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Athletes are turning to injections of plasma and sugar to heal injuries.
For Jennie Hansen, prolotherapy was a Hail Mary. While sidelined with a severe high hamstring injury, the professional triathlete had endured chiropractic care, physical therapy, massage and injections of anti-inflammatory medications. Nothing was working.
“I was at the point where I was willing to try anything,” said Hansen. In this case, “anything” included a series of injections known as prolotherapy. Though the ultrasound-guided injections were quite uncomfortable (“one of the most, if not the most, acutely painful experiences I’ve ever had,” says Hansen), the injury began to heal. At two weeks, Hansen was riding a bike once more; at six weeks, elliptical workouts were tolerable. At 10 weeks post-treatment, Hansen began a gradual return to running.
“I do feel that the prolotherapy did help me get over the hump,” says Hansen.
What is Prolotherapy?
“In its simplest form, prolotherapy is the injection of a natural substance to stimulate the growth of weakened, torn or damaged soft tissue such as ligaments, tendons, meniscus and labrum,” says Peter Fields, MD, DC.
The substances injected in prolotherapy vary based on the type and severity of injury. Dextrose prolotherapy is the injection of dextrose, or sugar, in mild-to-moderate soft tissue injuries, such as weakened ligaments and tendons. PRP, or platelet-rich plasma prolotherapy, is the injection of concentrated blood products into a severely torn ligament, tendon, or meniscus. For joint injuries involving a degeneration of cartilage (“bone-on-bone” injuries), some doctors utilize stem cell prolotherapy, where stem cells are harvested from the body and injected back in.
Not all soft-tissue injuries are candidates for prolotherapy treatment. Dr. Fields estimates approximately 5 percent of injuries—a complete rupture of a ligament or tendon, for example, or extremely degraded joints— would not benefit from injections. A very thorough history and physical, along with a review of MRIs and X-rays, can help a doctor determine a patient’s eligibility for prolotherapy.
Method of Treatment
The number of injections required varies based on the amount of damage in the injured location. For dextrose prolotherapy, the average treatment protocol is six to eight injections, spaced every three weeks; for PRP, three to four injections on average. Stem cell prolotherapy usually requires only one four-hour treatment.
All injections are guided by ultrasound and done under local anesthesia. Side effects include temporary stiffness, bruising and pain at the injection site.
Though the injections can be uncomfortable, most people walk out of the office after prolotherapy treatments. Still, that doesn’t necessarily mean an immediate return to tempo sessions and hill repeats. Prolotherapy expedites the body’s natural healing process, but it’s not an instantaneous cure.
“There are some limitations for the first couple of days, but then we want people to start their activities up slowly, building up over a few weeks to come back to full activity,” says Dr. Fields. “Basically, we want people healing themselves in a dynamic position which is movement, and not in the static position, which is no movement.”
Fields suggests athletes undergoing prolotherapy start with swimming and aqua-jogging before building to more strenuous exercise.
Prolotherapy is an emerging field of study with a mixed bag of results. According to a May 2016 article in the Journal of Family Practice, “basic science and preclinical research support ‘the promise’ of platelet-rich plasma, but patient-centered evidence is lacking, and tremendous variability exists between studies.”
Because of a lack of large, definitive studies supporting the effectiveness of prolotherapy, most health insurance plans will not cover treatment. Patients may pay anywhere from a few hundred to a few thousand dollars out of pocket for the treatment, mostly as a last-ditch effort to avoid the operating room.
“When surgery is done, it can never be undone,” says Dr. Fields. “Many of my patients have said if the [prolotherapy] technique they were having done in my office were not successful, they could always go forward and have surgery. But they can never do it the other way around.”