In prior issues, I have discussed prolotherapy and how it helps with musculoskeletal pain. Today, I will briefly summarize how prolotherapy works and then focus on how prolo helps knee pain. Prolotherapy is a natural treatment that strengthens ligaments, tendons and cartilage. This is achieved by a solution that stimulates a reaction in the body that leads to the growth of collagen, which is the building block of ligaments and tendons. The beautiful part of prolo is that the injury is treated by strengthening tissue. This stands in contrast to traditional treatments such as steroid injections, which can potentially degrade tissue. Physical therapy is effective for building and stretching muscle but does not strengthen the ligaments and does not heal a tendon injury. Prolo is effective for tendonitis such as rotator cuff and tennis elbow, sprains such as ankle and wrists, and arthritic joints such as knees and hips. There are multiple studies that have shown that prolo works! These include randomized double-blind studies. Without getting too technical this type of study is the gold standard of medical research.
Knee pain can be divided into pain from the ligaments, pain from tendons and joint pain. The most common of knee joint pain is arthritis. The knee joint consists of three bones: The femur (thigh bone), the tibia (leg bone) and the patella (kneecap). The most common cause of arthritis is wear and tear. Weakening of the ligaments is a contributor to this wear and tear. First the cartilage cushioning the bones wears away and then the joint space narrows while bone spurs form. While this joint space narrowing can cause pain, a more frequent cause of pain in the arthritic joint is weak ligaments. For example, it is not uncommon for someone to come in with knee pain for a month or two and then an x-ray reveals severe arthritis. Even though the joint arthritis was developing for years, the symptoms may be present for only a short period of time. This suggests that it is not the joints and bones generating the pain. Rather, the ligaments and tendons around the knee are generating the pain. The good news is that this pain can be treated with prolotherapy.
By strengthening the joint capsule, which surrounds the knee, prolotherapy relieves arthritic pain. Rather than injecting a steroid, which interferes with healing and can potentially eat away at tissue, prolotherapy can build tissue and provide medium to long-term relief. A knee replacement may wear out so it is generally recommended that younger patients hold off getting a replacement for as long as possible. Prolotherapy is a great option for these patients. Some are too old for a knee replacement or have a medical condition such as heart disease, which increases the surgical risk. They can still get relief with prolotherapy. While a knee replacement has been a relatively successful surgery, it does not work for everybody so it is better to first try prolotherapy, a natural treatment that has level 1 evidence (the most reliable kind, from randomized trials) for knee arthritis.
Meniscus tears result from trauma in younger patients and can be treated with prolotherapy. For those over 40, meniscus tears are usually an indicator of developing arthritis. Thus, as noted above, prolotherapy is ideally suited to provide relief and strengthen the tissue around the knee. Another option is arthroscopy to repair or remove the meniscus but this leads to removal of more tissue as part of “cleaning it out.” Long-term, it is better to have a treatment such as prolotherapy that builds tissue rather than a treatment that removes tissue.
There are four major ligaments of the knee. The collateral ligaments are on the inner and outer aspects of the knee and maintain side-to side stability. The cruciate ligaments cross each other within the knee and maintain front-to-back stability. When these ligaments are injured, there is pain and instability. Prolotherapy can strengthen these ligaments to heal the injury. Also, these ligaments tend to weaken in the arthritic knee, which is why prolotherapy is effective for arthritis.
Tendonitis is common around the knee. The patellar tendon is an extension of the quadriceps muscle (the muscle in front of the thigh) and inserts onto the tibia bone just past the knee. This tendon is commonly irritated and responds very well to prolotherapy. A related condition called Osgood-Schlatter’s affects adolescents, especially boys. There is pain at the insertion of the patella tendon. This can be disabling and often precludes participation in sports. Prolotherapy has been proven with studies to be effective for this condition. Hamstring tendonitis is characterized by tenderness where the hamstrings insert at the back of the knee. The tendon heals with prolotherapy.
Ligaments and tendons share in common that there is minimal blood flow in the area where they insert onto bone. The whitish yellow color of these structures highlights the lack of blood flow. This contrasts to muscle, which has a reddish color due to its ample blood flow. Thus, a muscle strain tends to heal quickly while a ligament or tendon injury heals slowly or not at all. This is why prolotherapy is such a valuable treatment as it is ideally suited to heal ligaments and tendons. The dextrose solution stimulates blood flow with migration of growth factors to the treated area, resulting in strengthening these tissues for long-term healing.
In summary, knee pain is attributed to many structures including the tendons, ligaments, meniscus and joints. All of these structures are susceptible to injury and/or degeneration. By strengthening the ligaments and tendons, prolotherapy is effective for knee pain by eliminating the actual source of pain and by strengthening the knee. Prolotherapy for knee pain provides short-term relief by treating the source of pain and long-term relief by strengthening the tissue around the knee.
By Warren Slaten, M.D.
Dr. Slaten is a pain wellness physician in Ridgewood, NJ. For more than 20 years, he has been practicing with great skill and an open mind. For more info, check out njprolo.com. You can also listen to his weekly show Sundays at 9PM on 77WABC.
