Prolo Therapy

In some cases tissues may have been damaged beyond the body's ability to heal itself by trauma such as a fall or car accident. The body will repair itself as best it can, but altered tissue motion, and its subsequent discomfort or pain, will not resolve with osteopathic manipulation or with medication/surgery. In addition to the many forms of hands-on diagnosis and treatment that are offered, we also offer a number of injection therapies to assist in the patients' healing process:

What is Prolotherapy?

Used specifically to restart the healing process of tendons, ligaments and joints, proliferative therapy (prolo) has been used for centuries to help the body to restart and continue to repair damaged tissues. It can be very useful in chronic pain conditions that have failed to respond to other methods of treatment such as whiplash and low back pain.

"Prolo" is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

Ligaments are the structural "rubber bands" that hold bones to bones in joints. Ligaments can become injured or weak and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, which can cause slow and incomplete healing. Taking anti-inflammatory medications after an injury can add to the damage by stopping the healing process. To further complicate this, ligaments also have many nerve endings that signal the body that there is damage (pain) at the areas where the ligaments are injured or loose.

Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons may also become injured, and cause pain.

Developed into its current form by George Hackett, M.D., prolotherapy uses a dextrose (sugar water), vitamins, local anesthetic and an arachadonic acid solution, which is injected into the ligament or tendon where it attaches to the bone. These causes a localized inflammation in these weak areas that then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

How long will it take to complete a course of treatments?

The response to treatment varies from individual to individual, and depends upon one's healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate.

Neural Therapy

The Huneke brothers originally developed neural Therapy in Germany. It involves the injection of Procaine, a common local anesthetic, or homeopathic injectables into various but very specific areas. Neural Therapy is based on the theory that trauma can produce long-standing disturbances in the electrochemical function of tissues (called interference fields). Among the types of tissues affected by trauma include scars, nerves or a cluster of nerves called ganglions. A correctly administered Neural Therapy injection can often instantly and lastingly resolve chronic longstanding illness and chronic pain.

What causes interference fields?

• Infections.
• Emotional trauma.
• Physical Trauma from any type of surgery, accidents, deep cuts, biopsies, childbirth, dental procedures, vaccinations, burns, tattoos, etc.

You then may wonder how a scar or infection becomes activated to become an interference field. General stress from illness, malnutrition, emotional stress, food allergies, pregnancy, etc. seems to convert an inactive interference field to one that creates a disturbance. In scientific jargon, the conversion depends on your allostatic load at the time of the injury. When a wound convers into an interference field symptoms begin to occur. Many times we will recognize this. When asked "when did your symptoms begin?", we can give a precise moment or incident.

How many Neural Therapy treatments are typically necessary?

Sometimes one treatment in the precise area will resolve the problem. More often, only a partial improvement follows each treatment. Three to six treatments are the average number to achieve lasting resolution of a chronic condition. What Neural Therapy does for many of my patients is to open the door to allow the other healing modalities to finish the job.

Neural Prolotherapy

(Adapted with permission from John Lyftogt, MD — Founder of technique)

Prolotherapy is a very effective treatment for most injuries and ongoing joint, tendon, ligament and muscle pain. The treatment involves a series of injections with a glucose solution, immediately under the skin with a very fine needle, targeting the source of the pain. It can offer a success rate of greater than 75% for most conditions.

Neural Prolotherapy was developed by Dr. John Lyftogt MRNZCGP in New Zealand. He has been in practice since 1978 and has extensive postgraduate training and experience in sports medicine and musculoskeletal medicine. Dr. Lyftogt began practicing Prolotherapy after training with Dr. Margaret Taylor in Adelaide, Australia in 2003. He has been a full time prolotherapist at the world-famous sports center built for the Commonwealth Games.

Dr Lyftogt's early research focused on the treatment of Achilles tendon problems and he has now treated more than 300 Achilles tendons with a success rate of more than 90%. He has published two level 4 articles on Achilles tendons.

The technique developed for the treatment of Achilles tendons differs from Classical Prolotherapy in that the injections are given immediately under the skin while taking great care avoiding contact with the exquisitely sensitive tendon.

This 'neural Prolotherapy' protocol was successfully extended to the treatment of tennis elbow, painful knees, shoulders, neck, hips, ankles, muscle injuries and low back. Results are consistent and two year follow up studies have shown success rates between 80-100%. The treatment is also less invasive than Classical Prolotherapy.

How Does It Work?

Because neural Prolotherapy does not target tendons, ligaments or joints the question had to be asked what causes the sometimes dramatic decline in pain levels after even a few treatments. A working hypothesis was developed that glucose assists in the repair of connective tissue in the nerve trunks under the skin in a similar way as repairing connective tissue in ligaments and tendons with Classical Prolotherapy. These skin nerves are now known to be responsible for painful conditions generally identified as 'neuralgias' or 'peripheral neuropathic pain'. They consist for up to 80% of connective tissue and are structurally quite similar to tendons and ligaments.

There is now also compelling scientific evidence that the very small nerves innervating the nerve trunk, known as 'nervi nervorum' are responsible for inflammation of the connective tissue of the nerve trunk and surrounding tissues. Interestingly and surprisingly this fact has been known for over 125 years.

It is also known that this 'neurogenic inflammation' differs from conventional inflammation in that it does not respond to anti-inflammatories or cortisone injections. This is one of the reasons why these commonly used drugs are proving to be ineffective in many painful conditions in addition to a growing awareness that their use is not without serious side effects.It is clear from clinical observations on more than three thousand patients and large case series that neural Prolotherapy effectively reverses 'neurogenic inflammation' and resolves neuralgia pain.

Treatment Protocol

Treatment typically involves a 6-8 sessions of microinjections just under the skin with a very small needle. Additional treatment sessions are sometimes needed if a patient has prior surgeries, moderate to severe whiplash injuries with widespread pain, and/or significant underlying medical illnesses (diabetes, autoimmune disorder or history of cancer.) Treatments are completed within 10 minutes. At most the patient may have some brief tenderness at the injection site or a small bruise. Physical activity is not restricted post-injection, with most patients returning to their usual workouts the same day or next day. More than 98% of patients tolerate the minimal discomfort associated with the injections without a problem. The occasional patient however who is needle phobic or quite pain sensitive may not be a good candidate.

Prolotherapy History

Classical Prolotherapy was developed in the 1940s by an American trauma surgeon Dr George Hackett, using injections of Sylnasol, a sclerosing agent commonly used at the time for shrinking varicose veins. He targeted 'lax' or 'weak' ligaments with these injections to make them stronger.Hackett reasoned that if 'weak' ligaments were the cause of most joint and ligament pain, strengthening them would resolve the pain. He was certainly successful, publishing 16 articles and a textbook on this procedure, and claiming an 80% success rate for the treatment of low back pain as well as many other painful conditions.A growing number of Prolotherapy studies over the last 40 years have indicated good to excellent results from this type of treatment, with doctors in the USA, Australia and elsewhere continuing to use glucose injections (now using more advanced glucose solutions) with no side effects for painful conditions affecting joints, ligaments and tendons.

With the advent of evidence-based medicine in the last 20 years, scientific research have become intensely demanding and financially well out of reach of most researchers, unless supported by large grants or the Pharmaceutical industry. As a result, it has been almost impossible to fund good highlevel evidence research on Prolotherapy. But three researchers, Professor Michael Yelland from Australia and Professors David Rabago and K. Dean Reeves from the USA have bucked the trend with some excellent studies published recently, including a randomized control trial for treatment of Achilles tendinosis (British Journal of Sports Medicine, 2009). Dr John Lyftogt has also published six level 4 studies in the Australasian Journal of Musculoskeletal Medicine since 2005.