Milne Medical Center

Prolotherapy, Prolozone, PRP

There are'three major regenerative therapies for joints, tendons and ligaments used in integrative medicine:

1. PROLOTHERAPY
2. PROLOZONE
3. PRP-PLATELET RICH PLASMA

PROLOTHERAPY
WHAT IS PROLOTHERAPY lN SlMPLE TERMS?
Prolotherapy is a rehabilitation method fdr treatment of damaged ligament, discs, cartilage, or tendon structure using natural medicines to induce the proliferation of new cells. "Prolotherapy involves the injections of substances at the weakened site to strengthen or weld the disabled ligaments and tendons, cartilage, or discs to bone at their attachment. This area is called the fibro-osseous injunction. "Fibro means fibrous tissue that forms the ligament or tendonand "osseous" refers to the bone. The Prolotherapy injection stimulates the production of new bone and fibrous cells. Prolotherapy, therefore, stimulates the body to repair the exact site of the painful area. It is a low cost alternative to surgical options and can even repair what numerous surgeries and cortisone shots have worsened or failed to accomplish - to actually initiate the healing process versus just covering up the problem.

Prolotherapy causes an inflammatory reaction at the exact site of injuries to such structures as ligaments, tendons, menisci, muscles, growth plates, joint capsules, and cartilage to stimulatethese structures to heal. Specifically, Prolotherapy causes fibroblastic proliferation. Prolotherapy comes from the word, "proliferate" meaning to "grow". Fibroblasts are the cells that grow the ligaments and tendons. By proliferating the fibroblasts, new, strong, collagen tissue is formed which is what is needed to repair ligament/tendon injuries.

Tylenol, and or Tylenol with hydrocodone. The application of HEAT - NOT COLD - helps to heal the treated area more rapidly. The application of COLD will decrease blood flow to the area, thereby increasing the healing time. Anti-inflammatory medications must be avoided such as: NSAle, (Aleve, Motrin, and Advil) because they decrease the Prolotherapy mild inflammatory effect. Mild to moderate exercise is encouraged; however strenuous exercise is to be avoided. It should be noted that after treatment, a few patients have moderately severe pain and may require more pain medication to relieve their discomfort. This is a normal variant of the therapy. Usually significant pain will subside within 1-3 days. Mild discomfort may persist for a week or so. Should significant pain, swelling or increasing redness be noticed, please notify the office so that the physician can evaluate the treatment area. Closely monitoring your results and communicating these to the doctor and staff are important follow-up measures. Unless one has an allergy, preventive antibiotics are given by injection to insure that infection is prevented. Healing continues from three to six weeks after treatment. Patients will notice less pain and improved mobility. After the 4-6 weeks, an evaluation can be made to determine whether further treatment may be needed. One to three treatments are the norm. Severe injuries and or advanced tissue/bone degeneration may require up to six treatments to obtain the desired results.

PROLOZONE
Prolozone is the second of the regenerative therapies for the rehabilitation of joints, ligaments, tendons, and cartilage. First used in Germany and Russia nearly 50 years ago, this therapy is now becoming more popular in the United States. Prolozone is a therapy whereby a small amount of medical grade ozone is injected in and around injured or affected joint areas. Ozone is a highly reactive oxidizing form of oxygen that has an extra oxygen molecule. This form of oxygen stimulates low levels of inflammation that help heal injured, damaged, or degenerated tissues. Since joints, ligament and cartilage have decreased blood flow and therefore less oxygen, the injections of extra oxygen/ozone stimulates the healing process. Your history and physical examination can help your physician determine whether or not prolozone therapy can be beneficial for a particular condition.

PRP-PLATELET RlCH PLASMA
Platelet rich plasma therapy is the third regenerative treatment method for rehabilitation ofjoints, ligaments, tendons and cartilage. This method involves drawing approximately 20-60 ccs of blood and spinning it down in a centrifuge, resulting in a layer of platelet rich plasma. The concentrated platelet rich plasma is then injected in and around affected tissues. The growth factors in the concentrated platelets stimulate, and accelerate tissue recovery and attract other biological proteins and healing growth factors into theinjected areas.

To date, research studies have shown that PRP does work. It is rapidly gaining popularity among professional athletes. ln 2009, a study was done on tennis elbow on patients who suffered from chronic lateral epicondylitis - tennis elbow for over six months, and pain ranking at least 5 on a 10 point scale. Patients were randomly divided into 2 groups. One group was given the corticosteroid shots and the second group was given the PRP injections at the same time.

Both injections were given directly into the area of maximum tenderness and also into the tendon using a ”peppering” technique in which the needle, after being passed through the skin, is inserted several times into the tendon. Patients who got the corticosteroid had much faster pain relief. But 26 weeks after treatment, patients in the PRP arm- were much more likely to have less pain and more function than those who received the corticosteroid. And, they kept getting better over the next year. By this time, PRP-treated patients reported a 64% improvement in pain and an 84% improvement in disability. Corticosteroid-treated patients reported a 24% improvement in pain and a 17% improvement in disability. Moreover, only three of the 51 patients in the PRP group went on to get tennis-elbow surgery, and only two went back for a corticosteroid shot. Among the 49 patients in the corticosteroid group who finished the study, six patients went on to surgery, six went back for PRP treatment and one returned for another steroid shot. These results speak for the effectiveness of PRP.