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Prolotherapy/Regenerative Injection Therapy

Regenerative Injection Therapy (RIT), also known as Prolotherapy, is an innovative field of Regenerative Medicine consisting of therapies that naturally stimulate the body to self-heal. Prolotherapy or RIT is performed to stimulate repair of weakened, injured or painful joints. During Prolotherapy, a series of injections is administered into problem areas to initiate the reparative healing response known as the healing cascade.

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Prolotherapy Solutions

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Dextrose Prolotherapy

Dextrose-based Prolotherapy is the simplest and most common option used in Prolotherapy today. When used in Prolotherapy, dextrose, a simple sugar in liquid form, promotes a mild inflammatory response due to its large molecular size. The irritant effect of dextrose, along with the micro trauma of the injection together initiates the much-needed healing cascade characterized by an elevation of growth factors so the body can repair the injury or deterioration. Dextrose is diluted in an anesthetic, is very safe and does not raise blood glucose levels in diabetics or non-diabetics. Most common musculoskeletal conditions are well treated with dextrose Prolotherapy.

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Ozone Prolotherapy (Prolozone)

Ozone Therapy has perhaps the broadest clinical use of any healing modality known. Ozone Prolotherapy combines the healing properties of ozone with the technique and benefits of Prolotherapy. The healing properties unique to ozone’s three oxygen atom structure, are its ability to improve the body’s utilization of oxygen, thereby upregulating energy production, healing, and repair. Additionally, both Prolotherapy and ozone promote the activation of growth factors. Ozone Prolotherapy is especially beneficial for musculoskeletal pain, osteoarthritis (cartilage degeneration) and a variety of low back pain syndromes. This is because ozone optimizes healing, in part by removing inflammatory and degradation compounds from the joints. In this way, ozone even possesses analgesic properties, helping treated areas become pain-free more quickly.

Ozone Prolotherapy is researched to be therapeutic for spinal stenosis, low back pain, disc herniations, radiculopathies, knee pain, arthritis, ligament and tendon injuries, nerve pain and other conditions. Ozone can safely be injected into joints, ligaments, tendons and muscles. Ozone Prolotherapy is compatible with both dextrose Prolotherapy and Platelet-rich Plasma (PRP) Prolotherapy.

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Platelet-rich Plasma (PRP) Prolotherapy

With PRP Prolotherapy, your blood is drawn in the office, just before the procedure. We place the blood in a special centrifuge machine which spins, separates and provides platelets in concentrations over 600% or six times higher than baseline platelets values to take advantage of their unique healing properties. We call this Platelet-rich Plasma. Your concentrated platelets are then injected into the damaged area or areas of your problem joint. PRP stimulates a more aggressive healing response compared to dextrose. Platelets maintain the ability to stimulate your own stem cells that are directed to the area treated. Platelets are also rich in growth factors that contribute to their beneficial healing properties. Research shows that PRP Prolotherapy is successful in the treatment of tennis elbow, rotator cuff injuries of the shoulder, ligament sprains, osteoarthritis of the knee, tendon deterioration, meniscal tears, injuries to the medial collateral ligament, plantar fasciitis and other conditions.

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Trigger Point Injections

Painful, muscular knots that restrict our range of motion are known as myofascial trigger points. These muscle spasms most commonly occur above and between our shoulder blades in the trapezius and rhomboid muscles, with recurring bouts of prolonged physical or emotional stress. In part, they are the body’s way of holding and protecting an unstable joint. Trigger points can refer pain around the affected area, and even radiate down an extremity mimicking a “pinched” nerve root. Painful trigger points are not only associated with a provoking stimulus but more importantly are associated with an underlying connective tissue dysfunction like unresolved sprains, strains, osteoarthritis and even joint misalignment. We help provide immediate relief of trigger point pain with a local injection of an anesthetic and a touch of B-vitamin into the taut muscle fibers. Although this provides immediate relief, for permanent success the joint must be in proper alignment and the underlying connective tissue dysfunction corrected with Prolotherapy.

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Conditions treated

Regenerative Injection Therapy or Prolotherapy treats any form of musculoskeletal pain including osteoarthritis, sprains and strains, minor tears, repetitive use injuries, and those sustained by athletes. Treatments help new injuries or older ones that never healed properly.

Ligament and tendon tears
Arthritis
Back pain
Groin pain
Joint laxity and hypermobility
Tennis elbow, golfer’s elbow
Pain and arthritis of the neck
Knee pain
Sacroiliac pain/dysfunction
Neck pain
Sciatica
Rotator cuff injuries
Pain at ischial tuberosity
Shoulder pain
Tendinosis

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Prolotherapy

What is Prolotherapy?

Prolotherapy, also known as Regenerative Injection Therapy, is a non-surgical, in-office procedure that helps restore function and heal from painful and injured joints. Prolotherapy addresses the site of injury, along with the surrounding structures. Prolotherapy owes its name to proliferation as treatments cause the proliferation of healing cells that repair connective tissue. These healing cells release collagen and matrix to repair stretched and torn ligaments, tendons and cartilage. A variety of formulas may be used in Prolotherapy and include dextrose and procaine alone or in combination with bio-cellular agents such as Platelet-rich Plasma and stem cells. No matter the formula used, injections of tendons and ligaments to stimulate healing and repair is Prolotherapy.

A Better Model for Understanding Chronic Pain

Prolotherapy takes account of the most accurate and current model of understanding chronic musculoskeletal pain. Chronic joint pain most commonly results from ligament and tendon dysfunction. Weakened and lax connective tissue allows instability and the transference of unequal forces through especially weight bearing joints contributing to cartilage damage. Finally, nerves within the connective tissue and around the joint begin sending pain signals. Prolotherapy is simply the most effective treatment for healing and repairing deteriorated, damaged and arthritic joints.

Why Choose Prolotherapy

Conventional therapies lack the regenerative quality of Prolotherapy and therefore do not address the underlying instability and deterioration. Braces and support, pain medications, surgery, extended periods of immobility, and other similar approaches do nothing to stimulate healing. Worse, by blocking the release of healing cells disparately needed for repair, the common prescribing of non-steroidal anti-inflammatories and corticosteroid injections accelerate ligament deterioration that ultimately leads to more pain, and disability over time.

How Prolotherapy Works

Research spanning decades has found that the body responds to Prolotherapy just as with any injury; that is by stimulation of the wound healing cascade. This is your healing biology in action. The healing cascade begins with the release of messenger cells, signals and growth factors characteristic of the inflammatory response. Collectively, these signals recruit and send special cells called fibroblasts to the treated area. On arrival fibroblasts secrete collagen and matrix. This new collagen becomes incorporated into the injured ligaments and tendons to repair and strengthen them over time. Ultimately, the structural integrity of the joint is restored, function returns, and painful nerves stop firing.

Wound Healing Cascade
The best way to understand how and why Prolotherapy works is to be aware of the basics of wound healing. After a trauma, injury or surgery, the healing cascade is initiated to heal the wound. The wound healing cascade follows through distinct, sequential and partially overlapping stages. Prolotherapy works by simply exploiting the wound healing cascade.

Wound Healing Cascade	Onset	Duration
Inflammatory Phase: Characterized by swelling, pain and warmth. The Injured tissue is exposed to proinflammatory substances and growth factors secreted by macrophages and platelets respectively.	Onset of injury	about 4 days
Proliferation Phase: The foundation of new tissue and blood vessel formation. Healing cells, most notably fibroblasts, produce collagen for wound repair.	72 hours after injury	about 4 weeks
Remodeling Phase: Characterized by ongoing tissue regeneration and remodeling. Here collagen health and deposition continue as the wound’s strength and elasticity progresses.		1-2 years

Prolotherapy’s History

Prolotherapy was first performed in the early 1930’s. The earliest contemporary pioneer of the art was George S. Hackett, MD, a Cornell Medical School trained trauma surgeon. He is known as the “father of prolotherapy.” He is also credited with discovering that chronic ligament and tendon dysfunction is the most common cause of chronic joint pain. He, along with Earl Gedney, DO and David Shuman, DO were early pioneers who developed much of its methodology and were responsible for training other physicians in the early years. Gustav Hemwall, MD learned about Prolotherapy by a presentation Dr. Hackett gave at a medical conference in 1955. Dr. Hemwall went on to receive hands-on training from Dr. Hackett. Later, Drs. Hackett and Hemwall together devised the Hackett-Hemwall technique of Prolotherapy, the most widely taught and practiced method today.
The work and concepts developed by Dr. Hackett and others, along with the relationship between ligament and tendon dysfunction and chronic pain have now been well validated by research and case studies over the past few decades. Several post graduate training programs hold academic and hands-on conferences around the world for doctors wanting to learn Prolotherapy. Prolotherapy is now practiced by thousands of physicians who want to see their patients experience healing from chronic pain.

The Benefits of Prolotherapy

Musculoskeletal pain is one of the most common reasons people visit a doctor. Chronic joint pain increases with age, with nearly thirty percent of people aged sixty-five and older being affected. Conventional medicine leaves most joint pain sufferers no solution aside from chronic non-steroidal anti-inflammatory drugs, opioid dependence and surgery. Most chronic joint pain sufferers would not benefit nor are candidates for surgery. On the other hand, Prolotherapy provides individuals a path to not simply have pain signals blocked but to actually have healthier, stronger joints and restored function. Most of all, Prolotherapy provides the opportunity for individuals to return to the activities they love. Treatments are helpful not only for chronic joint pain but for acute joint pain and injuries as well. Conditions treated include sprains and strains, tendonitis, tendinosis, arthritis, low back pain, tennis elbow, carpal tunnel syndrome, sciatica and others. Prolotherapy is proven to decrease or eliminate pain, to improve joint function and to provide a return to previous activity. In addition, prolotherapy gives individuals the opportunity to no longer rely on pain medications. Prolotherapy is beneficial to both young and older adults, and for athletes.

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