The Prolotherapy Worked? I Still Have Pain!
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A patient came in for his sixth Prolotherapy visit. The nurse told me the patient wasn’t feeling too much improvement in his knee pain, though he had already received five Prolotherapy treatments.
I examined his knee and there were no more crunching sounds. His anterior cruciate ligament had tightened. His anterior drawer sign was negative. He had only slight tenderness in his patellar ligament. Upon further questioning the patient did admit that he felt his knee was more stable but still it felt ‘funny’ when he was running. This is mostly what bothered him, he couldn’t run well on it and that was his main reason for getting it treated. I explained to John that his ligaments had been healed by Prolotherapy. It was then that he asked why he still had pain.
When a joint undergoes ligament damage, the muscles tense up to stabilize the joint. The muscles are then called upon to not only move the joint but also to stabilize the joint. Eventually they get overwhelmed and start to atrophy. When a joint is damaged or degenerated for a long time, one can bet that the muscles surrounding the joint will be significantly weaker than muscles in the other limb, which is what happened to this patient. The pain he was experiencing was due to quadriceps muscle weakness. As a matter of fact, he had lost about 50% of the muscle strength in his right quadriceps. It was one-half inch less thick than his other one. We then went through the exercises he was to do to preferentially strengthen his right leg. One simple maneuver was to wear an ankle weight just on his right side. I encouraged him to do extra sets of exercises just for his right leg. He was to do balance work which involves standing and holding various poses on his right leg.
So when you do get an injury get it checked out. Don’t wait until the joint degenerates. If it does, often you will need to preferentially strengthen the muscles of that joint along with getting Prolotherapy to obtain complete pain relief.
PROLOTHERAPY SLAPS IT TO ‘SLAP’ LESIONS
Ross A. Hauser, M.D.
It is common for patients to walk into Caring Medical and say that their orthopedist told them that surgery was their only option. Patients are commonly told that surgery in the only option for such conditions as meniscal tears, advanced osteoarthritis, labral tears of the hip and shoulder, and especially if they have a SLAP lesion.
A “SLAP” lesion is one in which there is a tear in the superior glenoid labrum from anterior to posterior. The symptoms of SLAP lesions typically cause patients to develop pain and a popping or clicking of the shoulder with elevation, adduction or internal rotation. Often, the physical examination is unremarkable. The condition is picked up on MRI arthrography.
The labrum is a fibrocartilagenous structure which helps to deepen the socket of the glenoid. When a person has a SLAP lesion, the shoulder joint becomes more unstable in the external rotation position. This puts increased pressure on the inferior glenohumeral ligament and the rotator cuff muscles Often patients come in saying they have been told they have a rotator cuff tear or ligament sprain, but the primary problem in these folks is deeper.
The SLAP lesion typically occurs when a person falls onto an outstretched arm. The typical orthopedic approach with SLAP lesions is to debride (cut out) the injured area and suture or tack down the flap that is left after the shaving.
A better approach than removing the injured structure is to rebuild it with Prolotherapy. Caring Medical in Oak Park has successfully treated numerous people with SLAP lesions. The typical program involves three to six visits receiving Prolotherapy with strong proliferants. The person uses physical therapy or exercises to strengthen the shoulder. Supplements are often given, and overhead exercises are curtailed until the shoulder becomes more stable. Prolotherapy to the SLAP lesion is done as well as Prolotherapy to the posterior and anterior stabilizers. Typically the person starts feeling better after their second or third treatment.
ANKLE SURGERY
ROSS HAUSER, M.D.
It is common for Prolotherapists to see people with continued pain complaints after surgery. This is a very common occurrence in our office in Oak Park, Illinois. Often overlooked causes of this post-surgery pain are that the surgery itself may cause ligament injury or the surgery may not repair the ligament injury. When performing surgery, the ligaments are stretched and pulled in order to gain access to the joint.
In 1992, researcher Dr. J. Albert and associates looked at what occurred in the ankle when the joint was opened or distracted for ankle surgery. What they found was that when the joint was opened in the clinically recommended range "complications of pin bending, excessive ligament strain, and bony destruction did occur." Anyone with post-surgery pain should be checked for ligament injury. Prolotherapy to the injured ligaments will eliminate the pain in such a case. Ankle fusion fixes nothing, but may provide some temporary pain relief, at least for a while.
Imagine how much motion your ankle normally has. What is going to happen when all of that motion is lost? Other joints around that fused joint must move more in order to compensate for the fused joint. This will cause excessive strain to these joints or the joints around them. The long-term outlook for fusion patients, no matter which joint, is long-term pain and disability. The reason why people succumb to these operations is that they feel they have no other options. There is an alternative to ankle fusion - Prolotherapy.
Ankle fusions typically have high rates of non-union.
This means that up to 30 percent of fusions fail, meaning that the bones do not hold together. In one study of 42 patients, the overall complication rate was 55 percent, including nonunion, fractures, pin-site infections, and hardware problems.
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Yet surprisingly, 85 percent of the people were satisfied with the results. People, we are setting our standards way too low! An operation has a 55 percent complication rate, yet we are satisfied?
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The most common long-term consequence of ankle fusion is arthritis in the joint below the ankle, called the subtalar joint. Guess how long it takes to become arthritic? It does not take long. The average time is about four to five years. Most studies show that after arthrodesis (ankle fusion) the subtalar joint is significantly arthritic in 50 percent of the cases. All that an ankle fusion does is cause arthritis to travel from one joint to the other. On top of that, the fused joint can no longer be moved at all. One study with a follow-up time of 12.3 years showed that 67 percent of people had pain in this subtalar joint and that 75 percent of patients had to wear special footwear after ankle fusion. The author (Ahberg, A. Late results of ankle fusion. Acta. Orthop. Scand. 1981; 52:103-105.) noted, "In conclusion, patients with ankle fusion often have persistent trouble; therefore technical and clinical development of total ankle joint replacements seems to be indicated." Can you believe this one? -The orthopedist's solution to the ankle fusion failure is "let's come up with another operation" so the sequence of events will continue: ligament sprain, RICE treatment, mild NSAIDs, then stronger and stronger NSAIDs, leading to cortisone shots, then arthroscopy, ankle fusion, and, finally, ankle replacement. We think not! How about just doing Prolotherapy after the initial injury? It is much simpler. Anyone starting out with the RICE treatment is most likely going to end up later in life with several masked people around them with sharp blades. If this is what you want, follow the standard sports medicine protocols. If not, run to a Prolotherapist, if you are still able. Your joints depend on it. The above scenario does not even take into account the dramatic gait abnormalities that occur with ankle fusion. Remember, fusion of the knee, back, or ankle means that the joint can never be moved normally again. At minimum, most of the motion in the subtalar joint will be lost. In regards to ankle fusion, the velocity of the gait will be much slower and the length of the stride will decrease. Other joints around the fused area, as already noted, will have to contract a lot more. This causes the energy expenditure of walking to increase dramatically.
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