PROLOTHERA PY
Sagiv Ben-Yakir DVM, MRCVS, BSc
The Academic College at Wingate Institute, ISRAEL
Netanya, ISRAEL
Prolotherapy is defined by Webster’s Third New International Dictionary as “the rehabilitation of incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells”, that is done for the purpo of strengthening weakened connective tissue and alleviating musculoskeletal pain. The term derived from the word prolo short for proliferation, as the therapy is intended to proliferate tissue growth in the damaged area.
Prolotherapy is also called "proliferation therapy" and "regenerative injection therapy” (RIT). Prolotherapy can be distinguished from sclerotherapy, the u of injections of caustics into the veins, in vascular surgery and dermatology, to remove varico veins and other vascular irregularities.
In prolotherapy we inject solutions into the area where connective tissue has been weakened or damaged through injury or strain. Many solutions are ud, including dextro, lidocaine, combination
of both, animal own blood, added growth factors, phenol, glycerine, sodium morrhuate etc.
The injection is given into joint capsules or where tendon connects to bone. Many points may require injection. The Injected solution caus the body to heal itlf through the process of inflammation and repair. In the ca of weakened or torn connective tissue, induced inflammation and relea of growth factor at the site of injury may result in 40% strengthening of the attachment points.
Prolotherapy treatment ssions are generally given every two to six weeks. Many patients receive treatment at less and less frequent intervals until treatments are required only every veral years, if at all. Prolotherapy is often ud as an alternative to an invasive and expensive surgery, and it is done at in-clinic & on out-patient status.
The Injections of irritant solutions were performed in the late 1800’s to repair hernias and in the early 1900’s for jaw pain due to temporomandibular joint laxity. Dr. George S. Hackett, MD developed the technique of prolotherapy in the 1940’s. He claimed in his book “Ligaments and tendons relaxation treated by prolotherapy” (1958) that he cured 90% of 656 patients. At the time he ud as an injection solution fatty acids mixture to induce inflammatory reaction, nowadays we are using a simple dextro solution diluted with local anesthetic as lidocaine to achieve the same results withou
t the possible risks (e.g. shock). Dr. Hackett found that the injected tendons incread in diameter by 40% after prolotherapy, and histological exams showed no destruction of nerves or blood vesls and no scarring, which is a chaotic matrix of collagen fibers. The ligaments and tendons produced after prolotherapy appear much the same as normal tissue, except that they are thicker, stronger, and contain fibers of varying thickness with normal histological organization. There is an increa in collagen producing fibroblasts, the ligaments orientation and internal organization is linear.
Dr. Gustav A. Hemwall, M.D. is one of the most famous Hacketts’ students, beginning his studies and treatments in the 1950s and continuing until the mid 1990s. In his study of almost 10,000 cas he found from 75%-90% successful results, and some of them for longstanding problems that have been resistant to other treatments.
If one is wondering what might happen in years to come with complementary and alternative veterinary medicine – the following story has a point of is interest – Dr. Everett Koop, M.D. USA Surgeon General had a vere pain followed by almost a complete paralysis of his right hand during 1980’. Since no therapy solved his condition, he approached Dr. Hemwall. Dr. Hemwall treated Dr. Koop by prolotherapy injections into his neck, and the medical issue was solved in a short time successfully. Dr. Koop studied more about the prolotherapy methods, endord it, and nowadays pro
lotherapy is considered as sub-speciality of the American Association of Orthopedic Medicine.
There are different solutions that can be injected in prolotherapy:
Osmotic proliferants that by their higher osmotic pressure induce the process of inflammation and healing. e.g dextro which is water-soluble and does not stored in the body but excreted out.
Irritants are substances that alter the surface of the cells and induce the process – e.g. phenol.
Particulates as pumic flour or animal own blood attract macrophages and induce the process
of prolotherapy.
Chemotactics directlyt attract immune system cells to the area as sodium morrhuate.
Growth factors.
Prolotherapy mechanism of action: the mechanism of action is complex and multifaceted.
Six identified components include:
大年夜1) The mechanical tranction of cells and matrix induced by the needle, c aus cellular
damage, stimulating an inflammatory cascade.
2) Compression of cells by the extracellular volume of the injected solution stimulates
intracellular growth factors.
痛快日记3) Chemomodulation of collagen through inflammatory proliferative, regenerative/reparative
respons induced by the chemical properties of the proliferants and mediated by cytokines
and multiple growth factors.
4) Chemoneuromodulation of peripheral nociceptors and antidromic, orthodromic,
sympathetic and axon reflex transmission.
5) Modulation of local hemodynamics with changes in intraosous pressure leading to the
reduction of pain. Empirical obrvations suggest that a dextro/lidocaine combination has a
much more prolonged action than lidocaine alone.
6) A temporary repetitive stabilization of the painful hypermobile joints, induced by the
inflammatory respon to the proliferants, provides a better environment for regeneration and
repair of affected ligaments and tendons.
E x a m p l e s o f s o m e s p e c i f i c v e t e r i n a r y c l i n i c a l c o n d i t i o n s t o b e t r e a t e d w i t h p r o l o t h e r a p y
Cruciates laxity or partial/complete rupture
Patellar sub-luxation
Atlantoaxial subluxation
Cervical Vertebral Instability (CVI)
Osteochondrosis discans (OCD)
Stifle collateral lig’ injury
Carpal/tarsal laxity of ligaments
最短的季节打一成语
TMJ luxation
Sacro-iliac subluxation
Recurent Shoulder/elbow/carpal disluxations
C o n t r a i n d i c a t i o n s:
Neoplastic lesions involving the near-by musculature and osous structures
Acute non-reduced subluxations or dislocations
Acute arthritis (ptic or post-traumatic)
Acute bursitis or tendonitis
Allergy to anesthetic or proliferant solutions or their ingredients such as dextro, sodium
morrhuate or phenol
A d v e r s e e f f e c t s+p r e v e n t a t i v e m e a s u r e s
Infection - do proper preparation
Pain - do Lidocaine in the injected solution, cold packs +/- NSAIDS as needed
Stiffness – physical therapy
Nerves/Blood vesls – know your anatomy
二月是什么星座In our practice:
Evaluate the clinical ca at hand
潇洒的走歌词Review the anatomy老夏和翠娥
Prepare the solution to be injected – 15% final concentration of 1 ml of
Lidocaine 2% without epinephrine, 3 ml of D-50 (Dextro 50%), 6 ml of sterile water
Shave the area to be injected, scrub it with Septal Scrub (4% Chlorhexidine), wash it with
70% alcohol, and finish up with application of P.V.P Iodine 10%
U 27\30 g needles 1 ½’ length & inject many small drops rather than large amounts
In some active animals : light dation or short acting anesthesia might be required
Quantity: 0.1-0.5 ml in small animal (cat) or small joint (carpus), up to 2-5 ml in large dog or
large joint (knee), 5-10 ml in hor (sacro-iliac joint)
Frequency: once every two wks at least for 4 ssions, then – re-evaluate
NSAIDS: on-off for the first few wks(?), as inflammation is what we are looking for (NO
steroids!)
Veterinary Low Level Lar Therapy (VLLLT) – bid for 6-8 minutes at lesion site for as long as you treat the ca
Improvement: usually after a few wks (rarely after 2 wks)
中小学生教师Physical activities: are allowed – but no jumping; do manual therapy 2-3 times/day/first few weeks
For the vere cas – add animal own blood (3 cc instead of the water)
In some animals “a tune-up” injection is needed after 6 months or 12 months.
Indications for Veterinary Prolotherapy?
Chronic pain from ligaments or tendons condary to sprains or strains.
Pain from overu or occupational conditions (e.g. dog/hor racing) known as "Repetitive Motion Disorders".
Chronic postural pain of the cervical, thoracic, lumbar and lumbosacral regions.
Painful recurrent somatic dysfunctions condary to ligament laxity that improves temporarily with manipulation.
Painful hypermobility and subluxation at given peripheral or spinal articulation(s) or mobile gment(s) accompanied by a restricted range of motio n at reciprocal gment(s).
Thoracic and lumbar vertebral compression fractures with a wedge deformity that exert additional stress on the posterior ligamento-tendinous complex.
Recurrent painful subluxations of ribs at the costotransver, costovertebral and/or costosternal articulations.
Osteoarthritis of axial and peripheral joints, spondylosis, spondylolysis and spondylolisthesis. Painful cervical, thoracic, lumbar, lumbosacral and sacroiliac instability condary to ligament laxity.
Intolerance to NSAIDs, steroids or opiates. Prolotherapy may be the treatment of choice if the patient fails to improve after physical therapy, chiropractic or osteopathic manipulations, steroid injections or radiofrequency denervation, or surgical interventions in the aforementioned conditions, or if such modalities are contraindicated.
Syndromes and diagnostic entities, caud by ligaments and tendon pathology that have been successfully treated with prolotherapy:
Cervicocranial Syndrome (cervicogenic pain, condary to ligament sprain and laxity, atlanto-axial and atlanto-occipital joint sprains, mid cervical zygoapophyal sprains). Temporomandibular Pain and Muscle Dysfunction Syndrome
Torticollis
Cervical gmental dysfunctions
Cervicobrachial Syndrome (shoulder/neck pain)
Hyperextension/Hyperflexion injury Syndromes
Cervical, Thoracic and Lumbar Sprain/Strain Syndrome
Costochondritis/chondrosis
Recurrent shoulder dislocations
Lumbar instability
Lumbar Spondylolysis
Sacroiliac joint pain
网红歌手
Sacrococcygeal joint pain
Myofascial Pain Syndromes
Ankylosing Spondylitis
Shoulder, stifle, foot and ankle chronic sprain, instability, laxity of ligaments
Specific veterinary examples –
cruciates ligaments laxity or partial rupture
patellar sub-luxation/luxations
stifle collateral ligaments injury
tarsocrural luxations
other carpal and tarsal luxations
TMJ luxation
shoulder, elbow, carpal, sacro-iliac luxation
wobbler’s syndrome.
In summary – prolotherapy is a safe and effective medical method in which mildly irritating solution is injected into ligaments, tendons, or their inrtions to bones or muscles, causing
mild inflammatory respon which stimulate healing. The result is a thicker, stronger, well-organized tendon/ligaments, a less nsitive one, that decreas local and remot e structure stress. Over 75-90% of patients treated with prolotherapy get significant improvement or cure.
