Have you ever had an injury that didn’t heal correctly? Does it still bother you or limit your activities? When resting, icing, and anti-inflammatories are just not enough, and your issue becomes chronic, there are other treatment options, but do they all work? Read further to see if prolotherapy may be an option for you.
A vast majority of acute sprains and strains are self-limiting. By following the typical RICE protocol of resting/modification of activities, icing, compression, and elevation, one is usually able to recover within a matter of weeks with no further intervention required. In recalcitrant cases, though, the area may not heal completely, or properly, and it becomes a chronic condition. When this happens, the problem is no longer inflammation, but degeneration of the ligament or tendon (1,2). Other treatment options are now often explored, which may include steroid injections, platelet-rich plasma, and/or prolotherapy.
Prolotherapy (aka proliferation therapy) is a nonsurgical, serial injection treatment option for chronic musculoskeletal (tendon, ligament, joint) conditions. The most common type reported is a dextrose solution, which gets injected into and around the affected area to stimulate an acute low-grade traumatic process, allowing the body to use its own inflammatory markers to aid in the body’s healing process naturally, thus regenerating and repairing damaged tissues, restoring joint stability, and improving pain (3).
The purpose of the injections is to interrupt the degenerative cycle, turning the chronic process into an acute one, which then initiates the healing process and tissue repair through inflammation, proliferation of new cells, and remodeling of the tissue (1,3,4).
There are various documented uses of prolotherapy in the lower extremity, including for osteoarthritis (e.g. ankle joint, subtalar joint, big toe joint), chronic ligament damage (e.g. plantar fasciosis, ankle ligaments), along with tendinosis (e.g. Achilles tendinosis). The research on prolotherapy injections is limited, but they have shown to decrease pain, as well as to improve stiffness, disability, and activity limitation (1,3,5,6).
Treatment protocol will differ depending on the physician, but I usually recommend routine injections until symptoms resolve (estimate 4-6 injections) or until improvement is no longer noted. Patients should avoid certain anti-inflammatory medications during the treatment time period as they can delay healing potential, and it is important to resume a good nutritional diet. Each physician will also have their own post-injection protocol, which may include avoidance of certain higher impact activities for a period of time. It is important to discuss the treatment beforehand with your physician to make sure you are a good candidate for prolotherapy.
If you are interested in prolotherapy and think you may be a good candidate, contact the doctor, or your own healthcare professional if you are out of area, for a consultation, and please stay tuned for further blog articles and information on advanced treatments for other lower extremity conditions.
Disclaimer: This blog is meant for educational purposes only and should not be construed as medical advice. The guidelines above are also generalized and should be customized to fit the needs of the individual patient. Please consult your own physician if you have questions or concerns related to your own health.
1. Kim, E., & Lee, J. H. (2014). Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM&R, 6(2), 152-158.
2. Reeves, K. D. (2000). Prolotherapy: basic science, clinical studies, and technique. Pain Procedures in Clinical Practice, 2nd Ed. Hanley and Belfus. Philadelphia, 172-190.
3. Sanderson, L. M., & Bryant, A. (2015). Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. Journal of foot and ankle research, 8(1), 57.
4. Soft Tissue Repair and Healing Review. Retrieved from http://www.electrotherapy.org/modality/soft-tissue-repair-and-healing-review
5. Van Pelt, R. S. (2011). Ankle and foot treatment with prolotherapy. J Prolotherapy, 3, 576-581.
6. Yelland, M. J., Sweeting, K. R., Lyftogt, J. A., Ng, S. K., Scuffham, P. A., & Evans, K. A. (2011). Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. British journal of sports medicine, 45(5), 421-428.