~ Performed by Dr. Patrick Bartoshyk, Naturopathic Doctor
What is Dextrose Prolotherapy?
Prolotherapy, also referred to as Regenerative Injection Therapy (RIT), is defined as both a “nonsurgical ligament reconstruction” therapy as well as a treatment for chronic musculoskeletal pain. The word “Prolo” is short for proliferation as prolotherapy treatment enhances the growth and formation of new ligaments, tendons and cartilage in areas where there is weakness or excess scar tissue. Prolotherapy incorporates the use of a specialized dextrose (sugar) solution, which is injected into a ligament or tendon where it attaches to the bone. The initial reaction of the treatment is localized inflammation triggering a wound healing cascade leading to increased blood supply and flow of nutrients and growth factors. This stimulates the tissue to repair itself by deposition of new collagen, the material that ligaments and tendons are made of. The new collagen then shrinks as it matures leading to ligament/tendon tightening and increased strength.
Prolotherapy (RIT) has been found to be an effective treatment for:
- Joint pain (all locations)
- Torn ligaments, tendons and cartilage
- Herniated / Degenerated discs
- Post injury / Trauma pain
- Low Back Pain / Rib Pain
- Neck Pain / Headaches / TMJ
- Unstable shoulder joints (dislocations)
- Surgical scar reduction
- Post fractures
- Pain conditions: Sciatica, Arthritis, etc.
- Frozen shoulder
- Whiplash injuries / Sports Injuries
How can I test myself to see if prolotherapy is for me?
The signature finding is pain that you can put a finger on. If you can precisely point to your source of pain (e.g., at the top of the neck or base of the skull for headache pain, top of the shoulder, inner or outer elbow, the sides of the knee), there is a great chance that prolotherapy can resolve it.
How many prolotherapy treatments do I need?
While highly individual, 3-6 treatments spaced 4-6 weeks apart are commonly performed to achieve sufficient pain reduction.
How long does Prolotherapy healing last?
Since we can continue to “wear out” or be re-injured, it is impossible to say how long your healing can last. Sometimes patients come back a year or more later for a “booster” procedure in the same area, others have to come back sooner. Some patients don’t require any boosters. It really depends how well you take care of yourself and how your body responds to the treatments.
What should I bring to my first prolotherapy treatment?
- Comfortable, loose, athletic clothing.
- Any reports of MRI’s, CT scans, x-rays, & ultrasounds, etc.
- Copies of all recent blood work (less than 6 months old).
What can I expect during a treatment session?
Prolotherapy treatments usually take 30-60 minutes in the clinic, depending on the area being treated. Patients are able to walk out/drive home on their own and there is generally little to no downtime.
What can I expect after a treatment session?
Some post-injection pain in the form of localized soreness and discomfort is normal and expected. Some patients may experience a flare of pain for 1 to 2 days after the injection. It is important to remember that it takes time to heal and instant results should not be expected. The regeneration of damaged ligaments, tendons, and joints may take months, but you can likely start to notice the benefits of your treatment well before this period.
What medications can be taken for pain after treatment?
- Acetaminophen / Paracetamol (Tylenol)
- Topical creams:
- ProloGel; Lidocaine containing creams without NSAIDS; Traumacare lotion
- Prescription medications:
- Tylenol 3, with codeine
- Opioid and synthetic opioids: Demerol; Lorcet; Vicodin; Norco; Lortab; Percocet; Oxycontin 40; RMS MS Contin (morphine sulfate)
What medications and supplements should NOT be taken before or during treatment?
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Acetylsalicylic Acid (ASA): Aspirin; Anacin; Excedrin; Percodan
- Propionic acid derivatives: Ibuprofen (Advil, Motrin); Naproxen (Aleve)
- Acetic acid derivatives: Indomethacin (Indocin), Diclofenac (Voltaren)
- Selective COX-2 inhibitors (Coxibs): Celecoxib (Celebrex)
- Topical Creams:
- Many over-the-counter topical pain creams and gels contain NSAIDs and should not be used.
- Read the label carefully and if unsure, check with the pharmacist.
- Hydrocortisone; Prednisone; Cortisone injections
- Natural anti-inflammatories (stop taking 5 days before and 7 days after injections):
- Bromelain; Curcumin; Proteolytic enzymes; Quercitin
- If you are uncertain if your medication is an anti-inflammatory check with your pharmacist, prescribing doctor, or call the office.
What about exercise?
Be active but modest:
- Gentle activity and stretching is encouraged and essential for recovery; let pain limit your movement or degree of stretching. Keep the joint moving and avoid prolonged sitting.
- Walking for 20 to 30 minutes per day is recommended, as this encourages functional orientation of the newly augmented collagen fibres.
- Avoid sport/vigorous activity and heavy lifting for 1 week after treatment. The majority of healing after a prolotherapy session occurs in the first 2 weeks; But, the first 3-5 days post prolotherapy are the most important and you should avoid stressing the joint or you may cause the treatment to be undone.
What about ice and/or heat application?
- Avoid excessive ice or heat application (>5 minutes and >3 minutes, respectively) in the first 72 hours. In the early phase of healing, heat is too pro-inflammatory, and ice is too anti-inflammatory, and both may hinder your healing.
- Do not submerge yourself in water (pool, hot tub, bath tub, ocean, etc.) for 72 hours following injections as this may increase your risk of skin infection. Showers are okay.
- From 72 hours onward, contrast hydrotherapy is recommended; perform the following:
- 3 minutes of heat followed by 1 minute of ice, repeat cycle 3 times.
- Can do this up to 3 times per day.
- Important: end with cold/ice.
What conditions or lifestyle factors may cause some people not to respond as well as others?
- Post-menopausal females with uncontrolled symptoms and/or hormone imbalance
- Men older than 50 years with low testosterone levels and metabolic syndrome
- Moderate to excess alcohol consumption