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Prolotherapy

What is prolotherapy?

Prolotherapy, or proliferation therapy, is the injection of a solution to stimulate the growth of new cells to heal painful areas. Ligaments are the most common sites for injection although muscles and tendons can also be treated.

Ligaments surround all our joints, connecting bone to bone.  They also have a large number of nerve endings so that if they are over-stretched, they cause pain! With the passage of time, ligaments become slack from our natural posture and daily activities. They can also be injured by trauma.

Will I benefit from this treatment?

Your candidacy for treatment by prolotherapy must be assessed. It is important that a trained clinician performs an assessment, as conservative therapies should be considered first.  The more information we have when you visit, the better judgment we can make about your treatment.

What do the injections consist of?

The injections consist of a mixture of a local anaesthetic and Dextrose.  The Dextrose solution is a strong enough concentration to irritate the injected tissue. This stimulates mild inflammation in the area, which is the first part of the healing process. 

Are there any risks?

The most common risks when puncturing skin, namely infection and bleeding, are very rare due to the small diameter of the needle that we use.

It is possible to enter the spinal canal, but this is rare, as injections directly over the middle of the spine are no longer used. If this happens, it may result in an intense headache for 2 – 4 days when upright.  Laying flat alleviates the headache.

The other risk of consequence is the possibility of puncturing a lung, when injecting the upper part of your back. This is rare.   

A very small percentage of the population is allergic to local anaesthetic agents. If you think you are, please let youor practitioner know.

An even smaller percentage of people are allergic to sugar, which is the source of medical Dextrose.  Some people have expressed a concern about becoming too tight after the injections.  This is not possible.

Is this painful?

The injections are uncomfortable, but the local anaesthetic removes the pain quickly.  In spite of this, or if you are having many levels injected, you may feel unable to tolerate the pain.  If so, we will discuss alternatives.   

Most patients in Calgary are able to drive themselves to and from the treatment and are able to return to work afterwards. Out of town patients should have a driver for their first treatment so they are able to change position as needed for the long drive home.

Most patients will feel stiff for a day or two afterwards. Changing position regularly, gentle activity, stretching, and heat are all that is usually required. If you are too stiff a muscle relaxant such as Robaxacet or pain medication such as Tylenol can be used. Please do not use anti-inflammatory painkillers (Advil, Ibuprofen, ASA, Celebrex etc). 

How Many Injections Will I Need?

Most men require three to six treatments. Women usually require six to nine treatments. Treatments are done weekly, biweekly, or monthly. You can expect to see improvement from the injections one to two months after the last injection.

What Follow Up Treatments Are Needed?

It is very important to see your physiotherapist two to seven days after prolotherapy. This is to check joint mobility and settle any muscle spasm. Physiotherapy is also important one to two months after the last injection when the ligaments are tightening. At that time you will get longer lasting relief from the IMS (intramuscular stimulation) and be ready to start increasing your stretching and strengthening program.

Is there a cost?

At present Alberta Health Care does not cover the cost of prolotherapy.  Please ask your physiotherapist about the current fee or contact the office. The fee varies depending on the number of areas treated. The fee will cover the cost of the procedure and materials used.  Insurance plans vary, but as evidence and clinical success increases, more and more insurance companies will reimburse for the treatment. There is a fee to replace lost receipts.  Payment must be made at the beginning of each office visit.  We do not direct bill your insurance company, nor does WCB pay for prolotherapy.

Other Considerations

Stay as active as possible without aggravating your condition. Break up tasks that bother you into shorter pieces e.g. vacuum one room at a time instead of doing the whole house at once. Walking every day is usually safe. For those who cannot tolerate walking, swimming or buoyant activity is a good way to stay active without irritating your symptoms.

Sleep disturbance is common with chronic pain. Watch for signs of depression such as mood changes, decreased energy, appetite changes, decreased memory and concentration, feelings of guilt or hopelessness, and suicidal thoughts. Discuss these symptoms with your doctor as soon as they are apparent.

Anti-inflammatory medications will block some of the effect of prolotherapy and should be avoided for at least two weeks after your treatment (six weeks is better).  Tylenol, muscle relaxants and prescriptions for other health conditions can be continued under guidance of a physician.

Stress or other stimulants such as cold medications can cause muscle tightening. Try to avoid these or consider relaxation training for stress.

Appointments

Please have your referring health care provider (doctor or physiotherapist) send a referral to Evidence.  Our staff will contact you for booking.

Your first appointment will be a consultation.  At that visit, we will review your condition.  We will examine you and discuss a treatment plan. Plan to arrive at least 30 minutes prior to your first appointment and bring any previously completed copies of any X-ray or MRI reports and bring these to the first appointment. If you are late, we may not be able to fit you in, regardless of the distance you have traveled.  There is a fee for not attending your scheduled appointment, or cancellation with less than 48 hrs prior notice.    

What should I wear and bring with me?

You should wear loose fitting clothing that allows easy access to the affected area.  This will also be more comfortable afterwards.  There is often some pinpoint bleeding after the injections which could stain your clothes. 

For additional sources of information, see www.prolotherapy.com 

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