Prolotherapy and the Unstable Knee
Noel Peterson, ND
When Mark injured his knee last spring playing tennis, he expected it to heal on its own. His orthopedist ruled out the all too common torn meniscus or ACL tear, and recommended ibuprofen, which helped the pain but did not make his knee feel stronger. After six months, he still had pain which prevented him from being able to play his game. His injury was getting more painful and limiting and after six months, his knee felt vulnerable and painful with any deep bend or rotational exertion.
When I examined Mark, I found an unstable tibialfibular ligament (the connective tissue that holds the head of the fibula to the lateral condyle of the tibia), a weakened fibular collateral ligament, and a torn, weak tendon of the biceps femoris muscle attachment at the head of the fibula. We scheduled a series of Prolotherapy injections, and three months later his pain was gone and he was back on the tennis court.
What is Prolotherapy?
Prolotherapy is defined in Webster's New Collegiate Dictionary as "the rehabilitation of an incompetent structure such as a ligament or tendon, by the induced proliferation of new cells." It was developed over fifty years ago as a natural non-surgical method of assisting the body in healing injured tendons and ligaments. Prolotherapy helps your body make new cells, which strengthen lax or torn tendons and ligaments. (Ligaments are the tough tissues which connect bones to bones, and tendons are the tough tissue which connect muscles to bones)
How is Prolotherapy performed?
Prolotherapy technique consists of using a fine needle to inject a proliferative solution into incompetent tendons, ligaments, and joints for the purpose of stimulating new growth and repair, thereby promoting joint stability and reduction of pain. The most common substance used is dextrose (a kind of sugar) diluted with procaine (a local anesthetic). When injected into the torn tendon or ligament, the dextrose and procaine solution induces a physiologic reaction that stimulates the healing processes to resume, and induces the migration of fibroblasts (the body’s repair cells) to the site of injection. Fibroblasts lay down new connective tissue and in so doing, enlarge and strengthen the damaged tendons, ligaments, and cartilage.
Do Prolotherapy injections hurt?
Prolotherapy injections are performed with a lot of care and a little local anesthetic. The pain of treatment is minor and only temporary when compared to the chronic pain of tendon and ligament injuries.
What kinds of injuries respond to Prolotherapy?
Soft tissue injuries (strains, sprains and bruises of muscles, tendons, fascia, and ligaments ) are the most common injuries encountered in sports, auto, household, and work accidents. These injuries produce chronic pain in the hands, elbows, shoulders, hips, knees, and feet, as well as neck, ribs, back, and sacrum. The majority of these injuries heal through the body's own internal mechanism of producing inflammation which triggers the proliferation of fibrous tissue that mends the damaged areas. The majority of these injuries heal, but many go on to chronic pain and dysfunction, and many common antiinflammatory drugs used in these cases actually inhibit the repair of these damaged cells.
Why would you still have pain and weakness, even after a healing period of weeks or months?
The answer lies in the fact that both ligaments and tendons have very poor circulation, and it is this lack of circulation which deprives them of the nutrients they need to heal properly. When ligaments become relaxed and weak, the nerves within and around the ligaments and tendons become stretched and irritated, and pain results.
What about conditions such as arthritis?
There are many forms of arthritis, the most common being osteoarthritis. Osteoarthritis is the gradual degeneration of joint surfaces, caused by overuse and under repair. Over time, this wear-and-tear of cartilage progresses to the point that the cartilage is worn thin and pain results. Degenerative joint disease can progress to the point where the patient needs a total hip or knee replacement. Prolotherapy has been proven to reverse the degeneration of joints when the condition is treated early enough.
Other forms of arthritis are autoimmune mediated, such as Rheumatoid Arthritis, Lupus, and Ankylosing Spondylitis. Unfortunately, these forms of joint disease do not respond to Prolotherapy.
How can you strengthen tendons and ligaments?
Unlike muscle tissue, exercise cannot build, strengthen, or repair ligaments or tendons. Prolotherapy has been shown to increase the size of tendons and ligaments up to 40%. It has also been shown to increase their tensile strength by as much as 200%. Prolotherapy thickens knee cartilage and relieves the pain of degenerative joint diseases. and no scar tissue is formed (as would be the case in surgical procedures). The tissue formed from Prolotherapy is healthy, strong, flexible ligament or tendon tissue. Once the ligament or tendon has been repaired by Prolotherapy, the nerves are no longer stretched or irritated, the pain goes away, and normal function follows.
What are the side effects of Prolotherapy?
Some patients experience pain and swelling at the injection sites for 1-3 days following the procedure. To counteract this, we recommend that patients take acetaminophen or hydrocodone with acetaminophen for pain, but not aspirin or anti-inflammatory medications like Advil which can inhibit the healing response. Patients can also apply moist heat and ice alternately to the area 3-5 times a day for 10 to 20 minutes as needed, and perform moderate exercise such as walking, but should avoid strenuous exercise or work with heavy lifting. Often specific exercises are prescribed to follow-up the injections. The natural proteolytic enzyme Bromelain can also be taken for swelling if needed. Reports of more serious complications have been extremely rare, and are associated with the inadvertent injection into the spinal canal or the lining of the lung rather than into the affected ligament or tendon, causing spinal fluid leak, nerve damage, or pneumothorax.
Who performs Prolotherapy?
The injection technique involved in prolotherapy requires skill and care. Dr. Peterson is certified in Prolotherapy techniques, and has been treating people for the past 4 years. Dr. Chong has recently completed his training and is now accepting new Prolotherapy cases as well.