Posted on 03/28/2002 8:32:55 AM PST by Lancey Howard
Prolotherapy as Alternative to Surgery
"What Exactly is Sports Prolotherapy?"
Prolotherapy stimulates the repair of injured, damaged structures. It involves the injection of natural substances (along with anesthetics so the injections don't hurt that much) at the exact site of an injury to stimulate the immune system to repair the area.
An Introduction to Prolotherapy and Sports Injuries
"Why are there so many athletes with injuries and why are so many of them succumbing to surgery?" It's not hard to understand the reasons when you consider all the myths that have been perpetuated in treating sports injuries.
Rate of Healing with Prolotherapy
The anesthetic in the solution used during Prolotherapy sessions often provides immediate pain relief. The pain relief may continue, after the effect of the anesthetic subsides, due to the stabilizing of the treated joints because of the inflammation caused by the Prolotherapy injections.
If anybody knows about this I would be most grateful.
"Why are there so many athletes with injuries and why are so many of them succumbing to surgery?" It's not hard to understand the reasons when you consider all the myths that have been perpetuated in treating sports injuries.
Probably because tendons, cartilage, and ligaments don't repair themselves. It's something beyond a "myth," BTW, when one considers the speed with which athletes are back in the game after what used to be career-ending injuries....
Any alleged treatment which mentions things like "structures" without specifying any, or their components, sounds suspicious to me.
Any discussion of an alleged treatment which asks broad questions- "why are there so many injured athletes" without specifying a particular type of injury, and the organ or tissue which is injured (broken leg? torn muscle? torn ligament?) sounds suspicious to me.
Any alleged treatment that uses a phrase like "natural substances" (cobra venom? Dung? Exudate from a syphlitic lesion?) without specifying them sounds suspicious to me.
my $.02
Mind you, my criticisms are based on abstracts, so I didn't have complete access to their statistical analysis, but both studies had low numbers of patients. This presents problems regarding statistical validity of their conclusions. Also, both studies only compared prolotherapy to placebo (saline) rather than to existing therapies. And, lastly, both studies were by the same pair of authors, so nobody else has independently corroborated their findings.
Prolotherapy is the injection of a dextrose (sugar water) solution into the joint capsule, in order to stimulate inflammation which the authors believe will accelerate healing. This seems like a crackpot theory to me. I'm a fellowship trained M.D. who puts in cochlear implants (although I didn't install Rush Limbaugh's), so I'm not specifically an orthopedic sports doc, but -- hey, it doesn't pass the smell test. Caveat emptor.
This is the 21st century. There were alot of things about 20th century medicine that need improvement. Just because we haven't done it this way before doesn't mean it's not valid and useful.
What's not valid is using FR as a place to advertise.
While searching for ligament healing info, I came across extensive mention of prolotherapy. There was no scientific info given with any of these articles, only remarkable claims of substantially tougher(higher modulus and yield strength) ligaments as a final result of the therapy. The FDA only permits a limited number of practitioners to do it.
Medical doctors and quack dudes on websites are not mutually exclusive.
I checked out the website, am suspicious...there are lots of anectodal reports from patients, but little in the way of science and double blind studies. Also, wording of the site is classic quacking...use a criticism and turn it into an asset. The site says that Prolotherapy is "little known" and presumably therefore not used much. I would say it is little known because it isn't very effective. Inject a local anesthetic into a joint and it sure as heck will feel better for awhile.
This business about "Natural substances" stimulating the immune system to repair damaged tissues is baloney. While the immune response is involved in healing, the healing response of all soft tissue with the exception of brain is identical...scar tissue forms. The website leaves the distinct impression that this therapy somehow causes the injured tissues not to form scar tissue but instead to completely regenerate.
My review: 5 Quacks.
I'll accept that.
However, when a guy starts talking about the "myth" of surgery; and about how of the thousands of people he's seen, fewer than five have been referred for surgery; I begin to sense a doctor who's probably not to be trusted.
If his methods were truly as effective as claimed, you know the pro sports teams would have been all over it by now.
IMHO, this is a guy who has taken a sometimes-valid approach far beyond reasonable bounds, for personal profit.
The effectiveness of prolotherapy has not been verified by scientifically controlled studies. As early as 1978, the Medical Procedures Appropriateness Program of the Council of Medical Specialty Services (CMSS), based on input from the American Academy of Orthopedic Surgeons, the American Association of Neurological Surgeons, and the American College of Physicians, concluded that prolotherapy had not been shown to be effective. Furthermore, the clinical practice guideline on "Acute Low Back Problems in Adults" by the Agency for Health Care Policy and Research does not recommend ligamentous and sclerosant injections in the treatment of patients with acute low back pain.
According to Martindale's Extrapharmacopoeia, Sarapin is a brand name for an extract of the pitcher plant, or Sarracenia Purpurea.Martindale's notes that "the roots and leaves of Sarracenia Purpurea have been used in the form of an aqueous distillate, administered by local injection, for neuromuscular or neuralgic pain."
Sarapin is typically administered in conjunction with prolotherapy. There is inadequate evidence of the effectiveness of Sarapin for pain. A MEDLINE search identified only two published studies of Sarapin for pain relief. One clinical study involving 180 patients found greater pain relief in patients administered facet blocks with Sarapin than those without.Another study, using an animal model, found Sarapin to have no effect.
The term "prolotherapy" is a derivation of "proliferative injection therapy" and is also known as sclerotherapy. The practice of prolotherapy is used by doctors of osteopathy and other physicians to treat a number of different types of chronic pain. Prolotherapy consists of a series of intraligamentous and intratendinous injections of solutions in trigger points near the pained area to induce the proliferation of new cells.
Proponents of this treatment suggest that looseness in the supporting ligaments and tendons around the joints causes the pain, inducing the muscles to contract against the ligament and irritate the nerve endings. The physicians using this treatment method for low back pain believe the ligament laxity to be concentrated in the sacroiliac joint. During a physical examination a physician will identify trigger points generally in the muscles overlying the sacroiliac joint. The physician then may inject proliferant substances into the supporting ligament and tendon tissue.
The practice of sclerotherapy or prolotherapy to produce dense fibrous tissue in an effort to strengthen the attachment of ligaments and tendons is not new. Forms of this therapy apparently date back to Hippocrates, however, prolotherapy recently found favor with osteopaths following the teachings of George Hackett, MD, who in 1939 began using a local injectable irritant to initiate the healing process. It was Dr. Hackett who coined the term "prolotherapy" because sclerotherapy implied scar formation, which, according to Dr. Hackett, did not occur with prolotherapy. Nevertheless, both processes use trigger point injections to form new cells in an effort to support weakened muscles. Although the method has been in use for some time, to date there is no strong clinical evidence to support the efficacy of the treatment.
Prolotherapy injections are intended to mimic the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue. The newly produced collagen is intended to support the injured or loosened ligaments, creating a more stable and strong muscle base, in the process, alleviating pain.
There are three classes of proliferant solutions used to initiate inflammation: chemical irritants (e.g. phenol), osmotic shock agents (e.g. hypertonic dextrose and glycerin), and chemotactic agents (e.g. morrhuate sodium, a fatty acid derivative of cod liver oil). The two studies supplied by the requestor used a dextrose-glycerine-phenol solution.
I would not do it for myself or my family.
My son is a very good baseball pitcher and he has sustained what was diagnosed from MRI scans as a "slight ligament tear" in his elbow area. He discovered this "prolotherapy" while looking for treatment options.
I will continue my research, but if you stumble upon anything ekse that could be helpful, please let me know.
Thanks again.
Regards,
LH
The healing rate for ligament repair is slow since ligaments are poorly vascularized(few blood vessels). The minimum time for the ligament to sustain ~80% of it's prior load is 17 weeks to 1 year. So having your son refrain from stressing the elbow will allow it to heal. The healing does occur by scaring, but keeping the joint flexed will result in scar tissue aligning with the original colligen fibril direction and give it max. flexibility and strength.
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