Prolotherapy with Platelet Rich Plasma Solution
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As most of you know, I have been doing Prolotherapy full time for sixteen years. It is what I have wanted to do since coming out of my residency training program in Physical Medicine and Rehabilitation in 1992. When I went to interview for hospital privileges and was discussing Prolotherapy and the use of it in the hospital the interviewer said saracasticly, “You don’t want to be known as a Prolotherapist.” I didn’t say anything to his comment, but inside I was thinking, “You bet I do. I want to be known as a Prolotherapist.”
Even before I any experience in Prolotherapy, I could tell from what I observed in the two months I rotated with Dr. Hemwall that Prolotherapy did indeed hold the cure for chronic pain for a lot of people. As most of you know, about six months later, I became Dr. Hemwall’s associate eventually took over his practice. So I feel like I am caretaker to something sacred and as such, I am hesitant to stray too much for the original technique taught by Dr. Hemwall to me. Dr. Hemwall did not have any experience with Platelet Rich Plasma, known as PRP, but now I feel comfortable enough to report on our experience at Caring Medical.
After sixteen years experience personally, in addition to Dr. Hemwall’s 40-plus experience doing Prolotherapy, Caring Medical has a good idea who is and who is not a good Prolotherapy candidate. We have looked at our results and for those people who do at least four Prolotherapy sessions (less if the pain is relieved with fewer treatments), the failure rate (less than 25% pain relief) is less than 5%. But if I am treating 20 plus patients per day and do this day in and day out, year after year, somebody will eventually not respond to the normal Prolotherapy solutions. For these clients, we believe that PRP is a good next step, because who wants to end up in the surgeon’s office? Let’s review again what happens at the injury site. Just to be clear, we are talking about the exact site where a person is injured or having pain. When tissue is injured, substances are released that activate platelets causing them to aggregate and produce a clot. These platelets then secrete a variety of cytokines, including adhesive proteins and growth factors such as platelet-derived growth factor, transforming growth factor beta, vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor 1, and epidermal growth factor. One doesn’t have to be a genius to figure out what these growth factors must do? They ultimately help the injured tissues repair.
As one searches the internet, it is easy to find studies that show that PRP enhances tissue healing cartilage, ligaments, menisci, and tendons. Specifically, one could say that platelet rich plasma is used when tissue healing needs help. In other words, PRP is the allopathic version of Prolotherapy. Yes, what I am saying is PRP is Prolotherapy.
What is Prolotherapy? Prolotherapy is a method to stimulate the body to repair injured areas.
What is the definition of PRP? PRP is a method of concentrating the patients’ own blood growth factors. Basically 20 to 60 cc of blood is withdrawn from the person. Special filters/separators are used in a centrifuge to concentrate the person’s platelet rich plasma. This fraction is used exactly where the person’s pain problem is located. The other fraction of the person’s blood is often injected around the site as well. For doctors who use this solution for the Prolotherapy solution, regular Prolotherapy can be injected in other areas around the central injury site as needed. So what conditions have we treated thus far at Caring Medical with PRP? Hamstring injury
Sacroiliac problem
Cartilage degeneration
tendinosis
Elbow tendinopathy
Meniscal Injury injury
Labral tear Because of the high success of normal Hemwall-Hackett Prolotherapy, PRP is not something we normally think of as a first line solution. For really, really, bad tears or injuries, especially if someone has had some Prolotherapy elsewhere, we may use it as a first-line therapy. Realize it basically doubles the cost of normal Prolotherapy because of the expense of the filters. For those who do get PRP solution as their Prolotherapy solution, we typically see them for follow-up in six to eight weeks. Generally, people know by the second PRP Prolotherapy whether it will work or not. Overall the results have been extremely positive. It is very safe. There have been no reactions related to the solution. When to consider PRP solution as your Prolotherapy solutions?
You have failed other Prolotherapy solutions (and are confident you received a good Prolotherapy treatment)
Your injury is very severe
You have a complex ligament injury
You have a complex tendon injury
Tendinosis is your diagnosis
MRI shows labral tear
MRI shows a very complex meniscal tear What is the take home message?
You know I am a big fan of doing everything you can to heal. So make sure that you maximize healing when getting Prolotherapy by:
- Eating according to your Hauser Diet Type.
- Stop using anti-inflammatory medications.
- Stop narcotic medications.
- Take supplements that aid healing.
- Get a good natural medicine evaluation (if needed).
- Get the whole area treated with aggressive Prolotherapy.
- Use as strong a solution as needed to get a positive result with Prolotherapy.
- Go to a clinic with a lot of experience using Prolotherapy.
- If normal Prolotherapy doesn’t work, then consider PRP.
Yes, Platelet Rich Plasma is a great step in the right direction, especially in regards to allopathic medicine using it to induce healing. It is too bad they do not realize that this treatment IS Prolotherapy and that this is the technique that should be utilized earlier for the vast majority of people in pain. Once that happens, we will be well on our way to eliminating the majority of chronic musculoskeletal pain.
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