What to expect from a course of prolotherapy
On your initial visit, you will be assessed for the appropriateness of regenerative therapy. We will learn your health history and perform a physical exam specific to your condition. Dr. Peterson will review your prior medical records, including CAT scans and MRIs, and X-rays. When these studies have been performed, the majority of patients will not require further laboratory tests. In some cases, additional tests may be discussed and ordered, and could range from X-ray films to metabolic profiles to nutritional to endocrine (hormonal) tests and evaluations. In most cases conclusive evaluation of the injury can be confirmed with hands-on palpation and range of motion testing in the office.
Once the location and nature of the injury is confirmed, a course of regenerative therapy will be prescribed. The usual threshold for improvement is 4 sessions of prolotherapy. In each session, a small needle will be used to inject the proliferative solution into the place where tendons and ligaments attach to bone, called the fibro-osseous junction. For every time the skin is pierced, several areas of the tendon or ligament will be injected and infused with the growth factor inducing proliferative solution. Most patients consider the pain of prolo injections to be significantly less troubling than the chronic pain of their injuries. Since one of the ingredients of the proliferative solution is a local anesthetic, pain at the site of the injection is minimized.
Many of the injuries we treat are complicated by muscle spasm. Tight and painful muscles occur as they attempt to guard the injured tendon or ligament. These activated and hypertonic muscles restrict blood flow, inhibit healing, and cause pain to be referred beyond the area of ligamentous injury. Most patients benefit significantly from the use of trigger point injections, where procaine is injected into these areas of hypertonic and spastic muscle bundles. Procaine relaxes these muscle spasms, inhibits reflex spasm, and increases blood flow to the injured tissue.
All patients are encouraged to moderate their activities for 24 hours following each session, after which they can resume appropriate physical activity. Pain following the injections is usually short term, and can often be controlled with the natural enzyme bromelain. Occasionally a few doses of aspirin or Tylenol may be recommended to ease post-injection pain, and rarely a narcotic pain reliever such as Vicodin is prescribed.
The response to treatment is cumulative: benefits compounding with each treatment. After the initial series of injections, patients will be given 4 -12 weeks to further accrue the benefits of therapy. Remember, the repair response after injection lasts 4-6 weeks, and further injections may be required to promote the healing of badly damaged ligaments. As the stabilizing effects of regenerative therapy accrues, and the supporting cast of nutritional support and muscle strengthening continues, pain free range of motion is enhanced.