What is prolotherapy?

Prolotherapy is short for proliferative therapy, also commonly referred to as regenerative injection therapy. Regenerative injection therapies are used to treat chronic pain conditions and musculoskeletal injuries. This treatment consists of injecting a proliferating agent into an injured tendon or ligament attachment site (bone or joint), to stimulate the body’s natural healing process. Prolotherapy treatment enhances the growth and formation of new ligaments, tendons, and cartilage in areas where there is weakness, laxity or excess scar tissue. Prolotherapy discussed here refers to Dextrose prolotherapy and is one of three Regenerative Injection Therapies (RIT) that also includes PRP Prolotherapy, and Adipose Stem Cells (known as Biocellular Prolotherapy).

Who performs prolotherapy injections?

In North America, prolotherapy can only be performed by a trained naturopathic doctor, medical doctor or osteopath (in the U.S.) in permitted jurisdictions. Currently, our naturopathic doctors use prolotherapy as part of the naturopathic process and will be introducing PRP or Platelet Rich Plasma prolotherapy in the near future. At this time, prolotherapy treatments are restricted to non-spinal parts of the body only.

How does prolotherapy work?

Prolotherapy is both natural and non-surgical. Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body’s healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that triggers a series of reactions that are collectively known as ‘the wound healing cascade’. As part of this process, the body recruits fibroblasts into the injured area. Fibroblasts are the body’s major cells responsible for the production of new collagen, the material that ligaments and tendons are made of. The goal of this treatment is to stimulate the growth of new, healthier and stronger connective tissue to restore structure and function to the joint.

what is the difference between prolotherapy and cortisone injections?

Prolotherapy is NOT the same as immunosuppressants. Medicated injections are used routinely for chronic pain due to their effectiveness in decreasing inflammation and pain for up to 8 weeks; however, patient’s should know common cortisone side effects:

• Medicated injections inhibit blood flow to the injured area, suppressing both new blood vessel formation and growth of immune cells like leukocytes and macrophages. This prevents protein synthesis, fibroblast proliferation and ultimately collagen formation.

• Medicated injections suppress the release of growth hormone, which further decreases soft tissue and bone repair.

• Medicated injections weaken collagen and therefore soft tissue such as ligaments and tendons.

Inflammation is how the body heals itself and by arresting this process, you are inhibiting tissue repair. In contrast, prolotherapy helps to direct healing factors that are part of the acute inflammatory process to help HEAL the old injury.

We do not discount the use of cortisone injections as they are sometimes necessary when inflammation turns chronic and needs to be contained. Typically this means that the underlying problem has not been addressed. However, chronic inflammation can lead to collateral damage and cortisone injections can help prevent further injury caused by this runaway pathological process. If your doctor has told you that you need cortisone shots, you should talk to a naturopathic doctor or medical doctor to see if prolotherapy is a feasible alternative for you.

how long does it take for prolotherapy to kick in?

Unlike cortisone injections, regenerative injections work cumulatively and more than one treatment is usually required to achieve full healing and function of the compromised joint. It is difficult to know the exact number of treatments since there are so many factors involved. For example, a chronic osteoarthritic hip joint will take much longer to heal than a mild partial tear of the knee ligament. Some of the variables that dictate length and number of treatments include:

• Severity of the injury

• Patient’s overall health status

• Patient’s age

• Patient’s gender

• Patient’s activity levels

• Patient’s diet and lifestyle

• Prior and ongoing use of anti-inflammatory medication

Wound strength studies show that it takes 6-12 months for maximum tensile strength to occur without prolotherapy and even then the resultant wound has approximately 60% of the original strength. With a treatment every 2 weeks, prolotherapy healing can occur in 1-2 months.

Commonly, patients start to see results after 3 to 6 injections. For some chronic conditions, it may take more than 10 injections and several months of treatment. There are no guarantees and sometimes a stronger proliferant may be needed to enhance the body’s healing response further.

is prolotherapy safe?

Prolotherapy is a very safe procedure but like all injection therapies there are some risks involved:

• Pain from needling/soft tissue trauma

• Bleeding and bruising

• Allergic reaction to the injectable materials such as dextrose or procaine

• Nerve injury

• Infection

• Flu-like symptoms

• Post-injection pain*

• Post-injection stiffness**

* Rarely, excessive post-injection pain can occur due to a “hyperinflammatory response”. This seems to be more common in young athletes and older women.

** Rare and commonly transient

Do prolotherapy injections hurt?

The injections are momentarily painful because the areas being treated are already injured, but if the treatment reproduces your exact pain, this is a very good sign that the correct areas are being treated and that they will heal over time. You may feel the needle lightly touching the surface of the bone where the ligament or tendon attaches – this is completely normal and maximizes the safety of the treatment by ensuring that the needle is not in an area such as a nerve, organ or blood vessel. You may feel brief but somewhat painful twitches or spasms in the muscle during treatment – this is completely normal and is actually an additional benefit where the needle treatment will help the surrounding tight muscles to relax. It is commonly known as a trigger point injection.

what is the cost of prolotherapy?

The cost of treatment usually depends upon how many injections are necessary during your treatment. The number of injections typically depends on the severity of the injury as well as the structures being treated. Hands and feet require fewer injections than hips for example.

• Individual sessions typically range from $150 to $250. For best results, it is recommended that patients get a minimum of 4 treatments for each body part.

• Initial prolotherapy injection consults cost $120 at our clinic. These appointments involve an assessment of the concern and review of any imaging and bloodwork as well as an opportunity for patients to discuss their treatment with the doctor.

Does alberta health cover prolotherapy?

Alberta Health does not currently cover prolotherapy at our clinic, however, there are many different extended healthcare insurance companies that will and it is best to check with your individual plan to see if the treatment is covered. The initial evaluation appointment is often reimbursable by insurance carriers depending on your policy. To learn more about direct billing click HERE.

Nova Naturopathic Clinic is located at Unit 208, 6707 Elbow Drive SW, Calgary, AB T2V 0E4, and we are open for you Tuesday to Friday, 10:00 am to 6:00 pm, and Saturday 9:00am-5:00pm. CALL US today at (587) 391-5753 to learn everything else we can tell you about Dextrose Prolotherapy and other regenerative injections, its benefits, and how they can help you with your overall wellness. You can also CALL US to book an appointment with us, or you can BOOK ONLINE. We hope to hear from you soon!