By Steven Meier
When considering medical treatment options in Los Angeles for joint injuries and the negative orthopedic effects of age and overuse, some people immediately think of surgery as the only effective option. However, modern regenerative medicine has provided effective and natural solutions for joint and muscle rehabilitation. Of the various regenerative medicine treatment options available today, prolotherapy treatment can provide effective restoration of ligaments and tendons on a cellular level. However, many do not understand what this type of therapy can do in the creation of healthier bodies and happier lives.
Get in touch with Dr. Steven Meier in Los Angeles by calling 310.736.2793 or filling out the online contact form to schedule an appointment and learn more about how prolotherapy treatment and regenerative medicine can help you.
What is Prolotherapy?
The term “prolotherapy” is short for “proliferative therapy” which involves the stimulation of a proliferative or regenerative process in the body. The technique of prolotherapy involves administering multiple injections of a dextrose-saline solution in specific concentration into or around the tissue requiring treatment. Prolotherapy can be used to treat musculoskeletal disorders in 2 main ways. One is to inject injured connective tissue structures like ligaments and tendons to induce healing. As injured or degenerated and lax supportive structures allow joint instability that causes painful inflammation, healing of these structures leads to retensioning and reduction of joint instability, allowing the painful inflammation to subside. Another way to use prolotherapy is to inject concentrated dextrose solution inside joints to reduce painful inflammation from bursitis, tendinosis or damaged cartilage.
Prolotherapy works in several different ways. Prolotherapy has been demonstrated to induce the production of collagen.1,2,3,4,5,6 Collagen makes up the substance of supportive ligaments much in the way of fibers in a rope or cable. Collagen also provides the framework to support cartilage just like the rebar in buildings.
Additionally, Prolotherapy stimulates the production of glycosaminoglycans and proteoglycans which are the building blocks of cartilage, providing its compressive and cushioning properties. 7,8,9.10,11,12,13 Also, very importantly, dextrose prolotherapy solutions have been shown to naturally decrease neurogenic inflammation, a common source of pain in many musculoskeletal conditions. 13
Prolotherapy sessions are usually administered in a series. An average number of orthopedic prolotherapy sessions within a series is about 5 but might range from 3 to 7 depending on the severity of the condition being treated. The injection sessions are usually spaced apart by 2-4 weeks. By repeating the injections at a certain frequency, the body’s healing mechanisms are being “primed.” It is important to realize that the body’s response to prolotherapy is slow and gradual. It is normal for patients to feel no significant effects until sometime after the 3rd injection series. Sometimes patients feel effects sooner but that is considered a bonus. Nevertheless, as slow and gradual as relief onset may be, the duration of effects can also be expected to be relatively long.
Prolotherapy is considered a relatively safe and natural intervention. The solutions used are simple and non-toxic. There are no serious side effects. The purpose of orthopedic prolotherapy essentially is to stimulate the body to heal itself. Prolotherapy can be used alone or in combination with other treatment modalities. The goal of prolotherapy is to reduce pain and improve function.
What Conditions are Treatable with Regenerative Medicine?
- Neck – Whiplash, Arthritis, Instability, Disk Disease
- Back – Arthritis, Instability, Disk Disease, Spondylolisthesis, Pain After Surgery, Sacroiliac Joint Dysfunction
- Coccyx – Coccygeal Pain
- Pelvis – Groin Injuries, Hamstring Injuries, Ischial Tuberosity Pain
- Shoulder – Rotator Cuff Tendinopathy, Impingement, Arthritis
- Elbow – Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfers Elbow)
- Hand/Wrist – Sprains, Tendonitis, Finger Arthritis, Basilar Thumb Arthritis, Carpal Tunnel Syndrome
- Hip – Arthritis, Tendonitis, Bursitis
- Knee – Arthritis, Chondromalacia, Patellofemoral Pain, Patellar Instability, Patellar Tendinosis (Runners/Jumpers Knee), Ligament Instability (ACL, PCL, MCL, LCL), Meniscal Tears
- Ankle/Foot – Arthritis, Achilles Tendinosis, Ankle Instability/Chronic Sprains, Posterior Tibialis Tendon Dysfunction, Medial Arch Pain, Plantar Fasciitis
Reasons to Consider Going to an Orthopedic Surgeon
Prolotherapy treatment is practiced by physicians from a number of different fields, most commonly general medicine, family practice and physical medicine and rehabilitation. It is unusual, however, to find an orthopedic surgeon who performs prolotherapy. The reason is that prolotherapy is not normally a part of the standard orthopedic surgery training curriculum. An orthopedic surgeon who practices prolotherapy would have sought out the additional training on their own. Once patients realize it is an option, more and more of them do prefer to trust their regenerative medicine treatment to the hands of a surgeon. An orthopedic surgeon spends many years of training learning musculoskeletal anatomy from the inside and out. A surgeon has a detailed knowledge of the exact location of anatomic structures from everyday experience in performing surgery. Thus it is quite natural and desirable for a surgeon to perform orthopedic prolotherapy treatments. Having a high level of technical skill and accuracy in performing prolotherapy treatment can help reduce the risk of complications and may lessen the number of sessions necessary for the desired result.
Dr. Meier in Los Angeles originally became interested in prolotherapy as a modality for treating patients who were not surgical candidates. As he gathered more experience in prolotherapy treatments, he also found that some surgical patients could experience enhanced postoperative results by incorporating prolotherapy as well. While some injuries and conditions respond best to a surgical approach, other musculoskeletal conditions respond favorably to less invasive means like prolotherapy treatments with a lower risk of complications. Some physicians who practice only prolotherapy or only surgery may tend to recommend their one treatment approach for every condition, even when it might not be the best option. Since Dr. Meier in Beverly Hills is proficient in a wide range of non-surgical and surgical modalities of treatment for musculoskeletal conditions, he can employ the most appropriate and effective treatment regimen or regimens for each individual patient without bias or favor for any particular method.
How Is the Treatment Administered and How Often are they Needed?
A prolotherapy treatment involves administering multiple injections with a small needle to the affected body part. This can be performed in an office setting with local anesthesia. Most patients require 3-6 injection sessions for the desired effect. Sessions can be spaced apart by approximately 3-6 weeks.
Dr. Meier’s Experience
Dr. Meier in Los Angeles is trained in the classic Hackett-Hemwall method, through the Hackett-Hemwall-Patterson Foundation, one of the primary originators of orthopedic prolotherapy treatments. Dr. Meier also has extensive experience in utilizing leading-edge therapies with mesenchymal stem cells (MSC) and platelet-rich plasma (PRP) in both surgical and nonsurgical settings. Depending on each individual patient’s condition and particular requirements, Dr. Meier in Beverly Hills is well versed in using classic dextrose solutions to the most progressive PRP and stem cell preparations.
Types of Prolotherapy Treatment
This is the original or “traditional” method of prolotherapy. A dextrose/saline solution is injected into injured or degenerated anatomic structures to stimulate the healing response.
Platelet Rich Plasma (PRP)
The effects of traditional prolotherapy can be enhanced for some procedures by incorporating PRP to provide additional, exogenous growth factors for a more vigorous healing response.
Traditional proliferative therapy treatment can be further “supercharged” by incorporating mesenchymal stem cells with exogenous growth factors for maximal stimulation of the healing response.
Learn more about prolotherapy treatment and regenerative medicine from ncbi.nlm.nih.gov.
Find Out More About Your Regenerative Medicine Treatment Options Today
If you think that prolotherapy treatment may be right for you or want to learn more about regenerative surgery options for joint injuries and other conditions, contact the team at Meier Orthopedic Sports and Regenerative Medicine in Los Angeles today. Call 310.736.2793 or fill out the online contact form to learn more about prolotherapy treatments as soon as possible and start the road to recovery today.
1. Schwarz R. Prolotherapy: a literature review and retrospective study. J Neurol Orthop Med Surg. 1991; 12:220-229.
2. Schmidt H. Effect of growth factors on proliferation of fibroblasts from the medial collateral and anterior cruciate ligaments. J Orthop Res. 1995:13:184-190.
3. Liu Y. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983; 2:95-102.
4. Maynard J. Morphological and biomechanical effects of sodium morrhuate on tendons. J Orthop Res. 1985; 3:236-248.
5. Hackett G, Ligament and Tendon Relaxation Treated by Prolotherapy. Charles C. Thomas; Springfield, IL; 1958.
6. Klein R. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measures of lumbar spine mobility before and after treatment. J Neurol Orthop Med Surg. 1989; 10:141-144.
7. Reeves KD, Hassanein K. Randomized prospective double- blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000;6:68–80.
8. Kim SR, Stitik TP, Foye PM. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: A physiatric perspective. J Phys Med Rehab 2004;83:379–389.
9. DiPaolo S, Gesualdo L, Ranieri E, Grandaliano G, Schena FP. High glucose concentra- tion induces the overexpression of transforming growth factor-beta through the activa- tion of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol. 1996;149(6):2095-2106.
10. Murphy M, Godson C, Cannon S, et al. Suppression subtractive hybridization identi- fies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem. 1999;274(9):5830-5839.
11. Ohgi S, Johnson PW. Glucose modulates growth of gingival fibroblasts and periodon- tal ligament cells: correlation with expression of basic fibroblast growth factor. J Periodontal Res. 1996;31(8):579-588.
12. Pugliese G, Pricci F, Locuratolo N, et al. Increased activity of the insulin-like growth factor system in mesangial cells cultured in high glucose conditions. Relation to glu- cose-enhanced extracellular matrix production. Diabetologia. 1996;39(7):775-784.
13. Reinhold D, Ansorge S, Schleicher ED. Elevated glucose levels stimulate transforming growth factor-beta 1 (TGF-beta 1), suppress interleukin IL-2, IL-6 and IL-10 production and DNA synthesis in peripheral blood mononuclear cells. Horm Metab Res. 1996;28(6):267-270.
14. Lyftogt J. Prolotherapy and Achilles tendinopathy: A prospective pilot study of an old treatment. Aust Musculoskel Med 2005;10:16–19.