Injections to Jump-Start Tissue Repair

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Injections to Jump-Start Tissue Repair

_http://www.totalwellnessmed.com/articles/article/5084167/89571.htm_

(http://www.totalwellnessmed.com/articles/article/5084167/89571.htm)

7 Aug 2007

 

By Jane E. Brody

Published: NY Times

 

The human body is held together by a network of connective tissues that are

highly vulnerable to injury through exercise, accidents and even the normal

lifting, pulling and pushing of daily life.

 

Few of us, for example, get through life without spraining an ankle. And as

many sadly know, once an ankle is badly sprained, it may be sprained again

and again. That often happens as well with other body parts: shoulders, wrists,

neck, back, jaw, feet, even fingers and toes, all of which are subject to

arthritic changes after an injury.

 

The risk of re-injury rises when the ligaments that hold bone to bone, or

the tendons that connect bone to muscle, fail to heal completely. And such

failure is apparently very common. Over time, and with multiple injuries, this

incomplete healing can result in lax connective tissues that cannot fully

support a joint.

Dr. K. Dean Reeves, clinical associate professor of physical medicine and

rehabilitation at the University of Kansas Medical Center, likens the damage to

a partly shredded rope that lacks the strength of an intact one, and to

stretched putty that will not return to its former length. Dr. Reeves is one of

several hundred physicians and osteopaths who specialize in a therapeutic

technique called prolotherapy, an alternative medicine method to promote

connective tissue repair even years after the damage occurred.

The technique received an endorsement of sorts from the Mayo Clinic. In its

April 2005 health letter, the clinic stated that when chronic ligament or

tendon pain fails to respond to more conservative treatments like physical

therapy and prescribed exercises, “prolotherapy may be helpful.†And when

surgery

is the only remaining option to relieve chronic pain, prolotherapy is a much

less invasive and expensive technique that may be worth a try — if you can

find an experienced and skilled practitioner.

 

What Is Prolotherapy?

 

Prolotherapy involves a series of injections designed to produce

inflammation in the injured tissue. To appreciate the value of such a seemingly

counterproductive measure, you need to know something about connective tissue

and how

the body normally repairs it.

 

When tissues are injured, inflammation is a common natural response. It

stimulates substances carried in blood that produce growth factors in the

injured

area to promote healing. Ligaments, tendons and cartilage have very poor

blood supplies, which can result in incomplete healing.

 

The healing process can also be impeded when injuries are treated with

anti-inflammatory medications like ibuprofen or Naprosyn, or prescribed

non-steroidal anti-inflammatory drugs (Nsaids) to relieve pain and swelling.

 

Unlike injections of corticosteroids, which also suppress inflammation and

provide only temporary relief for a chronic condition, prolotherapy injections

given over the course of several months are meant to provide a permanent

benefit. In effect, prolotherapy tricks the body into initiating a healing

response.

 

The technique reactivates the healing process by injecting a mildly

irritating substance — commonly a somewhat concentrated sugar solution along

with the

painkiller lidocaine — into the injured area to stimulate a temporary

low-grade inflammation. In some cases, growth factors themselves may be

injected.

 

With growth factors in place at the site of inflammation, new tissue is said

to be produced that strengthens lax or unstable ligaments and tendons. The

technique may even support damaged or degenerated cartilage, which normally

does not repair itself, by strengthening the fibrous connective tissues that

stabilize the area.

 

Practitioners cite experiments in laboratory animals that demonstrated

tissue growth in ligaments and tendons stimulated by prolotherapy injections.

Two

animal studies also showed healing of cartilage defects.

 

Prolotherapy cannot correct mechanical problems like spinal stenosis, in

which two bones pinch a nerve, nor does it reverse arthritic changes. But it

may

reduce or even eliminate the discomfort associated with arthritis by

tightening the connective tissues that support an arthritic joint.

 

A leader in the field, Dr. Donna Alderman, an osteopathic physician who is

medical director of the Hemwall Family Medical Centers in California,

published two long articles on prolotherapy this year in the magazine Practical

Pain

Management. She wrote that “prolotherapy has been used in the United States

for musculoskeletal pain since the 1930s,†that it has been endorsed by

former

Surgeon General C. Everett Koop, and that it is increasingly being used to

treat injuries in professional athletes.

 

Prolotherapy is also now the subject of a controlled clinical trial

sponsored by the National Center for Complementary and Alternative Medicine,

part of

the National Institutes of Health.

 

Since prolotherapy is a nonsurgical technique, patients who are now facing

surgery because all else has failed might consider trying it before having an

operation. Unlike many drugs and surgery, prolotherapy has minimal side

effects when performed by an experienced practitioner who uses sterile

techniques.

Patients may experience bruising and a temporary increase in pain in the

injected area because of the induced inflammation. Rare risks include

infection,

headache, nerve irritation or allergic reaction.

 

Does It Help?

 

 

 

There have been dozens of studies purporting to show benefits of

prolotherapy for people with chronic pain as well as those with sports

injuries. Among

scientifically designed controlled studies, most showed a significant

improvement in the patients’ level of pain and ability to move the painful

joint.

 

According to Dr. Alderman, in a study of people with chronic low back pain

resulting from injured ligaments in the sacroiliac joint, biopsies done three

months after treatment showed a 60 percent increase in the diameter of

connective tissue. The patients reported a decrease in pain and an increased

range

of motion.

In studies of knee injuries, patients with ligament laxity and instability

experienced a tightening of those ligaments, including the often disabling

anterior cruciate ligament in the center of the knee, Dr. Reeves showed in a

double-blind study. Other studies showed a significant improvement in the

symptoms of arthritis in the knee one to three years after prolotherapy

injections.

 

Dr. Alderman cautions that prolotherapy is appropriate only for patients

with musculoskeletal pain who do not have underlying conditions that would

interfere with healing and who are willing to receive painful injections in an

effort to recover.

A state-by-state listing of prolotherapy practitioners can be found at

www.getprolo.com. Beware of practitioners who make rash promises, fail to take

a

full medical history and to tell you about the technique and its side effects,

or who work in a disorderly or unclean facility.