Millions of people suffer from back and joint pain every year and don't get much benefit from the efforts of traditional therapies. Chronic as well as intermittent pain has been a problem plaguing people since the advent of physical activity and labor and has been a major cause of disability and health decline.
As usually occurs in the tradition of medicine, researchers on the pharmaceutical side have worked diligently at creating the eternal income scheme, medications that address the symptom. As this has occurred over time people have had hundreds of medications to choose from to make them feel a little bit better, but not to make the cause of the problem change. Inevitably, disease progressed and people got worse and lost significant amounts of range of motion and function. It seems that this is the status quo for many medical problems.
Every now and then a "free thinking" man or two comes on the scene and feels that the status quo is just not good enough. And with a little bit of creativity, a persistent desire to do better, observation of research and dedication, a new technique evolves.
Herein lies the story of Prolotherapy.
In the early years, 1920's and 1930's, Doctors Gedney, Schumann, Hackett, and Steindler had created a concept that seemed to really work to help people with connective tissue, back and joint pain.
This technique involved injecting a variety of different solutions into tissues to help stimulate a healing response. Initially the process was called Sclerotherapy and was used for hernias, varicose veins, and low back pain. As experience and research grew, it was adapted to use in other areas of the body, all areas of ligament and tendon dysfunction.
Dr. George Hackett is considered to be one of the more significant pioneers of the treatment because he brought this to mainstream medicine with journal publications and extensive case studies.
Next Dr. Gustave Hemwall incorporated these techniques of Dr. Hackett into his practice and began teaching other doctors how to apply the therapy. He was the main teacher in the technique in the US for many years.More recently Dr. William Faber and Dr. Thomas Dorman have published lectures and instructed thousands of physicians. Faber's hugely successful book "Pain, Pain, Go Away" has been an excellent lay person’s guide to the treatment. He has coined the phrase "Reconstructive Therapy."
I came on the scene close to 18 years ago, and had heard and learned about the therapy. I had gone to Dr. Fabers office and spent just over a week with him, daily, to pick at his brain and learn everything that his experience had to offer. It was a remarkable enlightenment and allowed me to bring this therapy to my patients. I then began taking other courses, created by the Osteopathic organizations on Sclerotherapy and Prolotherapy and widened my knowledge base. With my extensive nutritional background this had provided a more significant result.
It has been by far, the most beneficial and effective way to maxmize healing and results for patients, that I have ever seen or experienced.
It can be used to strenghten ligament, tendons and soft tissues all over the body.
From the head and neck, including TMJ , to the shoulders, elbows, wrists, fingers and hands, to the mid and lower back, sacroilliac, hips , knees ankles and feet.It works very well also for the patients with fibromyalgia and chronic muscle and fascia dysfunction.
The mechanism of action involves gently stimulating the tissues with a solution. This can consist of vitamins, minerals, dextrose, phenol or even pumice stone. The irritation provided enables the body to respond by creating a focus of healing. At the site of injection, cells will aggregate and start to develop new blood vessels. Growth factors are released and all of the excellent components of blood flow will be delivered to the area. As this occurs, the vitamins, minerals, hormones, and collagen create new tissue repair and growth. This also is a strong mechanism to relieve pain and immobility.
All patients differ with extent of injury and healing ability, and initially I evaluate the healing mechanism by doing blood testing for vitamins, minerals and hormones. The body has a far better capacity to heal and grow when these essentials are at optimal levels. The solution used also depends on patient response and result. At times I will add a slightly stronger solution to the mix to further result.
Please read the attached articles, and look at my website for further info.
Thanks,
Dr. Chris Calapai
——————————–
Randomized, Prospective, Placebo-Controlled Double-Blind Study of Dextrose Prolotherapy for Osteoarthritic Thumb and Finger (DIP, PIP, and Trapeziometacarpal) Joints: Evidence of Clinical Efficacy.
Objectives: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints.
Objectives: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints.
Design: Prospective randomized double-blind placebo-controlled trial.
Settings/Location: Outpatient physical medicine clinic.
Subjects: Six months of pain history was required in each joint studied as well as one of the following: grade 2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were eligible. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls.
Intervention: One half milliliter (0.5 mL) of either 10% dextrose and 0.075% xylocaine in bacteriostatic water (active solution) or 0.075% xylocaine in bacteriostatic water (control solution) was injected on medial and lateral aspects of each affected joint. This was done at 0, 2, and 4 months with assessment at 6 months after first injection.
Outcome Measures: One-hundred millimeter (100 mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint movement and pain with grip, and goniometrically-measured joint flexion.
Results: Pain at rest and with grip improved more in the dextrose group but not significantly.Improvement in pain with movement of fingers improved significantly more in the dextrose group (42% versus 15% with a p value of .027). Flexion range of motion improved more in the dextrose group (p _ .003). Side effects were minimal.
Conclusion: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.
Click on the link below to read the whole article
http://drreeves.com/Finger%20Arthritis%20Study.pdf
Prolotherapy: Dr. C. Everett Koop's Story.
Prolotherapy is the name some people use for a type of medical intervention in musculoskeletal pain that causes a proliferation of collagen fibers such as those found in ligaments and tendons, as well as a shortening of those fibers. The "prolo" in Prolotherapy, therefore, comes from proliferative. Other therapists have referred to this type of treatment as Sclerotherapy. "Sclera" comes from the Greek word "sklera", which means hard.
Sclerotherapy, therefore, refers to the same type of medical intervention which produces a hardening of the tissues treated – just as described above in the proliferation of collagen fibers. Not many physicians are aware of Prolotherapy, and even fewer are adept at this form of treatment. One wonders why that is so.
In my opinion, it is because medical folks are skeptical and Prolotherapy, unless you have tried it and proven its worth, seems to be too easy a solution to a series of complicated problems that afflict the human body and have been notoriously difficult to treat by any other method. Another reason is the simplicity of the therapy: Injecting an irritant solution, which may be something as simple as glucose, at the junction of a ligament with a bone to produce the rather dramatic therapeutic benefits that follow.
Click on the link below to read the whole article
http://carolinaback.com/pdf/drkoopendorse.pdf
Reconstructive therapy.
Reconstructive therapy uses injections of natural substances to stimulate the growth of connective tissue in order to strengthen weak or damaged tendons or ligaments. As a simple, cost-effective alternative to drug and surgical treatment, reconstructive therapy is an effective treatment for degenerative arthritis, low back pain, carpal tunnel syndrome, migraine headaches, and torn ligaments and cartilage.
Joint, tendon, ligament, cartilage, and arthritic problems are among the most common afflictions Americans suffer from today. Many remedies are used to treat those problems, such as rest, medication, traction, exercise, cortisone injections, physical therapy, and surgery, but for many patients these fail to provide lasting relief.
In many cases, however reconstructive therapy (also known as sclerotherapy, prolotherapy, or proliferative therapy), a nonsurgical method that stimulates the body's natural healing abilities to repair injured tissues and joints, can provide an answer. "Ligaments, tendons, cartilage, and bones have poor healing abilities due to the lack of blood supply to these tissues," says William Faber, D.O., Director of the Milwaukee Pain Clinic and a leading authority in the field of reconstructive therapy. "This is why injuries to these areas are so long lasting.
When these tissues become damaged, the joint becomes unstable, and in order to compensate, the body forms bony, arthritic spurs. This causes increased friction, increased pain and weakness, and a loss in joint mobility. Further injury often results."
Click on the link below for a complete article
http://carolinaback.com/pdf/recontx.pdf
Non-Surgical Tendon, Ligament and Joint Reconstruction.
In acute injuries, the ligaments and tendons become torn. Ligaments function to limit the range of motion that bones can move between each other, and function to stabilize joints and hold the joint together. Tendons function to attach a muscle to bone in order to provide motion. Discs and cartilage serve to absorb shock and keep the bones from rubbing against one another. If the ligaments become torn or over-stretched the joint becomes unstable and resultant friction causes the discs or cartilage to become worn down causing a loss of height. The disc and cartilage may also become worn away by repeated motion. This loss of height causes further ligament laxity and thus more instability. The friction of the joint is a stress.
In acute injuries, the ligaments and tendons become torn. Ligaments function to limit the range of motion that bones can move between each other, and function to stabilize joints and hold the joint together. Tendons function to attach a muscle to bone in order to provide motion. Discs and cartilage serve to absorb shock and keep the bones from rubbing against one another. If the ligaments become torn or over-stretched the joint becomes unstable and resultant friction causes the discs or cartilage to become worn down causing a loss of height. The disc and cartilage may also become worn away by repeated motion. This loss of height causes further ligament laxity and thus more instability. The friction of the joint is a stress.
Bones respond to stress by making more bone. This results in bone spurring which is the body's attempt to splint or stabilize the unstable joint. Degenerative disease is merely the body's attempt to stabilize joints as the tendons and ligaments have not been able to heal because of lack of blood supply. If a patient has considerable degenerative arthritis, the loss of disc or cartilage height causes a laxity of the supporting ligaments. This causes joint instability. Reconstruction has been shown to be effective in these conditions, causing the lax ligaments to become strengthened, thus stabilizing the joint and allowing for increased function and endurance.
Reconstruction therapy (also known as sclerotherapy and proliferative) is given by a slender needle similar to the hairline needles of the acupuncturist, into the fibro-osseous junction. This is the area where the tendon or ligament attaches to the bone. The substance used is sodium morrhuate which comes from cod liver fish oil and a local anesthetic. Repeated studies at the University of Iowa have shown that areas injected have increased in size by 35% to 40%, thus causing permanent strengthening.
Click on the link below for complete article
http://www.prolotherapy.com/articles/fabernstljr.htm
Severe arthritis and failed back surgery of thirty years resolved by reconstruction therapy.
Linda Sullivan, 50, suffered 32 years from back pain and lack of endurance after falling during gymnasium, in high school, and later a motorcycle accident. She had laminectomy surgery but she was left with pain. She was told she had to live with it. In desperation, she went to the Milwaukee Pain Clinic for evaluation. Spinal X-rays revealed severe degenerative arthritis throughout her lower back. This was from the instability of the spine.
The arthritis formed to stabilize the spine. Linda received non-surgical tendon, ligament and joint reconstruction therapy to her low back sacroiliac ligaments and after just 8 sessions, she was considerably improved. Her husband noted "Tears no longer form on her cheeks as we ride in our vacation van as we did for years before." Linda like many patients initially didn't tell her whole story. After suffering pain for so many years, she didn't want to initially tell how much pain she had in her arm and her shoulder, as she feared the answer would be, just to live with it as she heard from so many other doctors.
Examination of her shoulder revealed that the ligaments and tendons were torn and lax. She was given reconstructive therapy to the ligaments and tendons in the arm and the shoulder and this produced dramatic increased strength. Her main side affect was less pain. She gave Dr. Faber, a picture of the cement blocks she carried when building a new home.
Linda said, "Reconstruction therapy gave me a life again."
Click the link below for complete article
http://www.prolotherapy.com/articles/fabersa.htm
Treatment of consecutive severe fibromyalgia patients with.
The potential of tendon and ligament triggers as primary nociceptors in fibromyalgia led to treatment of primary fibromyalgia patients with tendon and ligament strengthening injection. Trigger injection of ligament and tendon with proliferant (TILT therapy or prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75 % of patients with severe fibromyalgia in this study. The implications of this for further study are considered.
Introduction
The search for 'central factors' in the cause of fibromyalgia has revealed evidence of possible alteration of pain modulation in the body such as a decrease in circulating serotonin and possibly antibodies that block serotonin receptors. Evidence has also been found for central factors affecting soft tissue homeostasis. (Possible glucocorticoid deficiency or deficient production of growth hormone related factors.)
Search continues for the primary nociceptor in fibromyalgia. It is notable that the classical tender points in fibromyalgia are over tendon and ligament insertions. Semi-elastic tissues are generally recognized to be the sites of acute damage in sprain and strain. Tendon and Ligament attachments to periosteum have the lowest pain threshold of any deep somatic structure. Inman and Saunders reported stimulating periosteum in a variety of ways including pressure, and elicited severe referred pain to muscles or bony prominences in the referral zone in reproducible patterns.
De Valera, Gorrell, Hackett, Kelgren, Kraus, Leriche and Travell have all described referral pain from tendinoligamentous structures, with patterns of referral most meticulously set out by Hackett. Tendon or ligament laxity or weakness has been proposed to cause chronic nociception via inadequate skeletal support, intermittent stretch of fixed-length sensory fibers, or development of myofascial trigger points.
The premise of this study is that weak or lax tendons or ligaments are potential nociceptors in fibromyalgia and that this is potentially a correctable nociceptor source. Prolotherapy involves injecting an area of ligament or tendon laxity or weakness with a solution that stimulates fibroblast proliferation. The goal of proliferation therapy is to restore normal connective tissue length and strength in the affected area, and in so doing to restore adequate skeletal support and eliminate sources of myofascial trigger perpetuation.
Borden demonstrated the ability of a simple dextrose solution in 12.5% concentration or more to create a prompt inflammatory reaction. 6 The simple dextrose solution is thought to create irritation by an osmotic gradient. Cells in the area lose water, and desiccate to the point of an injury response. Animal studies have shown a 40% increase in diameter and strength of injected tendons compared to contralateral tendons.
Changes persisted more than 12 months post injection and were not dependent on any difference in exercise levels of the animals. Human studies have demonstrated collagen fiber diameter increases and increased cellularity on biopsy of injected areas. Disability, range of motion, and pain levels all improved significantly in patients injected after 5 or more years of chronic pain. In human knees with reproducible ligamental laxity as measured by a computerized knee analysis device, a statistically significant reduction in ligamental laxity was demonstrated with a P value less than 0.05.
Randomized double-blind control studies with saline injected controls have demonstrated statistically significant improvements in low back pain and disability rating in treated patients compared to controls.
Click the link below for complete article