Dr. Allen Hooper Sports Clinic at City Centre 207 – 399 Main Street Penticton, British Columbia Phone: 250-487-1455 Fax: 250-487-1453 PROLOTHERAPY What is prolotherapy?
Prolotherapy, or proliferation therapy, is the injection of a solution to stimulate the growth of newcells to heal painful areas. Ligaments and tendons are the most common sites for injection. What do ligaments and tendons do?
Ligaments surround all our joints. They protect the joint by limiting its range of movement. Theyalso have a large number of nerve endings, so that if they are stretched, they cause pain. This tellsour body to change something to protect the joint from damage. Tendons join muscle to bone andhelp move the joints. How are the ligaments and tendons injured?
Our ligaments become slacker with the passage of time and the stress on the ligaments from ourdaily activities. For instance, ankle laxity is common with recurrent ankle sprains. Pregnancy is themost common cause of sacroiliac ligament laxity. Ligaments can also be injured by trauma, such ascar accident or falling. Tendons are typically injured from overuse, such as running and jumping. Will I benefit from this treatment?
First, we have to find out if you are a candidate for treatment by prolotherapy. It is important thatyou see your doctor or physiotherapist for proper assessment. This often takes more than one visitto your physiotherapist. Patients with a history of injury consistent with ligament sprain thatresponds well to stabilization with bracing or taping generally respond well to prolotherapy. Injuriesto the disc or nerves, such as disc herniation, nerve impingement or spinal stenosis are not goodcandidates. What are the injections?
The injections consist of a mixture of a local anaesthetic and Dextrose. The Dextrose solution is astrong enough concentration to irritate the ligaments. This stimulates mild inflammation in the area,Which is the first part of the healing process. The contents of the injection are very safe. The areasthat I inject are also very safe. Ligaments only grow where they are attached to bone. I thereforehave to feel the bone with the needle before injection, meaning that I know exactly where theinjection is going. Are there any risks?
The common risks when puncturing our skin, namely infection and bleeding, are very rare due tothe small diameter of the needle.
It is possible to enter the spinal canal, but this is rare, as injections directly over the middle of thespine are no longer used. If this happens, it may result in an intense headache for 2 – 4 days whenupright. Laying flat alleviates the headache.
The other risk of consequence is the possibility of puncturing a lung, when injecting the upper partof your back. This is rare.
A very small percentage of the population is allergic to local anaesthetic agents. If you think youare, please let me know.
An even smaller percentage of people are allergic to sugar, which is the source of medical Dextrose. Some people have expressed a concern about becoming too tight after the injections. This is notpossible. Is this painful?
The injections are uncomfortable, but the local anaesthetic removes the pain quickly. In spite ofthis, or if you are having many levels injected, you may feel unable to tolerate the pain. If so, wewill discuss alternatives.
Most local patients are able to drive themselves to and from the treatment and are able to return towork afterwards. Out of town patients should have a driver for their first treatment so they are ableto change position as needed for the long drive home.
Most patients will feel stiff for a day or two afterwards. Changing position regularly, gentle activity,stretching, and heat are all that is usually required. If you are too stiff, a muscle relaxant such asRobaxacet or pain medication such as Tylenol can be used. Please do not use anti-inflammatorypainkillers for two weeks after prolotherapy ( Ibuprofen, ASA, Celebrex, Naproxen, Diclofenacetc). How many injections will I need?
Most men require three to six treatments. Women usually require six to nine treatments. Treatmentscan be done weekly to monthly. Biweekly treatment allows you to see physio in between eachtreatment. You can expect to see improvement from the injections one to two months after the lastinjection. What follow up treatments are needed?
It is very important to see your physiotherapist two to seven days after prolotherapy. This is tocheck joint mobility and settle any muscle spasm. Physiotherapy is also important one to twomonths after the last injection when the ligaments are tightening. At that time you will get longerlasting relief from the IMS (intramuscular stimulation) and be ready to start increasing yourstretching and strengthening program. Other considerations
Stay as active as possible without aggravating your condition. Break up tasks that bother you intoshorter pieces e.g. vacuum one room at a time instead of doing the whole house at once. Walkingevery day is usually safe. For those who cannot tolerate walking, aquasize is a good way to stayactive without irritating your symptoms.
Sleep disturbance is common with chronic pain. Medications such as Flexeril or low dose Elavil atbedtime can help significantly. Watch for signs of depression such as mood changes, decreasedenergy, appetite changes, decreased memory and concentration, feelings of guilt or hopelessness,and suicidal thoughts. Discuss these symptoms with your doctor. Depression due to chronic painresponds well to antidepressants.
Anti-inflammatory medications will block some of the effect of prolotherapy and should be avoidedfor at least two weeks after your treatment. Tylenol, muscle relaxants and prescriptions for otherhealth conditions can be continued.
Stress or other stimulants such as cold medications can cause muscle tightening. Try to avoid theseor consider relaxation training for stress. Appointments
To arrange appointments please have your referring health care provider (doctor or physiotherapist)send a letter of referral to our office. This letter should clearly state your name, address, daytimephone number, email, and whom the referral is from. My office will contact you with anappointment time.
Your first appointment will be a consultation. At that visit I will review your problem as related tome by your referring health care provider and yourself. I will examine you and discuss a treatmentplan. Please give yourself time to reach my office. I try to keep my appointment schedule as tightas possible so that people are not kept waiting. It is very helpful if you can pick-up copies of any X-ray, MRI, CT Scan, or bone scan reports and bring these to the first appointment.
If you are late, we may not be able to fit you in, regardless of the distance you have traveled. Thereis a fee for not attending your scheduled appointment, or cancellation with less than 24 hrs priornotice. What should I wear and bring with me?
You should wear loose fitting clothing that allows easy access to your whole spine, or other jointsas indicated. This will also be more comfortable afterwards. Expensive (white) shirts or blousesare not a good idea as there is often some pinpoint bleeding after the injections, which could stainyour clothes. Is there any cost?
At present Medical Service Plan does not cover the cost of prolotherapy. Please ask yourphysiotherapist about the current fee or contact my office. The fee varies depending on the numberof areas treated. The fee will cover the cost of the procedure and materials used. Some insurancecompanies will reimburse you, so save your receipt. Payment must be made at the beginning ofeach office visit. Debit or credit cards are accepted. We do not direct bill your insurance company,so you must make the payment and receive reimbursement from your insurance company. WCBdoes not pay for prolotherapy. If your payments have not been made or discussed with my office,we will not be able to book any further appointments for you.
In summary, prolotherapy is a relatively safe procedure that will help to strengthen slack ligamentsor degenerative tendons. Proper assessment and follow-up by your physiotherapist or family doctoris very important. With proper selection and rehabilitation patients should respond well totreatment 80% of the time. Please read this information very carefully as it is important that youunderstand our process. I hope that we are able to offer you some help with your problem. Thank you for visiting our clinic. CONSENT FORM
I have been advised and consulted about the injection techniques of Prolotherapy.
I have been advised that Prolotherapy is an established technique for tightening of ligaments ordegenerative tendons. The technique requires the injection of local anesthetic (Lidocaine),concentrated dextrose (sugar) plus, on occasion, Phenol, Glycerin or Sodium Morrhuate (highlyrefined cod liver oil) into the ligament. The site of the injection is where the ligaments attach to thebone or into the tendon.
I have been informed that the procedure has been used on thousands of patients and has provengenerally safe. This procedure may alter and decrease my pain complaints, but may not completelyeradicate them.
I have been informed that the alternatives to Prolotherapy are:
1. Doing nothing. 2. Surgical intervention may be a possibility. 3. Injections with steroid may also be helpful but not give lasting results. 4. Maintenance therapy with physiotherapy, massage, or manipulation.
I have been informed that the risks and complications of Prolotherapy are:
1. Immediate pain at the injection site. 2. Allergic reaction to the anesthetic. 3. Spinal cord injury during back injections. 4. Pneumothorax-air on the outside of the lung. 5. Infection at the injection site. 6. Injury to the nerves and muscles at the injection site. 7. Temporary or permanent nerve paralysis. 8. There may be no effect from the treatment. 9. Death from complications of the treatment.
I have been informed that the risks of No Prolotherapy are:
1. No relief of the pain. 2. Continued degeneration of the joints adjacent to ligament laxity.
esTABLIsHeD PATIenT LeveL-Iv (99214) vIsIT worksHeeT Think level IV if you do any of the following at a patient visit:• See a new problem with uncertain prognosis (e.g., lump in breast);• See a complicated injury (e.g., fall with loss of consciousness);• Spend more than 25 minutes with a patient. To confirm that it’s a level-IV visit, check the requirements below. DOCUMENTATION-BA
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