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Chronic pain can take your life and spirit away.   When traditional treatment options fail, patients and family members often look elsewhere.  What are Lyftogt injections?  What is the difference between Prolotherapy and Neuroprolotherapy?  Is there a better way to inject nerves and ligaments?  Let’s dig in.

What Are Lyftogt Injections?lyftogt injections

Lyftogt Injections also referred to as perineural injections (PIT) or Neuroprolotherapy are small injections utilized to treat pain (1).  The procedure itself involves multiple small, superficial injections of low dose (5%) glucose.  The injections target superficial nerves that reside immediately beneath the skin.  Lyftogt injections are not performed with ultrasound or x-ray guidance but rather are blind injections.  They are reliant on physical examination and evaluation of tissue quality to identify the areas to be injected.  The injection of low concentration of glucose is thought to reverse nerve inflammation and reset the small nerve fibers back to normal thereby alleviating the pain.  Lyftogt injections have provided significant pain relief in patients with Achilles tendinopathy (2).  Areas of maximal pain and dysfunctional tissue are marked with a pen and then injected with low dose glucose as illustrated in the adjacent image.

What Is Prolotherapy?

Prolotherapy,  developed by Dr. George Hackett, is the injection of concentrated glucose to treat chronic musculoskeletal pain.  Musculoskeletal pain is pain that arises from the bones, tendons, ligaments, and joints in the body.  Of all the musculoskeletal complaints, neck and low back pain are the most common in adults (3).  Dr. Hackett theorized that loose or damaged ligaments and tendons are the cause of musculoskeletal pain (4).  Accordingly, prolotherapy injections target loose, damaged or irritated ligaments and tendons.  The injected glucose triggers an inflammatory cycle which triggers the release of growth factors and collagen deposition.  Like Lyftogt injections, the majority of prolotherapy injections are performed blindly without ultrasound or x-ray guidance.  Prominent boney landmarks are marked on the skin as illustrated in the image.   At each of these marks, the needle is advanced through the skin until bone is contacted.  Once this occurs the glucose is injected.  Did I mention that there are multiple injections??

What Is the Difference between Prolotherapy vs Neuroprolotherapy?

There are critical differences between Neuroprolotherapy injections and Prolotherapy.

  • Neuroprolotherapy uses low dose glucose (5%) whereas a higher dose(12.5-25%) is used with prolotherapy (5).
  • Neuroprolotherapy injections are superficial whereas prolotherapy injections are deeper
  • Neuroprolotherapy targets shallow, small nerves whereas prolotherapy targets deeper ligaments and tendons

What Are the Similarities?

  • Both Neuroprolotherapy and prolotherapy are most commonly performed without ultrasound or x-ray guidance.  Target areas are identified by touch,  marked on the skin and injected blindly.

Precise Injections into Ligaments, Tendons, and Nerves

At the Centeno-Schultz Clinic, we are committed to the highest level of care. Nerve injuries can be devastating and require experience, expertise, and precision.  Nerves are simply too fragile to be injected blindly and for this reason, all injections are performed under ultrasound guidance.  Nerves can be compressed as is the case with carpal tunnel syndrome where the median nerve is compressed with resultant pain and dysfunction.  Carpal tunnel syndrome and other nerve injuries are treated with a procedure called nerve hydrodissection.  During this procedure, the affected nerve is identified under ultrasound and using an ultra-thin needle, platelets are injected around the nerve and the scar tissue is released.  Click on the video below to watch a median nerve hydrodissection.  The dark injected fluid is the concentrated growth factors from the patient’s own platelets.

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Finally, PRP is a much better treatment option than glucose as it is rich in growth factors that can increase blood flow and promote healing.  To learn more about a type of PRP called platelet lysate which is used in nerve hydrodissections please click on the video below.

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In Conclusion

Lyftogt Injections also referred to as perineural injections (PIT) or Neuroprolotherapy are small, low dose glucose injections near superficial nerves intended to reverse nerve inflammation and pain.  Prolotherapy is high dose glucose injections directed at ligaments and tendons that are thought to be loose, inflamed or damaged and responsible for pain. Both neuro prolotherapy and prolotherapy are typically performed blindly without guidance.  At the Centeno-Schultz Clinic nerves, tendons and ligaments are critical structures that warrant guidance when injected. Nerve hydrodissection is an effective, nonsurgical treatment for nerve injuries utilizing ultrasound-guided injections of a patient’s own platelets..

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1.Reeves KD, Lyftogt J Prolotherapy: Regenerative Injection Therapy. In: Waldman SD (ed): Pain. Management. Philadelphia; Saunders (Elsevier), 2nd ed; 2011:1027–44.

2.Lyftogt J. Subcutaneous prolotherapy for achilles tendinopathy: The best solution? Aust Musculoskeletal Med 2007;122:107–9.

3.National Center for Health Statistics National Health Interview Survey. 2012. [Accessed June 21, 2014].

4. Hackett GS, Hemwall GA, Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. 5th ed. Oak Park, IL: Gustav A. Hemwall; 1993.

5. . Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R. 2011;3(6 suppl 1):S78–81.

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