31-05-2012, 10:43 AM
Prolotherapy
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INTRODUCTION
Prolotherapy (“Proliferative Injection Therapy”) involves injecting an otherwise non-pharmacological and non-active irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. It is an experimental treatment and there is conflicting evidence about its effectiveness. Prolotherapy can be distinguished from sclerotherapy. Sclerotherapy is the use of injections of caustics into the veins, in vascular surgery and dermatology, to remove varicose veins and other vascular irregularities. Prolotherapy is the use of injections in the treatment of connective tissue weakness and musculoskeletal pain. Prolotherapy is also called “proliferation therapy” and “regenerative injection therapy.’
Prolotherapy is often used as an- alternative to invasive arthroscopic surgery. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in July 2002 and concluded that the group that received actual arthroscopic surgery did not report better function or pain than the placebo group. Arthroscopic surgery of the knee is, however, rarely performed for the indication of osteoarthritis, but rather for mechanical tears or disruptions of cartilaginous tissue. Prolotherapy is not intended to address this type of problem. Doctors and surgeons have given anecdotal accounts of successful treatment for knee injur1ies, shoulder separation, and typical injuries to golfers (epicondylitis, shoulder strain, lower back strain and injury, hip and knee injury) However, the vast majority of established rnusculoskeletal health care professionals do not support prolotherapy as mainstream treatment pending further investigation.
WHAT IS PROLOTHERAPY
Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance, Notice I said “a little assistance”. Because often, that’s all the body needs, the rest it can take care of on it’s own. In most cases, commonly prescribed anti-inflammatory medications and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.
The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen the material that ligaments and tendons are made of new collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness, but depends upon the technique in the individual Prolotherapist. The most important aspect is injecting enough of the solution into the injured and weakened area. if this is done, the likelihood of success is excellent.
THE CONCEPT BEHIND PROLOTHERAPY
The term Prolotherapy was coined by George S. Hackett, M.D., the “father of Prolotherapy”, in 1956. He describes Prolotherapy as follows:
“The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the weld of fibrous tissue and bone to stabilize the articulation (where the bone and ligament meet) and permanently eliminate the disability. To the treatment of proliferating new cells, I have applied the name Prolotherapy’ from the word ‘Prolo’ (Latin) meaning offspring: ‘proliferate’ - to produce new cells in rapid succession (Websters Dictionary). My definition of Prolotherapy as applied medicallv in the treatment of skeletal disability is the rehabilitation of an incompetent structure by the generation of new cellular tissue.”
CONCLUSIONS
In conclusion, then, prolotherapy has been shown to be a technique with a salutary effect in patients with chronic ligamentous sprains, most characteristically presenting with chronic back pain, and at times buttock and leg pain. The diagnosis of the site of the sprain and a clinical decision on the suitability of any particular case for this treatment remains an art based on a thorough grounding in the concepts of orthopaedic medicine. The clinical skill, in learning the diagnostic approach of orthopedic medicine also calls for a thorough understanding of anatomy and a meticulous study of referred patterns of pain - a laborious intellectual pursuit, On the other hand, the application of the therapy does not call for complex pharmacological or technological accouterments. The technique of prolotherapy has appealed to a small cadre of clinicians who handle difficult cases of chronic pain and who have developed a high level of clinical skills appendent very little on technology. It should be remembered that ligaments are a tissue which images poorly, and its dysfunction has no laboratory counterpart.