Tendonitis? Pulcinella and PJ check this out

[big nut]

I currently get prolotherapy injections in my right bicep tendon, after rupturing it last year. I go in every 6-8 weeks, and so far have about 60% recovery. I decided to do this instead of surgery.

Prolotherapy helps repair and rejuvinate tendons. Tendonitis is routinely treated this way. After hearing on Pulsing Radio and IN The Iron Asylum with PJ, that you guys are having tendonsitis/tendon issues, I think you guys should look into it. I go to a sports rehab doctor in minnesota. I'm sure this is available in every major city.

Prolotherapy (rejuvenative injection therapy). Another part of comprehensive pain management program is prolotherapy (sclerotherapy) or so called ‘Canadian injections’. Prolotherapy is an injection therapy that helps to accelerate the collagen synthesis inside impaired ligaments and restores their tendon’s elasticity. Research and clinical experience proves that inflamed injured tendons and ligaments are unable to stabilize the joint or spine and might be a source of constant, dull aching (17). The idea of this therapy is an injection of a proliferant solution inside the impaired structures in order to rejuvenate the ligamentous tissue and naturally stabilize the joint. Prolotherapy is an ancient method that was actually proposed by Hippocrates and developed in this country by Dr. George Hackett and Dr. Gustav Hemwel. Both physicians had actively been promoting prolotherapy for 60 years in their Chicago based clinic. This method might be used in patients with severe allergies and patients who don’t tolerate traditional medications because of side effects or gastro-intestinal discomfort. Prolotherapy might be a good adjunctive therapy to intra-articular steroid shots, non-steroidal anti-inflammatory medications, and Opioids.

[JWolfe]

What about DMSO?

[big nut]

What about DMSO?

i'm not sure what this is...dimethyl sulfoxide?

[big nut]

Anyone else on rx try prolotherapy ever?

[JWolfe]

i'm not sure what this is...dimethyl sulfoxide?

Yes. It's great for pulling out inflamation from an area.

[sassy69]

Yes. It's great for pulling out inflamation from an area.

Noting it also smells funny and leaves u w/ a nasty taste in your mouth.


(I"m sure this will open up all sorts of jokes, but seriously .... DMSO is great but you'll know you're using it, and so will everyone else.)

[big nut]

Actually, prolotherapy creates inflammation at the site of the injection, thereby signaling the body to repair itself naturally. That's one of the reasons why u receive many injections at each treatment.

[yeahbuddy]

I have tried to get info on prolotherapy for a while but everyone seems to say it's total B.S. or that it is a miracle but can't tell me much more than that. I have not seen any research on it at all. I have not talked to anybody that has had it done for the shoulder and I am very curious. Even if it didn't work, I would be fine with that but what I worry about is that it might make things worse, especially if done wrong or something.

[big nut]

Yeahbuddy-i actually do get my shoulders treated with prolotherapy also. No major injuries, but I've tweaked them while lifting, and they got sore and swollen. One day after prolo, and I was not swollen anymore, and it didn't hurt to train chest or shoulders anymore. The doc I see has published articles and tonight I'll try to get a link to these articles and post it here.
Btw I have friends who also get their elbows, wrists, knees and backs treated.

[big nut]

I have tried to get info on prolotherapy for a while but everyone seems to say it's total B.S. or that it is a miracle but can't tell me much more than that. I have not seen any research on it at all. I have not talked to anybody that has had it done for the shoulder and I am very curious. Even if it didn't work, I would be fine with that but what I worry about is that it might make things worse, especially if done wrong or something.

heres the article...
A Shot at Relief

Often misunderstood, prolotherapy may deserve a closer look


Elena Polukhin, MD, PhD

Posted on: November 11, 2008
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Vol. 17 • Issue 11 • Page 19
Physician's Desk Pain management has changed drastically over the last 10 years. No longer content to just "live with it" or be passed off to an infinite number of specialists, consumers are taking control of their conditions. And they're increasingly reluctant to elect expensive pain medications and unproven, invasive surgeries.
Today's patients want safer, effective alternatives that bring long-lasting symptom relief.
I can't imagine operating a comprehensive pain management clinic without offering prolotherapy. I've seen this modality work wonders on general pain, such as fibromyalgia, migraines, myofascial pain and reflex sympathetic dystrophy, as well as specific joint pains such as temporomandibular joint discomfort, arthritis, carpal tunnel syndrome and tendinitis.
Prolotherapy has also been proven successful in reducing overuse syndromes and pain associated with injuries, such as meniscal tears, ligament sprains, herniated discs, spondylolisthesis and multiple sports injuries.
Recently, physicians have pushed the boundaries of what's possible with this modality, and are using it for hip dislocations, plantar fasciitis, rheumatoid arthritis, impotence, depression, alcoholism, drug addiction and AIDS-related neuropathy.
Yet despite its potential, prolotherapy isn't embraced by mainstream Western medicine. What is prolotherapy and why has it generated so much debate?
BEHIND THE TECHNIQUE
Variants of prolotherapy have existed for many centuries. Hip­pocrates was said to stick hot pokers into torn shoulder joints to reduce pain and speed healing.
While modern methods have advanced, the concept remains the same. By stimulating the body's natural aseptic inflammatory process, prolotherapy triggers self-repair mechanisms and promotes the body's innate ability to heal.1Prolotherapy involves injecting proliferant sub­­­­­stances such as dex-­­­
trose, phenol and ethanol to the fibro-osseous junction-the attachment site between liga­ments, tendons and bones.2-4This triggers a local aseptic inflammation that increases blood flow to the area. Increased nutrients stimulate fibroblast activity, collagen growth and the synthesis of bioactive substances, naturally rejuvenating the tissue.
Prolotherapy relies on the hypothesis that bodily pain is caused primarily by ligamentous laxity (enthesopathy). Because painful muscle spasms are secondary, and appear as late sequelae, restoring the body's damaged tendon structure must take place before muscle spasms and trigger point pain can subside. This theory has been widely accepted in Europe and Olympic sports medicine circles.5-8Ligaments are the structural rubber bands that hold bones in place. Tendons connect muscles to bones. Both tissue types can be damaged due to age, injuries and degenerative changes. Because of poor blood supply and limited collagen synthesis, tendons and ligaments heal slowly on their own. They may never recover their original strength or endurance.
Despite this, nerve supply is superior in these sites to other body parts. A high-functioning nerve network relays essential information such as ligament function, stretching, muscle tension and body position in movement and at rest.
These two properties make tendons and ligaments a common pain generator. Even minimal structural damage triggers chronic muscle spasms and discomfort. Pain can often radiate to arms and legs, resembling severe radicular pain.
While the exact mechanism of pain control behind prolotherapy isn't fully understood, researchers speculate that it relieves symptoms by reducing the effects of stretched and irritated intra-ligament nerve endings.
Prolotherapy is appropriate for patients with ligamentous laxity. You can make this diagnosis through a complete history, physical exam and provocative tests.3,4,7,8Imaging studies can help confirm the diagnosis.
Patients with ligamentous laxity often exhibit a history of chronic joint or spine pain that's exacerbated by physical activity. The pain may be a result of acute or chronic injury or a cumulative trauma disorder.
Patients may have realized limited therapeutic effect from simple analgesics. They often demonstrate limited response to physical therapy or chiropractic manipulations-these treatments may even worsen the symptoms. A physical exam often reveals tender focal areas over the painful site. X-ray imaging may not show the ligaments, but they're essential to rule out other sources of pain or limited range of motion.
Because prolotherapy doesn't use artificial substances or medications, it's a safe modality with no adverse effects. Any local or generalized side effects are minimal and self-resolving. Scar tissue doesn't form as a result of the injections, and new tissue is smooth, strong, flexible and highly functional. Additional research shows that prolotherapy may dissolve post-surgical scars, rejuvenate poorly differentiated scar tissue and promote intracellular collagen synthesis.
Prolotherapy often produces a burst of energy and feelings of euphoria. While this phenomenon is difficult to explain scientifically, some experts speculate that the skin and soft tissue penetration of prolotherapy releases endorphins and other bioactive substances that lead to a "natural high." Others claim that mood enhancement results from induced inflammation from the injection material.
TYPICAL TREATMENT
Prolotherapy is usually scheduled in the morning. This gives a patient time to recuperate after the injections.
A typical treatment session involves 20 to 30 injections of proliferative solution to the tendons and ligaments of the affected area. The low back typically requires more injections-often as much as 50 on each side.
After positioning the patient on the table and sterilizing the injection area with alcohol or iodine, prep the area with a local anesthetic. Most physicians mark bony prominences, attachments of tendons and ligaments, and tendon sheaths.
Most U.S. physicians use the Hackett-Hemwell technique of injections.1Experienced practitioners develop their own modifications, but the principles of injection remain constant-because you must inject the bony-tendinous attachments or the tendon sheath, never inject the solution if you don't feel the bone. This ensures the safety of the procedure, since you're not penetrating essential blood vessels or the pleural cavity.
Typical prolotherapy sessions last from 30 to 45 minutes. Back and neck injections take about 1 hour.1,3-4
Post-injection pain is often well-tolerated by the patient and can be controlled by simple analgesics. Discourage anti-inflammatory medications for 48 hours after treatment, as they may interrupt the localized aseptic inflammation process.
Good pain control is typically achieved after several prolotherapy sessions. Some patients respond well to a single session, especially when the injection is administered to smaller joints.
Other patients, such as the elderly, patients with chronic degenerative spine changes, physical laborers, professional dancers and athletes, may require 2 to 3 treatments, or as many as 8. As healing progresses, you can decrease the number of injections.
If prolotherapy doesn't yield quick results and pain continues, frustration for a patient may set in. Avoid this situation by setting reasonable expectations.
The collagen growth required to stabilize the joint differs from patient to patient, so it's difficult to predict a timeline for full symptom resolution. It's important for clinicians to remain patient and continue treatments for maximum benefits.
Prolotherapy is not a panacea. By itself, it may not be sufficient to eliminate tendonous pain. But when combined with physical therapy, topical anesthetics, medication, manipulations and acupuncture, prolotherapy is a valuable addition to your integrative pain management approach. It's time to give this safe and long-respected method a second look.
For a list of references and resources, go to www.advanceweb.com/rehab and click on the references toolbar.
Physician's Desk is created in conjunction with the American Academy of Physical Medicine and Rehabilitation (AAPM&R). For information about joining AAPM&R, a specialty organization for PM&R physicians, visit the Web site at www.aapmr.org or call (312) 464-9700.

Elena Polukhin, MD, PhD, is a board-certified physiatrist and medical director of Medical Rehabilitation Consultants in Maplewood, Minn.

[Yates21]

nothing about what the "proliferate solution" actually contains...

[Carson]

We run DMSO intravenously in horses and it does wonders! However, the smell is horrible and the judges will often glare when you ride past in the show arena from the smell.

[DECABEATZ]

Wow thanks for the info i do have a bad tendon in my right elbow. Not significant enough yet to go see doc but in future it will need some attention!

[big nut]

nothing about what the "proliferate solution" actually contains...

1Prolotherapy involves injecting proliferant sub­­­­­stances such as dex-­­­
trose, phenol and ethanol to the fibro-osseous junction-the attachment site between liga­ments, tendons and bones.2-4This triggers a local aseptic inflammation that increases blood flow to the area. Increased nutrients stimulate fibroblast activity, collagen growth and the synthesis of bioactive substances, naturally rejuvenating the tissue.

I do believe there are other nutrients that get injected as well. Another form of prolo I believe involves drawing up of a patients blood, and injecting that blood into the location of the injury. I haven't tried this technique though.

[BigJD69]

Should any Ortho. Dr. be able to perform these injections or do I have to see a Doc that practices this technique??