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Prolotherapy

Discussion in 'General Issues and Discussion Forum' started by Dieter Fellner, Nov 18, 2004.

Tags:
  1. Dieter Fellner

    Dieter Fellner Well-Known Member


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    Rick.....

    <ADMIN EDIT> I have split this and subsequent messages on prolotherapy off from this thread on Shock Wave Therapy, so we can keep the topics seperate<>

    Please help me out here:

    1. What is prolotherapy? :confused:
    2. Why do you start (almost) each word with a capital letter, and how do you decide when not to? :p

    Thanks
     
    Last edited by a moderator: Nov 28, 2004
  2. admin

    admin Administrator Staff Member

  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    Health Insurance - control?

    Thank you admin for the links. I note the two links are to the US Health Insurance companies Aetna & Medicare. My impression, acquired over the last 12-months in the US, leaves me to wonder how useful this is to the clinician.

    The American Health Insurance industry has been criticized for assuming increasing control, and taking away from the doctors, the freedom to make the best treatment choices for their patients. Although motivated by the need to control the ever spiraling cost of health insurance in the US, those with a critical eye now worry that this development, which seems to be gaining momentum, has gone too far and the patient looses out. There is now a risk that expensive treatments may be denied, over a cheaper alternative. This has left patients very :mad: and doctors frustrated.

    ECSW is a good example of this whereby insurance companies deny cover for this treatment, on the grounds of insufficient robust research evidence. The alternative i.e. surgical intervention in recalcitrant heel pain patients, has not been required to be validated to the same scientific standards. Yet adverse post-operative effects from such surgery are well documented. At the same time the adverse publicity levelled against ESWT is based, at least in part, on flawed evidence.

    It appears the same cannot be said for prolotherapy, a technique which seems devoid of any type of research, with a good or bad outcome. :eek:

    From a personal perspective, apart from the fact the prolotherapy technique uses some very exotic injectables, would injecting steroids / LA seem to fall within this category also?

    Some clinicians in the UK have used a course of LA injections to the "trigger" area of pain, and I have heard of good outcomes. :rolleyes:
     
  4. admin

    admin Administrator Staff Member

  5. nicpod1

    nicpod1 Active Member

    I work with two Physiotherapists who are both advanced traditional Chinese and, also, Western Accupuncturists. They have a technique for heel pain which involves 'peppering' the periosteum of the calcaneus with accupuncture needles. This also elicits an inflammatory response and apparently promotes healing and, therofore, pain-relief, in the same way as 'hitting it with a hammer' (see ECSWT thread on General Forum) and actual osteal drilling.

    It is, as you can imagine, extremely painful to 'pepper' in this way and I have recently been carrying-out a tibial nerve block prior to 'needling'. Results are to be awaited, but, obviously, this technique has the advantage of being able to be performed in a clinical room, with little, or no, post-op infection risk.

    Phyisos will also use a technique called myofascial release, with some success.

    (This reply is also on Surgery Forum) ;)
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    peppering ...

    jeeez.....what a choice! Get hammered or peppered with needles. Are the Chinese pure genius or just sadists? Hope I never have that kind of heel pain to worry about.

    One point occurs to me : of these ?new treatments which claim "to promote inflammation" - how do we know the treatment promotes inflammation and neovascularization in the right areas, which , we are led to believe, seems necessary to promote healing of the fascia/aponeurosis?

    The people working with ESWT assess changes in the thickness of the fascia to determine the effectiveness of the intervention, using ultrasound scan.

    I can feel a new thread coming on ..... :eek:
     
  7. podrick

    podrick Active Member

    prolotherapy/capital letters

    dieter,
    first let me address the letter issue,i didn't even realize i was doing it.i will have to take it up with my therapist.unfortunately,we have a lot of ground to cover and i don't know when we will get to it.
    now about prolotherapy,this form of injection therapy has been around for about 40 years.it consists of injecting coctails of glucose,saline,and local anesthetics into affected joints or connective tissues.the injections are usually with smaller gauge needles,such a #18.the objective is to create lesions in the tissue and promote the elemination of pain through the regeneration of healthy tissue via the healing process(i am simplifying).however,very similar to what is being done with eswt.let me know your thoughts.
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Rick...

    Capital letters: please don't stop doing it! That way I don't have to correct my typos! :D

    Prolotherpay - I have been reading up about it but thanks for the explanation also. Do you know what is the exact formula for the cocktail used by the neurologist? I would assume he anaesthetises the heel first? What volume is he injecting? Does he carry out a quantitative assessment to measure outcomes? It's all too easy to think treatments are working when we rely only on patient feedback....

    I have had correspondence from a pain managment consultant experienced in prolotherpay who would advise against using this for plantar fasciitis due to the risk of nerve damage, but, he hadded the formulation used in the UK differs to that in the US. He uses it on the ankle to tighten up ligaments when necessary.

    Re: cryosurgery - so far the company has studiously ignored my inquiry. I have heard from a colleague who has also been let down.... nice customer service.
     
  9. podrick

    podrick Active Member

    cryotherapy

    dieter,
    why don't you try the website in the u.s. or get on dr.fllat's own website,it has a link directly to the company in the states.
     
  10. admin

    admin Administrator Staff Member

  11. hazelnoakes

    hazelnoakes Active Member

    Are any podiatrists using prolotherapy in Melbourne? If so, what training did you get? Very interested in learning this technique but don't know where to start. Thanks Folks
     
  12. jimen

    jimen Welcome New Poster

    dear all..
    you can get training for prolotherapy by bedside teaching or join the organization of American Academy of Orthopedic Medicine..
    I learn this technique from dr pomeroy which is one of past time president of prolotherapy association.. I've absorb the technique completely so if you want you can buy the DVD for half the price.. Its worth $2200 you can check it on dr pomeroy website but ill sell it for only$1200.. come on its $200/therapy..
    if you want contact me panjipriambudi@gmail.com
     
  13. kayron

    kayron Member

    Does anyone know if prolotherapy training is offered for podiatrists in the UK?
     
  14. W J Liggins

    W J Liggins Well-Known Member

    Hi

    Just a couple of points here. I must plead guilty to originating the concept of serial bupivacaine injections for the treatment of recalcitrant plantar fasciitis. The original paper was published in the British Journal of Podiatry Vol4. No.3. David Wiley in Glasgow has done a good deal of work on long term follow up using the technique. No mechanism of action has been arrived at, although it is hypothesised that a reflex hyperaemia is initiated promoting rapid healing, which is certainly different to creating lesions in the tissue.

    I cannot comment on prolotherapy since I know little of the subject, but Martin Harvey at bhapodiatric@btconnect is experienced in using the technique and runs courses in the UK.

    All the best

    Bill Liggins
     
  15. kayron

    kayron Member

    Hi Bill,
    thanks for the info

    Kayron
     
  16. Bill, if memory serves, I first saw this treatment protocol presented in Brighton at a World Congress in the early 1990's. As I recall the guy presenting this was Asian in origin, was this you or one of your team? If not, I'll try and sort through my scrap-book to find the details. Maybe it was the same idea applied to interdigital neuroma's and not plantar faciitis? Regardless, could you give the full reference to your paper please?
     
  17. This is one of these topics that always intrigues. The potential for this kind of therapy, if the claims of the proponents are accurate, is enormous. Certainly in ankle ligament sprains or tears, should an infiltration of local anaesthetic and glucose produce a subsequent reaction in the adjacent tissues that stimulates contraction (or retrograde memory) in the damaged tissue, then this should be adopted as standard practice in management protocols. I know several podiatrists and pod surgeon who use prolotherapy routinely and claim great success, but quality research is still lacking. Anyone else have any experience - good or bad?
     
  18. W J Liggins

    W J Liggins Well-Known Member

    Hi Simon

    Although I was at that congress I don't recollect anything on the subject of serial LA injections for PF (I would have done if I had seen it). Certainly, the rigorous literature search carried out by my co-author, Julian Pavier, (my registrar at the time) did not reveal any previous work on the subject. Naturally, I will be intrigued if you can post any details here.

    My paper was published in the British Journal of Podiatry Vol 4, No. 3, August 2001 pp90-95. I had previously lectured quite widely on the subject for a number of years although these were only 'local' events.

    All the best

    Bill
     
  19. Thanks for the reference, Bill. As I said, the presentation I saw in Brighton all those years ago might have been a similar protocol for neuroma's, the truth is I can't remember. I found the document wallet from the conference, but sadly it's original contents were not in it.
     
  20. AngieR

    AngieR Active Member

    Kayron,

    http://www.aesthetist.co.uk/index_files/Page609.htm

    Masterclass Presentations -link above- are doing the course for 2011.

    I have found prolotherapy to be very useful for most MSK conditions and also any podiatry related painful condition.

    Mark - it is very successful in eliminating the pain caused by ankle sprains, and injection into the sinus tarsi are normally painfree but with a fabulous result. I am at the present moment using it to help an elderly gentleman with lateral ankle pain of some 60 years duration. He has had one into the sinus tarsi and remained pain free for 3 weeks, as he is normally in constant pain, I do believe a course will provide a positive outcome.

    Other conditions I have treated successfully include plantar fasciitis, capsulitis, I/D neurological pain, metatarsalgia, arthritic joints (if I can a needle in) and knees.

    It is certainly a course I have found to be very beneficial to my practice and have no hesitation in offering it for any painful areas.

    Angela
     
  21. Thanks. Can you give me any published work on the technique and its outcomes, please? Also, do you have a list of upcoming courses?

    Many thanks

    Mark
     
  22. goofyfoot360

    goofyfoot360 Member

    I am entering this discussion as a receiver of Prolotherapy some 12 years ago.
    I was the victim of a car accident leaving me with significant soft tissue damage to the neck and lower back. I suffered severe lower back pain for 2 years, living on a cocktail of pain killers. I was offered Prolotherapy to my lower back. I had 3 treatments (happily with Entonox). It did appear to have a significant benefit, noticeable after a few months and as a result I did not require as much pain relief.
    Was this Psychosomatic ? I don't believe so, the injections were to my ligaments, according to my Chiropractor I was standing more upright and my pelvis was not as tilted as on previous visits.
    I would tend to keep an open mind. There is lots of anecdotal evidence to suggest it is efficacious.
     
  23. goofyfoot360

    goofyfoot360 Member

    :drinks
     
  24. AngieR

    AngieR Active Member

    I have already posted the link to the course so won't repeat it.

    As for evidence based articles, I'm not sure. There are sites to google and I particularly like Ross Hausers site and the information he passes on is invaluable.

    http://www.upmc.com/healthatoz/pages/healthlibrary.aspx?chunkiid=21357

    http://www.healthline.com/natstandardcontent/alt-prolotherapy

    http://www.library.nhs.uk/musculoskeletal/viewresource.aspx?resid=238289

    http://onlinelibrary.wiley.com/doi/10.1211/fact.2001.00022/abstract

    http://www.prolotherapy.com/

    http://www.prolotherapy.org/

    http://www.bimm.org.uk/Prolotherapy.shtml

    http://www.painclinic.org/treatment-prolotherapy.htm

    Try these for information, some negative and some positive so you have a good all round view and to formulate your own opinion:empathy:

    Angie
     
  25. Graeme Franklin

    Graeme Franklin Active Member

    Have you been on the visco-supplement course as well Angela? I just wondered how the modalities compare. And was it easy obtaining insurance?

    I was thinking of trying the prolotherapy course first...

    Regards,

    Graeme
     
  26. AngieR

    AngieR Active Member

    Hi Graeme,

    Yes I have done the visco-supplementation course but haven't used it yet. I prefer to use prolotherapy and have some very good results. The biggest problem I seem to face is the cost! Prolotherapy is reletively inexpensive, whereas Ostenil is not! The other problem is patients who attend with joint pain are already showing the later signs of OA so getting into the joint margin without diagnositic US is rather more difficult, although I am getting rather good at palpating them.

    I offer injection therapy to everyone who moans about joint pain, give them the literature and let them make up their mind - but it all boils down to cost, 1 x Ostenil vs 4 Prolotherpay for a similar result.

    Insurance for the visco-supplementation is from the Society but they won't cover Prolotherapy so I joined the Institute for that.

    I do hope you look at Prolotherapy course, it certainly was the best money I spent on a course in a long while - also helps to sort out my own MSK problems :D

    You meed a POMs cert to be able to get hold of the glucose, but I'm sure the course leaders will be able to advise you on this. Lidocaine should be easily accessible as you have an LA cert. and the homepathic additions such as Traumeel and Zeel are readily available too.

    If you need any more info please don't hesitate to contact me.

    Angie
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    From Science Based Medicine:
    Prolotherapy
    Full story
     
  28. trevor

    trevor Active Member

    The Hacket Hemwall Foundation runs a conference at the University of Wisconsin Madison each October.
    I think there are links on their web site for recent published papers.
    A former US surgeon general Dr C Everett Coop was a prolotherapy patient and wrote articles about his experience with prolotherapy.
     
  29. RachWadd

    RachWadd Member

    It appears there was a RCT completed in 2013 with positive results for the use of prolotherapy in knee OA...

    http://www.annfammed.org/content/11/3/229.full

    Nothing for foot conditions that I can find however.

    I recently had a patient enquire about prolotherapy for chronic plantar fasciitis after finding out from a friend about their positive outcome from this treatment 2 years ago.

    I am currently looking into the availability of prolotherapy in Melbourne. If anyone knows of a practitioner with experience in the applications for foot pathologies that I could chat to, I would appreciate the heads up.

    Thanks
     
  30. trevor

    trevor Active Member

    Dr Margret Taylor in Adelaide is the person you need to see. She runs regular courses and I believe she has been to Wisconsin to HHF.
     
  31. drmkatz

    drmkatz Member

  32. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review
    Lane M. Sanderson and Alan Bryant
    Journal of Foot and Ankle Research 2015, 8:57 doi:10.1186/s13047-015-0114-5
     
  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy – a systematic review including meta-analysis
    Oliver Morath, et al
    Scandinavian Journal of Medicine & Science in Sports: 27 April 2017
     
  34. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis.
    Ersen Ö, Koca K, Akpancar S, Seven MM, Akyıldız F, Yıldız Y, et al.
    Turk J Phys Med Rehab 2018;64(1):59-65.
     
  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    This clinical trial was just registered:
    Evaluation of the Efficacy of Prolotherapy Treatment in Patients With Plantar Fasciitis: a Randomized Double-blind Study
     
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