PRP Therapy, Prolotherapy & Prolozone

Prolotherapy

(“Proliferative Injection Therapy”), also known as nonsurgical ligament reconstruction, is a regenerative injection therapy for chronic pain, that is promoted and supported by the Mayo Clinic. It is an alternative to surgery, arthroscopy, cortisone shots, non-steroidal anti-inflammatories, and / or chronic use of narcotic pain medications, and has become particularly popular amongst athletes as a result. Developed back in the 1940s by Dr. George Hackett, MD, and further developed by Gustav Hemwall in the 1950s (99% of his 10,000 prolotherapy cases found relief from their chronic pain), it involves injecting a local anesthetic along with a solution of dextrose (sugar water), into damaged or weakened connective tissue such as a tendon or ligament. This irritates the local area causing inflammation which then encourages the repair that never fully occurred previously. The release of growth factor at the site of injury may result in a 30-40-% strengthening, thus reducing the ongoing pain, chronic inflammation and weakness.

Prolotherapy treatment sessions are generally given every four to six weeks. Many patients receive treatment at less and less frequent intervals until treatments are required only every several years, if at all.

The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ, avoiding hip or knee replacement surgery,  damaged knee ligaments, chronic ankle sprain, plantar fascitis, frozen shoulder, rotator cuff injuries, tennis/golfer’s elbow, and sciatica.

Prolotherapy offers a safe and effective approach to treating pain that doesn’t just mask symptoms but actually stimulates the body to repair. Anti-inflammatory drugs (NSAIDs) such as Aspirin, Advil, Motrin and Celebrex cause damage to ligaments after prolonged use, are known to cause kidney failure and the Centers for Disease Control in the U.S. published a report in 1998 that cited 20,000 deaths a year from NSAIDs.

Evidence Basis: Rabago et al. [A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med. 2005 Sep;15(5):376-80] noted: “Two [randomized controlled trials] on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy.”

PRP Therapy

Platelet-Rich Plasma (PRP) is a fraction of blood plasma that contains high levels of platelets and multiple growth factors (which are directly responsible for tissue regeneration). It has been shown in clinical studies to stimulate the proliferation of various cell types and accelerate healing and connective tissue regeneration when re-injected into damaged or weakened tendons or ligaments. The bioactive proteins increase the production of stem cells which initiate the healing of connective tissue, regeneration and repair of bones, promotion of new blood vessels and stimulation of the wound healing process.

It is an advanced technique used in prolotherapy to accelerate healing and tissue regeneration, and it has received great interest and media attention due to its popularity amongst professional athletes and its effectiveness in treating their sports related injuries. Among those who have sought treatment are Tiger Woods, Hines Ward and Troy Polamalu, of the Pittsburgh Steelers. Previously, PRP was used for years in surgical centers around the world to improve the success of bone grafting, and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. It has only been in the last few years that doctors and surgeons have been injecting PRP for the treatment of chronic pain. Tennis elbow, plantar fascitis, Achilles tendonitis/tendinosis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are all being treated with the prolotherapy injection of PRP with the goal of regenerating degenerated connective tissue.  PRP injections prove to be very successful at a magnitude greater than regular dextrose prolotherapy.

PRP is isolated from a small amount of blood taken from the patient prior to re-injecting it into the treatment areas.

See a PRP Preparation Technique Animation »

The growth factors or cytokines, found in the PRP, include:

By concentrating these growth factors and injecting them at the site of injury, the body’s own stem cells are drawn to the injured area and differentiate to form new healthy and robust regeneration of damaged ligaments and tendons.

PRP provides a fibrin matrix graft: Fibrin matrix provides the scaffolding for new collagen to form along damaged ligaments and tendons. With a fibrin matrix graft, even severely damaged tissues can re-organize and heal.

Platelet Rich Plasma acts as a tissue growth accelerator which amplifies the natural process of the tissue reparation and healing, due to its potency. Studies have revealed that PRP stimulates not only the production of new collagen at the fibroblasts, but bone and cartilage cells at the site of the injection. This strengthens injured ligaments and tendons by rebuilding the joint cartilage. This new, strong, collagen is naturally incorporated into the existing cartilage and ligaments making them thicker and more elastic.

Some interesting Research Articles:
http://www.orthohealing.com/plateletrichplasmatherapy-prp/prp-publications/#physiology

How Does PRP Prolotherapy Compare With Cortisone Shots?

According to certain studies, cortisone injections may actually weaken tissue. Although cortisone injections have been known to provide temporary relief and to stop inflammation, they may not provide long-term healing. The process of Platelet Rich Plasma therapy heals and strengthens the tendons and ligaments and in some cases thickening the tissue up to 40%.

How Does PRP Regenerative Injection Therapy compare with regular Dextrose Prolotherapy?

When regular dextrose prolotherapy has provided positive results but recovery has not been ideal, PRP Regenerative Injection Therapy is especially useful. In these types of situations PRP is often the treatment option that will resolve the less responsive or more injured areas. In fact, clinical and anecdotal experience has demonstrated that using PRP as the prolotherapy injection solution creates a deeper healing effect and results in an accelerated healing process in fewer treatments than the regular dextrose prolotherapy.

Frequency Of Treatments

Usually patients feel the benefits of PRP injection therapy after only two treatments. Sometimes satisfactory results may occur even sooner. Although individual responses to the treatment do vary, most people require 3-6 sets of injections. Each treatment is spaced four to six weeks apart.

So what conditions are successfully treated with PRP?

Due to the high success of normal Dextrose Prolotherapy, PRP is not something we normally think of as a first line solution. For really bad tears or injuries, especially if someone has had some Prolotherapy elsewhere, it may be used as a first-line therapy. Because of the greater cost of PRP, due to the cost of filters and PRP technology as well as preparation, it is preferable to begin with regular prolotherapy as it provides excellent results 80% of the time. Generally, people know by the second PRP Prolotherapy whether it will work or not. Overall the results have been extremely positive. It is very safe. There have been no reactions related to the solution.

When to consider PRP solution as your Prolotherapy Option:

  • Regular prolotherapy has resulted in some success, you are confident the treatment has been done properly into the appropriate areas, but the results are not optimal
  • Labral or Meniscal tears
  • Your injury is very severe or complex
  • High performance athletes who put more demand on joints
  • Out of town patients who cannot return for frequent visits
  • Persons who wish to maximize their results with a minimum number of injection visits

The PRP Hair Treatment is a non-surgical and non-invasive treatment for hair loss, and is typically done only once per year for patients with hair loss. Studies have shown hair diameters to increase via growth factors, causing hair to appear thicker and fuller. The total number of hairs in the growing phase (anagen) as well its duration, likewise appear to be positively affected to a great extent.

Micro-needling and laser therapy are utilized at White Rock Naturopathic to optimize results. Micro-needling improves natural collagen induction in dermal layers, while laser therapy is one of the most reliable methods to improve long term circulation and modify the vascularization of the scalp, thus preventing further hair loss and restoring previous hair growth, coverage, thickness, color, and health.

Prolozone therapy is an injection technique similar to prolotherapy that uses ozone. The use of ozone causes the joint to heal much more quickly than in traditional prolotherapy. This is because ozone is a highly reactive molecule and when injected into a joint capsule it is able to stimulate the repair of fibroblastic joint.

From the American Academy of Ozonotherapy website:

Prolozone® is a homeopathic/oxygen-ozone injection technique developed and pioneered by Dr. Frank Shallenberger. It is excellent for all forms of musculo-skeletal and joint pain including chronic neck and back pain, rotator cuff injuries, degenerative and arthritic hips and knees, degenerated discs, and shoulder and elbow pain. Because in many cases Prolozone actually corrects the pathology of the disorder, there is a 75% chance for the chronic pain sufferer to becoming permanently pain free.

Prolozone is a form of non-surgical ligament reconstruction and is a permanent treatment for chronic pain. Prolozone is a connective tissue injection therapy of collagen producing substances and ozone gas which can reconstruct damaged or weakened connective tissue in and around joints. These substances are injected into the damaged connective tissue in and around a joint to rebuild the damaged areas.

By repairing the connective tissue this is all that is needed to permanently reverse chronic pain.

Prolozone Therapy is an injection technique similar to Prolotherapy that uses ozone. The use of ozone causes the joint to heal much more quickly than in traditional Prolotherapy. This is because ozone is a highly reactive molecule and when injected into a joint capsule it is able to stimulate the fibroblastic joint repairing abilities.

Prolozone is derived from the word ozone and the Latin word “proli” which means to regenerate or re-build. It literally means re-building tissues with ozone. It is important to understand what the word Prolozone actually means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

Ligaments are the structural “rubber bands” that hold bones to bones in joints – acting like the body’s shock absorbers. Ligaments can become weak or injured and may not heal back to their original strength or endurance. Ligaments will also not tighten on their own to their original length once injured. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings, and therefore the person will feel pain at the areas where the ligaments are damaged or loose.

We can think of our joints as the hinge on a door. Until the hinge is fixed the door just isn’t going to open or close right and it’s the same exact story with our joints. If we are athletic or if we are just getting older there is some gradual and natural degeneration of the moving parts of the body due to ongoing recurrent mechanical stress, and failure of tissues to repair. This can come from lack of nutrients, lack of circulation, aging and inflammation. When this happens the ligaments, tendons, and cartilage become dehydrated and weaker. This results in laxity and more abnormal mechanical stress and shearing forces on the joint. Abnormal shearing forces and torsion cause more joint dysfunction. This leads to a progressive separation of the ligaments from the superficial covering on the bone called the periosteum. This pulling on the periosteum creates a space, which the body fills in with new bone. These new parts of bone are called osteophytes. They are the premier signs of degenerative arthritis in & around the joint. Osteophytes and joint laxity result in a reduced range of motion, which causes strain on surrounding muscles which then become either over or under worked leading to more dysfunction & pain.

What does the Ozone do?

Ozone stimulates circulation and increases energy production in cells by increasing oxygen utilization. It breaks down into peroxides, which have been shown to stimulate growth factors, so stem cells and blast cells get what they need to reproduce/proliferate. Circulation and cell membrane stability improve, and tissues are able to heal.

Prolozone causes repair and tightening of the lax structures, partially torn connective tissue and ligaments. Prolozone halts the pain/inflammation cycle. This allows for better circulation, increased blood flow carrying nutrition, and hydration of the damaged tissues. This allows for a healing environment within the joint to develop and results in increased range of motion and decreased pain.

Prolozone works by providing energy-producing oxygen to the innermost parts of your joint. This is where ozone, which I call the miracle healer, does its magic. Ozone is a powerful stimulant of cellular growth factors, such as Transforming Growth Factor Beta (TGF-B). This powerful cytokine activates cartilage cells to produce matrix proteins necessary for the body to make the white cartilage substance.

TGF-B improves matrix protein arrangement. It protects the surface of the cartilage. It modulates the activity of enzymes that dissolve other proteins and compounds that are involved with inflammation. That’s a 1-2-3 punch for healing. Injecting ozone in or around the joint stimulates tissue regeneration, a build up of antioxidant enzymes and a reduction in inflammation. Can it actually regenerate your cartilage? Post treatment knee X-rays that show a definite increase in cartilage thickness confirm that it does in fact regenerate cartilage.

Ozone reacts almost instantly with the membranes of the cells it contacts. The oxidation of the membrane jump starts the cells. Immune cells are particularly responsive to ozone. They will produce a cascade of powerful healing chemicals called cytokines. These are the very short proteins immune cells use to talk with each other. Immune cells not only provide protection against infection, they also clean up debris and modulate inflammation.

What is the difference between Prolozone vs Prolotherapy?

Prolozone uses oxygen to promote healing.
Prolotherapy uses inflammation to induce fibroblast hypertrophy and growth (strengthens ligaments.)

Prolozone has very little to no pain and people may be pain free faster. It is less expensive because it works quickly.
Prolotherapy can be painful, and takes longer for healing to be complete.

Prolozone can be effective in regenerating the cartilage in damaged knees and hips in preliminary observations.
Prolotherapy is helpful for ligament/tendon laxity. (Prolozone may help with this as well)

Ozone Therapy works to stimulate regeneration of damaged connective tissues. The fibroblast cells that produce connective tissue to replace injured tendons and ligaments sometimes need to be stimulated to do their job. Micro-Dosing (Ozone Acupuncture) uses a  technique of injecting small doses of ozone subcutaneously (under the skin) in areas of injury or in areas related to injuries, to stimulate connective tissue regeneration.

Hyaluronic acid injections (Durolane or Synvisc), also known as viscosupplementation injections, are used for the treatment of knee, hip, shoulder, elbow and ankle osteoarthritis. Hyaluronic acid is a naturally occurring molecule that is normally present in healthy cartilage. In unhealthy or arthritic cartilage, the levels of hyaluronic acids are lower. These injections can help control pain, provide lubrication, and replace hyaluronic acid in the joint. The injection also stimulates your joint to make more of this important molecule. These injections can successfully improve symptoms in three quarters of patients (75%). The benefit of these injections is temporary and typically lasts from 2 – 6 months. Hyaluronic Acid injections work best in mild to moderate arthritis.

The potential benefits of DUROLANE for osteoarthritis (OA) sufferers include:

  • Directly treats the affected joint
  • Repeatable as required
  • May help to avoid or delay hip or knee replacement surgery
  • Long-term freedom from knee & hip pain
  • Simple & quick to administer
  • Drug-free alternative to pills

DUROLANE has been developed specifically to treat the symptoms of osteoarthritis in the knee and hip. It works by restoring the lubricating and shock-absorbing properties of joint fluid, which are depleted in osteoarthritis.