Who Has Knee Pain?

Noel Peterson, ND

What do Nathan, a 12 yr. old gymnast with a torn ligament in his left knee; Jewell, a retired PR executive with degenerative arthritis of both knees; Jayme, a 46 yr. old dancer with debilitating pain and swelling in both knees; and Joel, a heavy set contractor with degeneration of both knees and a history of 2 unsuccessful surgeries have in common? All of these patients’ knee problems were helped by a series of Prolotherapy injections.

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). Prolotherapy can also stimulate your body to regenerate worn cartilage surfaces, such as in osteoarthritis and degenerative arthritis.

What injuries are knees susceptible too?
Our knees are amazing. They carry us through our days, walking to work, dancing in the kitchen, running our favorite trails, gliding through our bike rides. They are functionally superb- flexible, mobile, and strong. They can provide us trouble free service for 70 years and more, but the very qualities we take for granted also make the knees vulnerable to wear-and-tear arthritis and athletic injury.

We call the wear-and-tear arthritis osteoarthritis. For many people, it’s a natural consequence of daily living. Most people over 30 have signs of osteoarthritis in their knees, some more than others. Activities and habits that cause arthritis include underactivity or overactivity without adequate nutritional support for repair, anti-inflammatory pain medications, steroids, mineral deficiency, and trauma. These all contribute to wearing away of the smooth cartilage that covers the surface of the knees, causing achiness and swelling after heavy, or in many cases, even mild weight bearing activities. Some cases lead to the eventual development of bone-on-bone arthritis, and can progress to the need for knee replacement surgery.

Athletic injuries to the knee happen in the young and old. The most common injuries involve the ligaments and articular pads of the knee. Ligaments can be over-stretched by an injury so that they becomes lax. Lax ligaments and weak leg muscles cause the surfaces of the knee to track unevenly, causing trauma and wear-and tear arthritis to the cartilage. The knee becomes unstable, hurts, and swells. Instability stresses the ligaments, which can eventually become frayed and torn. Once complete tearing occurs, surgery provides some relief.

How can I prevent knee surgery?
Ligaments, and especially knees have very specific requirements for healing. We can provide a complete menu of what your knee needs to heal. The basics include glucosamine for the cartilage, calcium for the bone under the cartilage, Magnesium, Zinc, Copper, Manganese, and vitamin C for collagen repair, and Fish oils for balancing inflammation. For athletic injuries and other trauma, treat the joint early: Don’t wait until the pain and laxity causes instability in the joint, weakness in the muscles, and more laxity and instability. Prolotherapy can strengthen these ligaments. Strengthening the ligaments will stabilize the knee so the joint and muscles can do their job. The pain will clear up when the knee functions better. If you want your knees to get better, avoid anti-inflamatories: These drugs inhibit collagen synthesis and stop the migration of fibroblasts sent to repair the injured tissue.

What if I already had surgery? Can Prolotherapy help me now?
Yes. Surgery can re-attatch torn ligaments and remove loose pieces of bone or cartilage. The repair and regeneration of lost cartilage and strengthening of weak and lax ligaments is best accomplished with prolotherapy injections. Prolotherapy and exercise can work together to stabilize the joint and restore normal function.

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. Prolotherapy injections are also used to thicken joint cartilage by injecting proliferative substances directly into joint spaces. 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, which then 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, enlarging and strengthening the damaged tendons, ligaments and cartilage. Glucosamine sulfate, hyaluronic acid and a plant enzyme called Sarapin are also commonly used in proliferative solutions.

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. More serious injuries can go on to chronic pain and dysfunction and the chronic use of common anti-inflammatory drugs. Over time, the anti-inflammatory drugs used in these cases will actually inhibit the repair of these damaged cells and contribute to the worsening of the injury.

How did these patients respond?
Nathan, our young gymnast, was able to stabilize his knee and get rid of his brace. He now performs gymnastics and his other sports without pain.

Jewell was able to just about throw away her cane and is only using it for stairs now. She is increasing her exercise without knee pain.

Jayme can perform deep knee bends, get back to a standing position without having to use her hands to help her up and has no more knee pain. Her knees no longer swell when stair climbing and she performs her leg strengthening routine almost daily.

Joel can get in and out of his truck without his knees popping out, can work without discomfort and recently returned from a painless 3 day elk hunting trip with his son.

Amazing what the right therapy can accomplish.