Non-Surgical Pain Relief + Management
What is Prolotherapy?
Prolotherapy is a type of regenerative medicine which repairs soft tissue structures and eliminates pain associated with such injuries. The injection of substances which are clinically proven to promote cell proliferation (such as PRP and dextrose solutions) into specific anatomical sites triggers an inflammation healing cascade which leads to the formation of new tissue. Prolotherapy is especially helpful for individuals with soft tissue injuries, whether this is from physical trauma or years of repetitive motions. Soft tissue injuries, such as tendon pathology, are especially hard to diagnose and many times are the origin of chronic pain.
Prolotherapy is a broad category that includes pro-inflammatory (dextrose), Platelet Rich Plasma (PRP), and Stem Cell injections into musculoskeletal tissues. Perineurial Injection Technique utilizes the former on painful and inflamed peripheral nerves. The popular “Vampire” makeovers use PRP for cosmetic enhancement of the face, sun damaged areas, scars, and stretch marks. All stimulate new healing that may have been compromised by steroids, anti-inflammatories, re-injury or a weakened immune system.
Different kinds of prolotherapy solutions are used for injection, and these are chosen based on the problem being treated. Amongst the prolotherapy types are Pro-inflammatory dextrose, prolozone, PRP (platelet-rich plasma), and stem cell (from bone marrow or fat) solutions. Santa Cruz CORE offers both PRP and stem cell injections.
Why Use Prolotherapy?
Many of the activities that we engage in have the potential to injure soft tissue structures like tendons and ligaments. When weakened, they can contribute to joint instability and degenerative conditions like osteoarthritis. Over time, pain related to soft tissue damage can become chronic and disrupt other mechanical aspects of the body (like joints and nerves).
Prolotherapy is an injection-based regenerative treatment that has shown tremendous promise when it comes to treating musculoskeletal pain. Prolotherapy is successful in treating pain of the lower back, wrist, knee, rotator cuff, and sciatica. Furthermore, the regenerative capacity of prolotherapy injections restores damaged tissues to not only treat pain but regain mechanical function.
Prolotherapy • Platelet Rich Plasma (PRP) Stem Cell Injection Therapies with Dr. John Grady, D.O.
Common Conditions Treated:
Platelet-rich Plasma (PRP):
As the name entails, PRP is a form of prolotherapy which involves the injection of a platelet concentrated plasma solution to the site of injury. Platelets are tissue repair components that release various growth factors that drive forward healing pathways. The patient’s blood is collected and subsequently centrifuged. This process separates blood plasma and concentrates platelet content. Cosmetic concerns are also a common reason to receive PRP injections. For instance, the popular vampire facial uses PRP. When injected into the face, it yields a more youthful look and repairs scars. Read more here...
Stem cells for prolotherapy are from the patient’s own bone marrow or adipose (fat) tissue. The cells collected are adult pluripotent mesenchymal stem cells (MSCs) which have the potential to take the place of other cells in a variety of tissue structures and induce healing. Bone marrow stem cells, for example, can be used for bone repair where it is needed. Read more here...
Questions About Prolotherapy, Stem Cell, and PRP Treatments:
PRP stands for “platelet-rich plasma”. PRP is blood that has been centrifuged to concentrate the platelets and white blood cells within. These concentrated platelets are high in bioactive proteins and growth factors that help in tissue repair and regeneration. These same materials are used in the body’s natural healing process to correct soft tissue damage (such as wear on a joint or arthritis). By injecting PRP into the site of injury, sometimes with the help of ultrasound, the body’s healing response is triggered. Unlike with surgery, cortisone, or steroids, the healing process is not halted, and inflammation is increased rather than decreased. However, this is necessary to properly and permanently heal chronic pain, rather than provide short-term relief.
Stem cells are natural healing cells within your body. Formed in the bone marrow, they work constantly to make repairs in many tissues. As we age, sometimes the degenerative processes overwhelm the repair processes, resulting in the breakdown of joints and the development of problems such as arthritis. By withdrawing and concentrating these cells (sometimes in conjunction with PRP treatments), degeneration can be countered to heal joints and soft tissue. Through a process of inflammation, proliferation, and remodeling, your body works to heal itself in a way that can result in long-term, even permanent pain relief. Again, like PRP, it increases inflammation to begin healing, unlike medications such as steroids, cortisone, or ibuprofen which are proven to slow the healing response.
Our bodies do contain different types of stem cells. Most prolotherapy treatments utilize “Mesenchymal Stem Cells” harvested from adipose (fat) tissue or from bone marrow. Stem cells harvested directly from bone marrow are proven to be very effective in regenerative procedures, and are therefore more expensive than treatments using adipose/fat tissue.
There’s a lot of evidence of prolotherapy being successful in treating tendonitis, ligament injuries, back pain, and knee injuries/pain. Prolotherapy can also help with calcification of joints and is most commonly used for wounds. When one overuses the site of an injury, one’s body may undergo differences, and the body’s tension becomes improperly aligned. By overusing the site of an injury, that injures other areas to compensate for the instability. With prolotherapy, multiple injections tighten those areas, working to bring stability back, and be a mild stimulant to the area that’s injured and restart that healing process.
In addition, PRP injections can also contribute to cosmetic wellness. Vampire facials and PRP injections start a natural process of producing more collagen. Conditions such as hypopigmentation and hyperpigmentation are also treatable with this therapy.
Alternately, stem cell therapy is also often used in dental surgery. Many people with bone breakdown in their jaw and their maxilla are unable to get implants because there’s not enough bone to hold those implants in. By using stem cell therapy, bone and soft tissue can be regrown, making implants possible.
By using injectables such as dextrose, stem cells, and PRP right at the site of pain, the body is triggered into an inflammatory response which leads to the formation of new tissue. When one is injured, the healing process only lasts a period of about 6 weeks, and often stops before the site of injury is completely healed, resulting in chronic pain or discomfort. By re-stimulating the site of injury, prolotherapy works to continuously reheal an old injury. This includes the growth of new ligament or tendon fibers, thereby resulting in permanent stabilization of the joint or other musculoskeletal sites.
The number of visits will depend on the site of injury and its severity. Some small issues may only require 1-2 visits. Many patients require 3-5 injection visits, every 4-6 weeks, which is the length of body’s natural healing cycle. The osteopath may wish to perform additional exams between injection visits to ascertain how well the treatment is taking.
Like using the hyperbaric chamber or osteopathic therapy, the number of visits depends on the site of injury and injection, how long you have had this injury, its severity, and the health of the patient. Similarly, the number of treatments depends on the injection type you receive (PRP, stem-cell, etc). With PRP, many require 2-6 treatments or more, again depending on the severity of the wound.
Each treatment is a same-day office procedure. Patients may be sore for 1-2 days after an injection but most are able to return to work the next day with discomfort dissipating over time.
The PRP solution is injected through the skin, or percutaneously, into the site of injury. The needle peppers the tissue in order the accept the PRP. Once the needling is complete, the PRP and growth and healing factors within are accepted into the skin through these punctures, thereby stimulating a healing cascade. PRP is effective in treating tendons, ligaments, areas surrounding joints, and other sites of soft-tissue damage. Depending on the site being treated, the total number of injections can vary greatly. You will receive a better estimate of how many injections are needed once you receive a consultation with our osteopath.
In the case of healing, the inflammatory response is the body’s response that allows the body to heal. Much of the time, steroids have shut down the healing process too early and the site of injury is not fully healed. Prolotherapy works to strengthen the site of injury, doing the exact opposite of what a steroid is doing. Instead of shutting down the inflammation, it starts it up again in order to restart the healing process.
Steroids often just work as a big band-aid, not curing or resolving anything. Steroids can numb the pain enough for the person to do some corrective exercise or get some treatment, but in this case, using prolotherapy can do both. It can resolve the actual tear or injury, and continue to get the person out of pain by corrective exercise. Other treatments such as oxygen therapy, chiropractic, and massage are all available at CORE and pair great with clients doing prolotherapy or PRP.
You should experience decreased pain and increased physical function of the injured area within a matter of weeks following treatment. By treating the cause of pain, the PRP will decrease occurrences of irritation or pain in the site of injury, and decrease the likelihood of it occurring again. And, unlike steroids, you will not become dependent on the treatment to continue improving. After a certain number of treatments (dependant on your body), most wounds will be naturally healed enough to discontinue treatment and get you back to normal physical function!
Specifically, it depends on the site being treated. For example, a hand, a wrist, a finger, a shoulder, a knee, an ankle, or a hip are all classified as one site. However, the neck is two sites, and the back is three sites. Based on the area covered, the number of injections also varies and therefore effects price. Once you have a consultation with our osteopath, we can provide a more in-depth estimate of price.
Prolotherapy is not covered by insurance. It is still considered investigational because it’s effectiveness needs further verifying in scientifically controlled studies. However, prolotherapy and PRP injections are still growing in popularity as they are cheaper out of pocket than most surgeries. For pricing, please call our front desk at 831.425.9500.