Prolotherapy?

Has anyone had any experience with prolotherapy for chronic shoulder and/or knee pain? Both positive and negative feedback would be greatly appreciated. If you have any recommendations on doctors that administer prolo in the Boulder/Denver area, I'd be interested in that, as well.

I've been dealing with tendonitis in left shoulder (rotator cuff and short head of the biceps tendon) for 2.5 years. I've also been dealing with chronic pain in both knees for almost as long. I had to quit climbing for nearly a year. To occupy my time, I started training for the Leadville 100 (run). I got up to 30 mile runs and suddenly my knees went from great to not being able to run. I've been able to climb sporadically for the past 1.5 years, but I haven't been able to run at all. Prolotherapy is about the only thing I haven't tried. Here is what I have tried:

2 shoulder surgeries (1997: repair torn labrum, 2005: remove floating chunk of cartilage; my tendonitis started after second surgery)
acupuncture
rolfing
pilates
2 cortisone injections in shoulder and 1 in each knee
oral anti-inflammatories
chiropractic
weight training
PT
friction massage (this is the only thing that seems to help, but doesn't keep the tendonitis from returning)
knee surgery on both knees (2006: removed plicae in both knees)
diet modifications
I even quit drinking coffee a few times!!!

Anyone that's been out of action with injuries before knows how desperate I am to sort out at least one of my ailments.

Feedback on prolo or anything else would be greatly appreciated. Thanks!

Dana - my feedback is not specifically about prolotherapy, but instead about tendonitis in general and how NSAIDs and prescription anti-inflammatory drugs may do more harm than good in the long run.

There was a good editorial in early 2006 about using NSAIDs (non-steroidal anti-inflammatory drugs like aspirin and ibuprofen) in tendonitis, and what they found was that these drugs may help in the short term, while the injury is acute. But long-term, these drugs inhibit the healing process, and can keep tendons, ligaments, and other connective tissues from healing. (Jan/Feb 2006 issue of Clinical Journal of Sport Medicine, Non-steroidal antiinflammatory drugs in tendinopathy: friend or foe?).

So, while these drugs help mask the symptoms of pain and inflammation, they exacerbate the underlying condition by not allowing it to heal properly. My concern is that staying on these medications at this point might not be doing you much good, and may be exacerbating your condition.

Talk to your doctor about this, and there are non-drug alternatives for inflammation that might help your pain and inflammation and still allow the healing process to occur. I know of a Boulder company that markets a natural anti-inflammatory called Inflamend (www.inflamend.com), and there are other things that can help, like fish oil, glucosamine, etc., but these take time to work. Let me know if you'd like a copy of the editorial I mention above. Best of luck!

My husband has just finished 6 sessions of prolotherapy on his left wrist. He was diagnosed with displaced scaphoid-lunate bones in the wrist as a result of a torn wrist ligament. An orthopedic surgeon told him that there was nothing short of major reconstructive surgery to fix the problem, and he would not be climbing anymore forever. As this is not an acceptable solution, he found an orthopedic surgeon in Chicago that does prolotherapy. And, as a result--No Pain! It seems to be working. The next step is occupational therapy and working to recover strength in the hand/wrist/arm. I only know of docs in the Chicago area who are practicing prolotherapy.

On another note, I don't think any type of massage therapy will help you. I've practiced clinical massage therapy for fourteen years and have found that if, in a few treatments of massage, the problem is not resolving it's most likely not the needed treatment.

Good luck finding someone in Boulder/Denver. Best wishes, Anita

Dana, sorry to hear about all your trouble. I am in a similar boat with chronic shoulder pain and also knee pain too (even have had medial plica removal as well...don't see that too often).

I have not tried prolotherapy, but am interested if you do go through with it since I have been interested. The word is that you need to find someone truly experienced in it, and unfortanetly no insurance covers it (at 430 bucks a pop for a shoulder it adds up after the first session). Anyway, I know down in the Springs Dr. Mary Harrow performs it, but I don't know beyond that or in the Denver area.

Something that seems to be fairly important with prolo is to make sure you maximize your nutrition (ie. all the proper nutrients, a protein supplement, and maybe Type I & III collagen...this provides all the building blocks for it to heal).

Good luck and I know how frustrating it can be. Hang in there, the body has a miraculous ability to heal itself when everything is in proper order, it's just a matter of getting it there.

Ian

-Side note: I've seemed to notice an association with IT band tightness, calf muscle soreness (laterally) and medial plica syndrome. It seems if the IT bands are out of whack it may exacerbate the medial plica to become inflamed...my own two cents.

Our insurance covered prolotherapy--Blue Cross/Blue Shield.

So jealous...

Thanks for all the feedback! Ian, I agree with you about the IT band tightness being linked to medial retinaculum pain. I'm a foam rolling fanatic. I know my knee pain would be worse if I didn't roll everyday.

Unfortunately, my student health insurance won't cover prolo, but I'd almost pay any amount of money if I was confident that it would work. I'd like to keep climbing, get back to running and/or cycling, and at the very least be able to play in the yard when my son gets older.

I'm really hoping that someone on MP.com has prolo experience with someone in the Boulder/Denver area!

Anybody know anything about Dr. Jo Ann Douglass from Colorado Osteopathic and Sports Medicine in Lakewood?

My friend had the nerves in his foot completely ruined by prolotherapy.

That sucks! Hmmm, that's definitely a mark against prolo.

Dana, my shoulder history is similar to yours..with some added rotator cuff tears/inflammation. One of the problems with PT (in my experience) is that they focus a lot on rotator cuff rehabilitation (which is good), but, climber's put an inordinate amount of stress on the shoulder and the light rubberband/weight work doesn't compensate for the strength imbalance caused by intense climbing. My problem: years of bench pressing as a young man, genetics, not employing consistent shoulder warm-up/dynamic range of motion/stretching on a regular basis - all of this resulting in protracted/internally rotated shoulders.
*Grade 2 tears on all rotator cuff muscles multiple times
*torn glenoid labrum
*tendonosis of lat/teres minor tendons

I am a strength and conditioning coach, meaning that I am qualified to help athletes get stronger for their sport and am NOT qualified to give clinical advice. My shoulder experience lasted around a decade and kept me from climbing for most of 03-05, so our experience (I think) is common among climbers. Because I am a strength coach, I looked at the problem from a muscle balance aspect (after MRI showed impingement and atrophied rotator cuff muscles). At that point I knew that because of my protracted/internally rotated shoulders, it was putting my rotator cuff muscles in a vulnerable position.

So, essentially I had to tackle the problem from the base of the shoulder toward the elbow.
Inlcudes:
scapular retraction
rotator cuff strengthening
stretching pectoral major/minor
stretching biceps
getting regular sport massage
chiropractic

Massage treatments were a trade for me, so I understand that not everyone can do that because of the expense. But, I really feel like consistent massage was a big help for me. Prolotherapy was something I started to look into, but never followed up on - so, I too, would be interested in your outcome.

As far as the knee goes, because you said that you had no traumatic injury to the knee, my guess would also follow that your IT Band is tight. As long as you have had diagnostic review to determine whether or not your knee has something else going on - IT Band syndrome is super-common in runners and can cause the patella to track laterally resulting in constant friction. Stretching/myofacial release on a foam roller (I use dog tennis balls because they don't collapse like regular tennis balls)and strengthening the gluteus medius and vastus medialis muscles.

David Wahl
www.athletikspesifik.com

Thought I would add that many rotator cuff tendonitis cases are misdiagnosed by PT's. Get a second, or third opinion before you start any therapy. My wife was misdiagnosed with rotator cuff tendonitis and given exercises that made her condition worse. When she finally realized she had an impingement issue and changed therapy accordingly she healed quickly. I would bet some cash that you might be in the same boat if you are also having bicep issues.

As for the knees......I used to run 12-18 mile runs often and developed a similar condition. Focused strength training and cutting back the mileage helped considerably. Think Plyometrics and sprint training to develop the strength needed for long pounding runs....obviously wait tell your knees are not killing you first.

I would second David's comment about IT tightness. Run the palm of your hand down the outside of your leg with moderate pressure. If that makes you jump get the only real IT therapy device which is a foam roller. It will make you scream but it WORKS.

Kevin Stricker wrote: If that makes you jump get the only real IT therapy device which is a foam roller. It will make you scream but it WORKS.

Hear hear.

You might try looking into ASTYM for tendonitis...it's a relatively new discipline of PT. Has worked great for me on my feet and elbows, two problem areas for me.

Mike, I would be interested to hear what they mean by 'control injections' since prolotherapy itself is just the injection of normal saline or 5% dextrose and normal saline, so I don't know what they would have used for control injections...unless they're comparing it to like cortisone studies or something. Just curious as to what they meant by that. Any ideas?

Ah, that's the part I was missing. Simultaneously though, it may not be the substance that is causing the healing, but rather the act of injection which injures the tissue, causing inflammation could be the cause, so it would be easy to see that there would be similar responses.

Anyway, I guess it's all just a matter of study design. Thanks for that info Mike.

Ian

Dana your post is quite timely actually. I have been having wrist problems for quite sometime due mainly to falling skateboarding and snowboarding as a kid. Last summer I took a bad tumble on my bike and the wrist took the brunt of it. Shortly after I broke my hand but long after the hand healed the wrist still hurt. While dealing with the hand I had them x-ray the wrist and the synopsis was real bad same as Anita's husband displaced scaphoid-lunate in stage 2. The surgeon told me that my only option was to drill a hole in the scaphiod (which is about the size of the tip of your pinky) string the tendon through it tie a knot and hopefully it would pull the bone back into place...giving me about ten more years of use where as afterwards they would have to fuse my whole wrist (I'm 27). This was bad to say the least. I asked aren't there any alternative options? His response: None.

So I went looking for anything I could to not give my money to a con-artist surgeon and stumbled across prolo. The results are mixed and I'm still kind of in the middle of it.

The down fall:

Expensive
Not a guaranty
Painful (My pain threshold is very high, I didn't think it hurt that bad but apparently that is not most people's case. I told the doc it hurts but not as bad as the invoice. He replied "that is the first time in my 25 years I've ever heard anyone say that.")
Most insurances do not cover

Pro's:

-If it works for you it is much cheaper than drilling holes in little bones and threading tendons through.

-It's maybe the only way to heal stressed tendons

-If it works you are actually healed and not cut up with left over scars and a timeline as to how long it'll last with no reverse options

-Doesn't put you down for long

So did it work for me? kind of not really...yet. I've gone twice he said it would take 2-4 times. The first visit I was actually feeling quite a bit better after the two-three day hurt wore off. I was pretty impressed actually. He injected me it swelled up for a couple days hurt but in a good way and then just felt better. The tendon was feeling tighter and kind of stopping hurting. I was skiing within a week of the injections. Then I went back...he was really excited to see how good my progress was going and said I might get away with just two sessions. Then he injected again it's been about a month or so and it doesn't feel that great. I've been debating whether to go back or not...this is making me think maybe one more time is worth it.

Doctor:

Everyone I've talked to has said that the best guy is Tom Raven. He lives in Denver is a good guy. Works out of his house. Big skier and adventure type guy. 303.331.9339

If you want to talk about it I would be happy to do so...PM me and I'll give you my number. Hope this helps.

-Jeff

As to the way it works...so Tom says when tendons are injured red blood cells go into them but they only stick around for 2-3 days. Since you have to have red blood cells for body parts to heal the fact that they leave tendons so quickly never allows them to fully heal. By injecting with Prolo (a simple sugar water sometimes with some hormones added) it effectually re-traumatizes the tendon making the body send red blood cells back. This triggers the healing process and allows the tendons to tighten up again.

Tom says that a large base of his clientele are rock climbers and that his success rate is very high.

Thanks Jeff for all the feedback. Thanks to everyone, actually. Keep it coming!

Mike Morley wrote:A 2004 medical review concluded that: "There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low-back pain. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently."

The thing is, no therapy of ANY kind is ever 100% effective in all cases. Not surgery, not physical therapy, not acupuncture, etc.

For some people prolotherapy can be highly effective if the doctor performs it well and your injured tissue/condition is appropriate for this type of therapy (which the doctor should also be able to evaluate appropriately). A friend's brother had it done for some chronically injured wrist ligaments. I don't remember the exact mechanism of injury but his bouldering was highly impacted. A series of 6 prolo injections made the laxity and pain in his wrist disappear. One anecdotal experience that may or may not mean anything in relation to you.

My only other suggestion would be to check into Active Release Technique, a type of myofascial release that is usually performed by chiropractors and sometimes by PTs. It may not be helpful for an "itis" but I've personally had it done for other chronic injuries where ligaments and/or nerves have entrapment issues due to adhesions and it works 500 times better than standard myofascial release.