Besides our authors and readers commenting on their experiences with Prolotherapy, we hope to notify our readership about some of the more interesting articles published around the globe on Prolotherapy and painful conditions. Ultimately, we all benefit by continuing to educate ourselves on the latest research and publications regarding chronic pain.
Besides letting readers know where to find the noteworthy article on the internet, we hope to publish the article summary and/or abstracts. We will also comment on why these articles should be of interest to everyone. Please let us know if you have read a good article and it applies to those interested in helping people get out of chronic pain! We may use it in this section of JOP. We know it is a wide, wide world out there and we cannot know of all the articles! JOP’s mission is to educate the world on the life-changing effects of Prolotherapy. If other therapies or knowledge that will help us in our quest to rid the planet of musculoskeletal pain (as much as we can) is available, then we need to get the word out!
Treatment of tendinopathy: What works, what does not, and what is on the horizon.
Andres B, et al. Treatment of tendinopathy: What works, what does not, and what is on the horizon. Clinical Orthopaedic Related Research. 2008. 466(7):1539-54. E pub: April 30, 2008. http://www.ncbi.nlm.nih.gov/pubmed/18446422?dopt=Abstract
The authors performed a review of literature to determine the best treatment options for tendinopathy, evaluating a wide array of treatments, including surgery, growth factors, and stem cell treatment. The outcome was that the results were promising but inconsistent and that more research needed to be done to determine the ideal treatment for tendinopathies.
Treat the underlying cause of tendinopathy, ligament and tendon weakness, with Prolotherapy.
This is a great article about the many traditional and alternative treatments available for the treatment of tendinopathy. As Prolotherapy physicians have known for many years, corticosteroids, NSAIDs, ultrasound, and shock wave therapy do not provide repair or strengthening of the underlying cause of many painful conditions, which is weakened or stretched ligaments or tendons; nor do these treatments provide long term pain relief. We do know that ligaments and tendons have poor blood supply which inhibits much of the body’s own ability to heal injuries to these structures. Exercise alone will help keep the joints moving and may help the overall blood flow to the ligaments and tendons, but in reality, exercise only helps keep the muscles strong and the joints moving, while the degenerative process of the joints still occurs. Sclerotherapy, also known as Prolotherapy, directly addresses not only the lack of blood flow to the ligaments and tendons, but also causes a localized inflammatory response to attract the immune system to repair the weak, stretched, or torn ligaments and tendons through increased fibroblast activity. We have seen many patients through the years who have failed the previously mentioned therapies, yet succeed after a few treatments of Prolotherapy.
As for their preliminary work on growth factors and stem cells, many Prolotherapy physicians, including our office, have been utilizing growth factors retrieved from a patients’ blood samples (PRP) and have seen great results in the repair of not only tendinopathy, but also of labral tears in both the shoulder and hip.
What is the clinical course of acute ankle sprains? A systematic literature review.
Van Rijn R. What is the clinical course of acute ankle sprains? A systemic literature review. American Journal of Medicine.2008;121(4):324-331. http://www.ncbi.nlm.nih.gov/sites/entrez
A database search was conducted by reviewing literature related to subjects who suffered from an acute lateral ankle sprain conventionally treated with one of the following outcomes: pain, resprains, instability, or recovery. Thirty-one studies were included. After one year of follow-up, a high percentage of patients still experienced pain and subjective instability, while within a period of three years, as much as 34% of the patients reported at least one re-sprain, and from 36% to 85% of the patients reported full recovery within a period of three years.
Another option for ankle sprain healing? Prolotherapy?
The most common ligament injury is the ankle sprain. How well do ankle sprains heal? According to this study, they do not heal very well. Clearly three years after the injury, many people remain in pain with a high re-sprain rate. While no Prolotherapy study to date has shown whether ankle sprains remain healed with Prolotherapy, the clinical experience of Prolotherapists is that ankle sprains that are treated with Prolotherapy remain healed.
Performance-based functional evaluation of nonoperative and operative treatment after anterior cruciate ligament injury.
Moksnes H, et al. Performance-based functional evaluation of nonoperative and operative treatment after anteriorcruciate ligament injury. Scandinavian Journal of Medicine & Science in Sports. Online publication May, 2008.
The objective of this study was to compare the functional outcome after nonoperative treatment to individuals versus those with surgical treatment at a one-year follow-up. One hundred and twenty-five subjects were included. Nonoperated subjects performed significantly better on two of the four tests compared with the ACL-reconstructed subjects at the one-year follow-up. ACL-injured subjects should be informed of the possibility of success after nonoperative treatment, but future studies are needed to determine significant predictive factors for success for non-operative and surgically treated individuals.
Could conservative treatment with Prolotherapy be a better option than surgery for ACL-injured patients?
As this article points out, the traditional treatment for the ACL deficient knee is surgery. This study refutes that. The study showed nonoperated subjects performed significantly better on two of the four single-legged hop tests compared with the ACLreconstructed subjects at the one-year follow-up. The bottom line was that patients treated conservatively (exercise and no surgery) did just as well as those who underwent surgery. Our question is what would results would we see with doing Prolotherapy in the knee including the ACL (assuming incomplete tear), as well as the other supporting structures, plus proper rehabilitation? We suspect this approach would show a significant improvement over surgery based on our clinical experiences in treating ACL-injured knees.
The roles of growth factors in tendon and ligament healing.
Molloy T, et al. The roles of growth factors in tendon and ligament healing. Sports Medicine. 2003; 33(5):381-94. http://www.ncbi.nlm.nih.gov/pubmed/12696985
This review covers some of the recent investigations into the roles of five growth factors whose activities have been best characterized during tendon healing: insulin-like growth factor-1 (IGF-1), transforming growth factor beta (TGF-beta), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF). This review also covers some of the most recent studies into the use of these molecules as therapeutic agents to increase the efficacy and efficiency of tendon and ligament healing. The abstract reviews how these growth factors affect healing, particularly related to cellular proliferation and collagen synthesis.
How does Prolotherapy work? This article will enlighten you.
We are often asked the question, “How does Prolotherapy work?” This article will provide some answers. Growth factors clearly enhance tendon and ligament healing, as does Prolotherapy. One of the proposed mechanisms by which Prolotherapy “proliferates” tissue is by enhancing growth factors in the area treated. With human growth hormone and platelet rich plasma now available to use as proliferants in our Prolotherapy solutions, some of these growth factors can actually be injected directly into the injured areas to even further enhance healing. This is a good article to read to glean more of the proposed “biology” of Prolotherapy.
Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee.
Van der Esch M, et al. Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum. 2006;55(6):953-9. http://www.ncbi.nlm.nih.gov/sites/entrezt
This study was done to establish the impact of knee joint laxity on the relationship between muscle strength and functional ability in osteoarthritis (OA) of the knee. Tests were performed to determine varus-valgus laxity, muscle strength, and functional ability. Patients with knee OA and high knee joint laxity show a stronger relationship between muscle strength and functional ability than patients with OA and low knee joint laxity. Patients with OA, high knee joint laxity, and low muscle strength are most at risk of being disabled.
Weak ligaments need to be treated in osteoarthritis patients.
The bottom line here is this study showed that people with knee joint laxity and osteoarthritis possessed lower muscle strength and were more disabled. This goes along with the philosophy of most Prolotherapists that the ligaments must typically be treated in people with osteoarthritis. One of the reasons for this is due to the fact that it is the joint laxity that causes the muscle spasm and leads to the osteoarthritis. Both the muscle spasm and overgrowth of bone (osteoarthritis) are the body’s attempt to stabilize a loose joint. Eventually enough bone overgrows that the joint loses motion.
Many reading this article might conclude that what is needed for patients with osteoarthritis and knee pain is muscle strengthening in the legs. This is a given. However, what most will miss is the fact that the joint laxity must also be treated. In our opinion the best option for this is Prolotherapy.
The use of Prolotherapy in the sacroiliac joint.
Cusi M. The use of Prolotherapy in the sacro-iliac joint. British Journal of Sports Medicine. April 9, 2008. E-published ahead of print. http://bjsm.bmj.com/cgi/content/abstract/bjsm.2007.042044v1
An author’s private practice examined whether Prolotherapy was effective in the treatment of deficient load transfer of the SIJ. The treatment given was three injections of hypertonic dextrose solution into the dorsal interosseous ligament of the affected SIJ, under CT control, six weeks apart. This descriptive study of Prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the three months and 12 months’ follow up visits and for the 32% of patients who attended follow up visits at 24 months. The findings of this study warrant further research.
Prolotherapy shows remarkable improvement in patients with SIJ pain!
This study reported improvement among 76% of their treated patients with only three injections into the dorsal interosseous ligament. This is remarkable! It could also be argued that if the entire sacroiliac joint with all of the connecting ligaments were injected that an even more positive outcome would result. We commend these private practice clinicians for using their own time and funds to show the world that Prolotherapy should indeed be the treatment of choice for patients suffering with SIJ problems.
A randomized trial of arthroscopic surgery for osteoarthritis of the knee.
Kirkley A. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. The New England Journal of Medicine.2008;359:1097-1107. Abstract: http://content.nejm.org/cgi/content/short/359/11/1097
The efficacy of arthroscopic surgery for the treatment of osteoarthritis of the knee is unknown. A singlecenter, randomized, controlled trial of arthroscopic surgery in patients with moderate to severe osteoarthritis of the knee was conducted. Patients were randomly assigned to surgical lavage and arthroscopic debridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. Of the 92 patients assigned to surgery, six did not undergo surgery. Of the 86 patients assigned to control treatment, all received only physical and medical therapy. After two years, outcomes failed to show superiority of surgery. Arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.
Arthroscopic surgery does not work for osteoarthritis of the knee.
Of the 1 million arthroscopic surgeries in the United States every year, about one third of them are performed for degenerative arthritis. In this study, patients with moderate to severe osteoarthritis were randomly assigned to receive surgical lavage and arthroscopic debridement together with optimized physical and medical therapy or to treatment with physical and medical therapy alone. A total of 86 patients in each group were assessed after two years by various standardized questionnaires. The authors concluded that arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.
This is another landmark study which will hopefully put a nail in the coffin for “clean-up” arthroscopies. It is the Journal of Prolotherapy’s opinion that degenerative knee arthritis causing symptoms is better treated with Prolotherapy than arthroscopy, lavage, cortisone shots, and physical therapy. While arthroscopy for specific reasons, like complete ACL tears, has its place, its role in degenerative arthritis is extremely limited. After this study, one could even argue that there is no role.
This study shows us that arthroscopic surgery for OA of the knee is not the best treatment option. As we have seen, surgery for OA should be saved as a last resort therapy once Prolotherapy, physical therapy, and other regenerative therapies have been exhausted. What an OA patient really needs is Prolotherapy with HGH which not only addresses cartilage growth, but also the overall strengthening of ligaments and tendons around the entire joint. Physical therapy can also be helpful to regain muscle strength which many OA patients have lost while looking for a solution to their pain.