Sean Mulvaney, M.D.
Prolotherapy, which stands for proliferative therapy, has been used as a treatment modality since the 1950’s. Prolotherapy targets chronic ligamentous laxity as the cause of many chronic cases of joint and spine pain. The theory behind prolotherapy states that gradually accumulated ligament laxity (through trauma or chronic repetitive actions) allows the joints or spine to move beyond their intended parameters. This additional joint motion from “loose ligaments” then leads to painful chronic conditions such as vertebral disc bulges or cartilage degradation resulting in osteoarthritis. In cases that produce chronic pain, these lax (loose) ligaments do not induce a productive healing response. Prolotherapy is also effective for tendinopathies. Prolotherapy is generally used as a regional modality, as many ligaments work in concert to promote normal joint motion. The most studied “proliferant” solution is 15% dextrose, and although there are other solutions, this is what we use because it is safe and effective. When injected into or near a ligament or tendon, the hyperosmolar dextrose induces a mild cellular injury, which in turn initiates an inflammatory response. The intention of prolotherapy is that focused initiation of the healing cascade will eventually heal the previously unrecognized ligamentous injury to its ideal length and structure, and that by healing all or most of the major ligaments in a painful joint or section of spine, normal motion parameters will be restored, allowing the area to heal over time. This is an inflammatory process, and inflammation is the vital first phase of healing.
What to expect and how to prepare for Prolotherapy
2 weeks prior to the procedure: depending on the procedure, you may need to arrange for a driver to bring you home.
7 days prior to the procedure: Stop taking anti-inflammatory drugs like ibuprofen, Naprosyn, Celebrex. Let your doctor know if you have been taking prednisone or other corticosteroids in the last month.
The day before the procedure: thoroughly shower and clean your skin. You will not be able to shower for 24 hours after the procedure.
The day of the procedure: Wear loose-fitting clothing like sweatpants or shorts. If you are having an upper body procedure wear a top that can button or zip up.
Prolotherapy will initiate healing and a productive inflammation, and prolotherapy therapy will make the body part treated sore for 4 days to 10 days. Anti-inflammatory drugs (i.e. ibuprofen, Naprosyn, Celebrex) and corticosteroids such as prednisone can blunt or stop this process, so it is important to not take any anti-inflammatory drugs for 7 days before getting prolotherapy therapy, or for at least three weeks after prolotherapy. Corticosteroid injections can blunt inflammation for 30 days, so let us know if you have had one recently. You may need a driver to bring you home, but most people feel well enough to safely drive. Tobacco is a potent toxin and its use constricts small blood vessels which are needed for tissue repair. Tobacco use will limit the effectiveness of any treatment and stopping tobacco use is one of the single greatest actions you can take to improve your health. Avoid toxins like alcohol, which inhibits and depresses the cells needed for tissue repair.
What happens during the prolotherapy procedure?
The prolotherapy used is a solution of 15% dextrose and is mixed in either IV fluid or 1% lidocaine (a “numbing” medication) to make the correct concentration. The skin at the injection site is numbed with a small needle and local anesthetic (buffered lidocaine). Dr Mulvaney will then precisely inject the prolotherapy into the specific anatomic locations using ultrasound guidance.
What to do after your procedure
I may give you specific medicine to control any discomfort you may have after the procedure. Usually very little or no medication is needed by most patients. Avoid NSAIDs like ibuprofen. Acetaminophen can be used for mild pain. Avoid showering for 1 day and avoid immersion in water for 3 days. Any bandages can be removed after 1 day. After 3 days, unless otherwise instructed, the treated body part should be used and slowly moved through its full range of motion. It will be sore, but you will not be doing damage by moving it, in fact it needs to move to heal. For the next month avoid activities that specifically hurt you before being treated. Exercise is vital to good health and finding a way to cross train around your injury is important not only for your physical health, but for your mental health as well. Ask me about cross training options for your injury. Some brief (10 minutes or less) period of heat or ice therapy will not hurt the therapy, but it is not required. Often, depending on the injury, physical therapy is started from two weeks to four weeks after injection. Improvements in pain and function should be expected from 8 weeks to 12 weeks after injection. Prolotherapy is most commonly done as a series of three treatments, each about one month apart.