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 tendonitis. 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.
A tendon is an extension of the muscle that connects the muscle to the bone. To understand the value of prolotherapy, it is helpful to understand the difference between muscle and tendon. Muscle is pliable and fleshy while tendon is fibrous and somewhat rigid. Muscle is red while tendon is whitish yellow. This reflects the generous blood flow that supplies muscles and the lack of blood flow supplying tendons. Because of these differences, muscles heal relatively quickly. A common example of this is a hamstring tear. Depending on the severity of the tear, this will usually heal within a few weeks. On the other hand, a tendon will usually heal more slowly. This is because a lack of blood flow leads to poor healing, and the increased rigidity of the tendon tissue creates increased tension at its attachment to the bone.
While this paints a bleak picture for tendon healing, the good news is that prolotherapy is a great treatment that helps resolve tendonitis. To clarify, the more accurate term is tendinosis, which describes wear and tear of the tendon rather than the inflammation that tendonitis implies. While there may be some inflammation, the predominant pathology is wear and tear of the tendon fibers and that is what prolotherapy treats best. I use the term tendonitis by convention since that is the commonly known term.
Prolotherapy is the use of a regenerative solution, with the most commonly based solution dextrose-based. Prolotherapy helps strengthen the tendon by creating a mild irritation at the point where the tendon inserts onto the bone. The body reacts to this irritation by stimulating increased blood flow in the area and with this, the migration of growth factors around the tendon. This leads to the growth of stronger tendons, which helps resolve the pain and leads to long-term healing. Unlike a cortisone injection, which tends to give short-term relief while eating away at tissue, prolotherapy builds tissue and this provides long-term relief.
The other great part of prolotherapy is that it is a comprehensive, holistic approach. For example, when treating a tendon, a good prolotherapist will also look at the factors that led to the tendon wear and tear in the first place. For instance, a common tendonitis is called tennis elbow. This involves a group of muscles on the back of the forearm, which join together to form a common tendon that inserts at the elbow. It is very commonly stressed because those muscles are overworked and the tendon bears that stress. A good prolotherapy approach involves strengthening the tendon while also strengthening the ligaments around the elbow. This is because the lax ligaments create stress at the joint, which further stresses the elbow tendon. So by treating both the tendon and ligaments around the elbow we achieve resolution of the tennis elbow.
A similar thought process is used to treat rotator cuff tendonitis. The rotator cuff is a group of four tendons that form a cuff around the humerus (the arm bone). These muscles help stabilize the shoulder during arm movements. When the ligaments are lax, this causes strain on the rotator cuff that leads to rotator cuff tendonitis. For effective treatment, we apply prolotherapy to the shoulder ligaments and the rotator cuff tendons. This helps resolve the rotator cuff tendonitis.
Plantar fasciitis is one of the most common causes of foot pain. This is caused by wear and tear of the plantar fascia, which is the tissue that covers the muscles on the bottom of the foot and has characteristics of tendon and ligament. When mild to moderate, it can be painful with increased activity such as running. When severe, pain with simple walking or even at rest becomes debilitating. Fortunately, with prolotherapy to the fascia and the ligaments in the foot, the plantar fasciitis is resolved.
I am running out of space so I will share with you several other tendon problems that improve with prolotherapy. Achilles tendonitis, golfer’s elbow, wrist tendonitis, hamstring tendonitis, iliotibial band syndrome, posterior tibial tendonitis, wrist tendonitis and Osgood-Schlatter’s are among the many tendon conditions that respond very well to prolotherapy. All these conditions share in common a weakening tendon that is strengthened with prolotherapy. This provides relief of pain in the short-term and resolution of the condition in the long-term.
By Warren Slaten, M.D.
Dr. Slaten is a pain wellness physician in Ridgewood, New Jersey. 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 call the office at the number in my ad on this page to discuss if prolotherapy is the right treatment for your condition. Dr. Slaten is going to Honduras for a prolotherapy mission and looks forward to sharing his experiences with you when he returns.