently at least partially linked to ligaments. Structural headaches, migraines specifically, are connected with ligament relaxation.

MUSCULOSKELETAL PAIN

Musculoskeletal pain is usually due to some problem involving the joint or joint capsule, and the joint capsule contains the ligaments. The pelvis is composed of large bones which have to be held together by massive ligaments. If you injure these ligaments and they weaken, then the support in the pelvis will be compromised. There are many ligaments between the vertebrae and these are critical in order to stabilize the spine and make sure the mechanics of the spine are good. Joints and ligaments have an enormous number of pain receptors and anyone who has a sprained a joint knows how sensitive these receptors are. We can have both acute and chronic pain. Acute pain is defined as lasting less than six months. It is very localized, it is sharp, we know where it is, and can point to it. It can radiate, for example, from the back down the leg or from the neck down an arm, so it radiates from the point of origin. It is usually as a result of acute injuries or disease, and usually passes quickly. Chronic pain is somewhat more difficult. By definition, chronic pain lasts longer than six months, and it is dull and aching. It is poorly localized, and much more diffuse. It may persist a long time after recovery, and is usually accompanied by fatigue and exhaustion, because if you have pain for a long time, it will wear you down eventually. In chronic pain, typically, women will get depressed, and men will get angry. The important thing about chronic pain is that the site where you feel the pain is not necessarily where the pain originates, so in orthopedic medicine we look for the areas which don’t move to tell us what is going on.

* * *

You may reach Dr. Aubrey’s clinic in Sturgeon Falls, Ontario at 705-753-2300.

For more information on prolotherapy, read Pain Pain Go Away and Instant Pain Relief by Dr. William Faber.

~ by 619 on January 17, 2010.

One Response to “PROLOTHERAPY: NON-SURGICAL JOINT RECONSTRUCTION”

  1. Great medicine prolotherapy…has helped my elbow so much…

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