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CASE STUDIES
Caring Medical is a comprehensive Prolotherapy practice. In the years 2009-2010, 102 patients were seen, with 85 being women and 17 being men, who carried the diagnosis of Ehlers-Danlos Syndrome or Joint Hypermobility Syndrome. This represented approximately 8% of the total patients seen during this time. The following cases are typical of the response one would expect utilizing Prolotherapy in the treatment of JHS or EDS, where resolution of the individual’s joint instability/hypermobility is the primary concern.
CASE STUDY: 21 YEAR-OLD FEMALE WITH EHLERS-DANLOS SYNDROME, HYPERMOBILITY TYPE
EK first began experiencing the symptoms of Ehlers-Danlos Syndrome, Hypermobility type in the fifth grade, when one of her knees subluxed. Over the next 12 years, the pain and joint subluxations spread to other joints including the other knee, elbows, shoulders, and spine. EK tried many different forms of therapy including physical therapy, massage, ultrasound, taping, and compression braces which managed her pain well enough to perform daily activities as well as gymnastics, track, and cross country. At the age of 19, she tore the meniscus in her right knee and underwent surgical meniscus repair. Following the operation, she experienced intense pain, and subsequently underwent a second operation. While the symptoms in her knee appeared to be resolved, pain in her other joints persisted. During this time, EK also began experiencing other health issues including hypothyroidism, eczema, chest pains, food allergies, irregular menstrual periods, and degenerative disc pain in her neck and back.
In the search for a treatment for her joint pain, EK found Prolotherapy, which she felt was needed for the pain in her neck, thoracic, low back, knees, and shoulders. During this time, she continued physical therapy, and managed her pain with multiple medications. After a year and a half of minimal improvement, her pain doctor referred her to Caring Medical in Oak Park, Illinois for Prolotherapy. As a 21 year-old college student, EK was living with constant joint pain, which disturbed her ability to exercise, study, and sleep. She contemplated dropping out of school. By this time, she also suffered from joint dislocations in her shoulders and elbows causing its own amount of excessive pain and stiffness. Her spine, including the neck, thoracic, and lumbar regions, would also “freeze,” sending shooting pain up and down her back.
EK’s first Prolotherapy treatment at Caring Medical consisted of Prolotherapy injections to her neck, spine, both scapulas, low back, and knee. Within a week of her first visit, EK reported a decrease in her thoracic and scapular pain and improved physical stamina and energy. A month later, she began running again and no longer required treatment to her knee. By her second visit, EK had discontinued all use of pain patches, and only required occasional Tylenol for pain and muscle relaxers to help her sleep. For the next six months, EK continued to receive monthly treatments to her neck, thoracic, and shoulders, showing gradual improvement of pain and well-being. After eight months of treatments, EK no longer required any pain medications, was no longer experiencing any joint dislocations, and was back to running and gymnastics. After her initial eight months of therapy, she was seen an average of once per year throughout her college and Masters program. She has not been seen for treatment for over seven years now, during which time she has received a PhD in her chosen profession. She continues to lead a full life, without daily pain or disability. She has no limitations while exercising most days.
DISCUSSION
Sometimes Prolotherapy is so successful that when the joints are stabilized, even clients with Ehlers-Danlos Syndrome, do not need further treatments. To be fair, EK did need more than the customary three to six visits, most likely because of the Ehlers-Danlos Syndrome. I have not seen this client for over seven years, but have communicated with her, and I can emphatically say that she now has a completely normal productive life. She went from living in fear of multiple subluxations in multiple joints, to complete stability in those joints, even with exercising most days. Prolotherapy, in this patient with Ehlers-Danlos Syndrome, appears to have permanently stabilized the unstable joints. The next case is presented because some patients with Ehlers-Danlos Syndrome, Hypermobility type, need periodic care to keep the various joints from dislocating or subluxing.
CASE STUDY: FEMALE WITH EHLERS-DANLOS SYNDROME, HYPERMOBILITY TYPE
PF is now a 55 year-old retired school teacher and mother of two adult children who lives in Canada. She came to Caring Medical because her Prolotherapy doctor, Fred Cenaiko, MD, retired. She had always known she was “hyperflexible” but had controlled her various joint aches, pains, and subluxations with physiotherapy and chiropractic care. Her pain became unbearable 15 years prior to the first visit at Caring Medical, when she began experiencing pain and instability in her left sacroiliac (SI) joint. After seeing many specialists over the course of several months for her SI pain, including her general practitioner, orthopedists, physiotherapists, and chiropractors, PF was left upset and disappointed by her continued pain and lack of improvement. She was having difficulty working, in addition to raising her two children. If something wasn’t found to help the unrelenting pain, she was destined to soon be completely disabled. Chiropractic adjustments helped for a few hours only to have her lower back go out again. She was told by one orthopedist to get a sacroiliac fusion.
As her low back pain increased, so did the rest of her joint pain. Her popping, clicking, and a feeling of looseness throughout her body increased. No longer were physiotherapy and chiropractic manipulation able to control her pain. Within a year, she had whole body pain and instability that almost completely disabled her for two and a half years. She was unable to take care of her children and she had to rely on strong pain medications in order to function. One day, her European-trained physiotherapist gave her some research articles from medical journals that talked about the tightening of joints with Prolotherapy. PF noted that the main doctor doing Prolotherapy was in Oak Park, Illinois, Dr. Gustav Hemwall. When she called Dr. Hemwall’s office, she was referred to Dr. Fred Cenaiko who worked in Saskatchewan, Canada. It was Dr. Cenaiko who diagnosed PF with Ehlers-Danlos Syndrome, Hypermobility type, and began treating her back and other areas of her body every six weeks with Hackett-Hemwall dextrose Prolotherapy. It took PF, 1.5 years of receiving dextrose Prolotherapy to her lower back to experience complete resolution of her SI pain. She reports that her other joints, including her knees, shoulders and hips healed much more quickly and she only required a couple treatments to each joint to resolve her pain complaints.
After one and a half years of doing Prolotherapy, PF was completely pain free. Because various joints of her body would begin to sublux and become painful over time again, she and Dr. Cenaiko realized that receiving Prolotherapy two to three times a year was what was needed to keep her stable and pain-free. PF has continued to receive Prolotherapy two to three times per year for the past 13 years. She was able to complete the necessary years as a teacher to be eligible for full retirement benefits from teaching. Prolotherapy also helped her get back to being the type of mother, wife, and friend that she wanted to be. PF currently swims laps, jogs, or hikes on a daily basis with no pain. She states that she also enjoys biking but she has to be careful because if she cycles at a high resistance for long distances, her knees start to become unstable. PF also avoids massages because she has noticed that massages tend to loosen her joints. Dr. Cenaiko retired in 2010 and referred PF to Caring Medical to continue her maintenance Prolotherapy treatments.
DISCUSSION
It has not been the “norm” at Caring Medical for a client with Ehlers-Danlos Syndrome to need periodic Prolotherapy treatments. Dr. Cenaiko used dextrose as the proliferant for PF. When I evaluated her and noticed that indeed there were some joints that were unstable, I suggested at her first visit to Caring Medical that we use a strong proliferant. To start, she received dextrose Prolotherapy with sodium morrhuate added to the solution. While she still believes she will need Prolotherapy twice per year, it is my hope that we will get her joints stable enough with the stronger Prolotherapy treatments, that eventually she will no longer need Prolotherapy.
This case is presented here so patients with Ehlers-Danlos Syndrome know that generally Prolotherapy can permanently stabilize joints. But some patients, like PF, are happy that Prolotherapy is available if periodic treatments are necessary.
CASE STUDY: 31 YEAR-OLD FEMALE WITH JHS, WITH CONSTANT SHOULDER, THORACIC AND RIB SUBLUXATIONS
NP is a 31 year-old registered dietitian who came to Caring Medical in February 2009 from a referral by her osteopathic doctor, because of the diminishing benefits manipulation was having on her pain. She was very interested in the potential benefits Prolotherapy might have on her significant shoulder and thoracic/rib pain. She stated that she “has always had loose joints” and for most of her adult life has needed either chiropractic or osteopathic care to function. Her significant pain started 10 years earlier while on the rowing team at college. Her primary pain was located in the left T1-T4 area and left shoulder. A previous MRI of the thoracic area was read as normal. She had tried acupuncture, electrical stimulation, physical therapy, and various medications and manual therapies without lasting relief.
On physical examination, she had noticeable ligament laxity in multiple thoracic/rib junctions (costovertebral) and her left shoulder easily subluxed anteriorly. Her Beighton Hypermobility Score was 5. At the initial visit, dextrose Prolotherapy was given to her left thoracic facets and costovertebral junctions. When seen one month later, she felt 40% better and another Prolotherapy treatment was given to the same area. She was not seen again until June and felt her thoracic pain didn’t need treatment anymore but she wanted to start treatment for her left shoulder instability. Because of the degree of instability, sodium morrhuate (1cc/10cc syringe) was added to the dextrose Prolotherapy solution and treatment was given primarily to the anterior shoulder.
NP did not return for one year because of resolution of her thoracic and shoulder pain with the previous Prolotherapy treatments. When seen in June 2010, her primarily complaints were clicking, pain and an “unstable feeling” in the left hip. On physical exam, a definite palpable click was felt and a moderate degree of instability was seen. Her anterior and posterior left hip was treated on that date and again one month later. She had complete resolution of these symptoms. She was seen in October 2010 because of low back pain which wasn’t resolving with physical therapy and exercises. Physical examination revealed hypermobility of her left sacroiliac joint. Dextrose Prolotherapy with sodium morrhuate was administered to the left lower back region emphasizing treatment of the left sacroiliac joint.
When NP was seen again in February 2011, the only complaint she had was recurring subluxation of her left shoulder joint during activity. She again had evidence of shoulder joint instability anteriorly. Treatment of dextrose Prolotherapy with sodium morrhuate to this area resolved this issue.
DISCUSSION
It is common with genetic hypermobility cases for symptoms to “pop” up in other joints once the primary painful and hypermobile areas are stabilized with Prolotherapy. For instance, NP had hip instability that was stabilized with Prolotherapy, subsequently causing her hypermobile left sacroiliac joint to cause symptoms. The nice effect of Prolotherapy is that even with genetic hypermobility syndromes, the joint pain is often relieved permanently. But sometimes periodic treatments are needed because of the recurrence of joint hypermobility in a previously treated area.
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