What Is Prolotherapy?
“Gateway drug for regenerative autologous ortho-biologics (stem cells and PRP)”
“Prolo” is shorthand for proliferative therapy. Its origins can be traced as far back as the ancient Egyptians and Hippocrates when they used cauterization to induce scaring for laxity. Modern-day prolotherapy was first described for orthopedic use in 1930 when an orthopedic surgeon injured his thumb and was told his surgical career was over. Dr. Earl Gedney DO sought an alternative therapy that was used for abdominal hernia via using an irritating substance. Dr, Gedney later published the first article, “The Hypermobile Joint” published in 1937 – and termed the treatment “sclerotherapy.”
Prolotherapy was named by Dr. Hackett in the 1950s when he published a series of articles describing injection techniques for various musculoskeletal injuries such as ligamentous laxity and enthesiopathy. In short, Prolotherapy is the injection of an irritating solution that stimulates an inflammatory response, producing a localized healing stimulus. Early injectates used were sodium morrhuate and various concentrations of hypertonic dextrose.
Neural-Prolo
Neural-Prolo, is also known as Neurofascial Prolotherapy (NPT). Born from traditional prolo-therapy, Neural-Prolo is described as: Subcutaneous peri-neural injection of 5% dextrose. It was created by a New Zealand physician, Dr. John Lyftogt while he was treating a series of Achilles tendon injuries. Similar to how traditional prolotherapy helps strengthen loose ligaments and damaged tendons, Dr. Lyftogt discovered that a low concentration of dextrose (5%) in the subcutaneous tissue can help in resolving chronic nerve inflammation and restoring the normal physiology of the nerve cell.
Neuritis is also thought to be a contributing factor to chronic pain syndromes and why sometimes the pain continues even after the tissue has healed! Nerves are the central processor of our bodies and our bodies respond one way or the other based on what the nerves are telling it to do.
Neuritis can create a vicious cycle of inflammation: inflammation neuritis messes with the regular flow of impulses, switching direction of nerve impulses in the wrong direction and cause confusion! These are transmitted vià blood vessels in nerves and surrounding tissues stimulating a release of excess neurohumoral mediator substance (the nerves are over-reacting as in panic) which cause a neurovascular vasdilation-edema-sterile inflammation neuritis.
When Do We Use Neural-Prolo?
NPT is a great treatment option that is typically used in conjunction with other Ortho-biologics. A good example of this is a knee injury to an ACL or MCL, which creates local tissue edema and intra-ligamentous neuritis. As an adjunct therapy, we can utilize Neural-prolo at the same time as treating the underlying issue such as sprain in other ligaments to address the original injury and subsequent neuritis that resulted from the injury. We can also use it as a solo treatment, for example, post-operative pain after an invasive surgery often creates chronic neuritis and the patient continues with pain – this is a good time to use NPT as a solo therapy to help calm the nerves down to allow for pain reduction.
Upside
Baxter’s Neuropathy
It is an entrapment syndrome, like carpal tunnel syndrome in your hand. This is an entrapment of a nerve in your foot, right around your heel, on the inside part compressing a branch of your tibial nerve called your inferior calcaneal nerve, and that is the Baxter’s nerve. Now, the inferior calcaneal nerve is the first branch of the lateral plantar nerve, which is a branch off your tibial nerve. It lives between a muscle belly called your abductor hallucis muscle, as well as the medial calcaneal tuberosity, which is a small bump where a common heel spur occurs in the foot.
Read More About Baxter’s NeuropathyGuyon’s Canal
Guyon canal syndrome is a condition caused by the compression of the ulnar nerve as it passes through the Guyon canal, a narrow passageway located on the palm side of the wrist. This syndrome is commonly seen in people who perform repetitive tasks with their hands or use tools that vibrate, such as jackhammers or drills. Other causes of Guyon canal syndrome may include trauma or injury to the wrist, arthritis, or tumors. Treatment for Guyon canal syndrome may include immobilization of the wrist, anti-inflammatory medications, physical therapy, or– in severe cases– surgery. If left untreated, Guyon canal syndrome can lead to permanent nerve damage, muscle weakness, and loss of function in the affected hand and wrist.
Read More About Guyon’s CanalMCL tear
The medial collateral ligament AKA MCL is a thick, strong band of connective tissue on the inside portion of your knee. It connects the top part of the tibia (shin) to the bottom part of the femur (thigh). This is a vital ligament that works along the lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL) to bring stability, structure, and movement to the knee. The MCL provides support and stability for the inside (medial) aspect of the knee. MCL tears are a common injury in sports such as football, hockey, and skiing. The ligament can…
Read More About MCL tearPCL Tear
The Posterior Cruciate Ligament (PCL) is a paired ligament in the middle of the knee. It is made up of two separate bundles: ALB (anterior lateral bundle) and PMB (posterior medial bundle). These bundles work synergistically to provide stability. The PCL plays an important stabilizing role in the knee joint by resisting excessive posterior translation of the tibia relative to the femur. Between 90 and 120 degrees of knee flexion, it serves as secondary support for preventing excessive rotation. PCL tears happen when force is applied beyond what the PCL tensile strength is capable of resisting. The tensile strength of the PCL is well documented…
Read More About PCL TearThoracic Radiculopathy
Thoracic radiculopathy is a painful medical condition that affects both men and women alike. Pain, paresthesia, decreased sensation, and weakness are the major symptoms. Radiculopathy refers to the whole complex of symptoms that can be caused by irritation or compression of a nerve root in the spine. Thoracic radiculopathy is irritation or compression of a thoracic spinal nerve. Causes of radiculopathy in the thoracic region are thoracic disc injuries, thoracic facet arthritis, ligament thickening, facet cyst, unstable rib attachments, and bone spurs. Diagnosis of thoracic radiculopathy can be difficult….
Read More About Thoracic RadiculopathyAt the Centeno Schultz Clinic, our physicians are armed with years of expertise in musculoskeletal medicine. We know that no 2 patients are alike! We take the time to examine, listen and understand your unique injury or condition to develop a comprehensive personal treatment plan designed to get you back to living your best life!
Doctors That Provide Neuro-Prolotherapy
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
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John Schultz, MD
John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…
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John Pitts, M.D.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
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Jason Markle, D.O.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
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Brandon T. Money, D.O., M.S.
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
Read moreReferences
- Alderman D. A history of the American College of Osteopathic Sclerotherapeutic Pain Management, the oldest prolotherapy organization. J Prolotherapy. 2009;1(4):200-204.
- Gedney E. Special technic: hypermobile joint: a preliminary report. Osteopathic Prof. 1937;9:30-31
- Hackett GS. Ligament Uninhibited reversible antidromic vasdilation in brochiogenic pathophysiologic disease. Lancet. 1966;86:398-404.
- Hackett GS. Ligament relaxation and osteoarthritis, loose jointed versus close jointed. Rheumatism. 1959;15:28-33.
- Hackett GS, Huang TC, Raftery A. Prolotherapy for Headache. Pain in the Head and Neck and Neuritis. Headache. 1962;3-11.
- Hackett GS, Huang TC. Prolotherapy for sciatica from weak pelvic ligaments and bone dystrophy. Clinical Medicine. 1961; 8:2301-2316.
- Hackett GS. Uninhibited reversible antidromic vasdilation in pathophysiologic diseases: arteriosclerosis, carcinogenesis, neuritis and osteoporosis. Angiology. 1966;17, 2-8.
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