PRP and Prolotherapy

By  Dr. Jason Porter - at  January 7, 2014    

What are Platelet Rich Plasma (PRP) and Prolotherapy Injections?

Platelet Rich Plasma (PRP) is concentrated platelets and leukocytes (white blood cells) derived from a patient’s own blood. The platelets and leukocytes act as growth factors that stimulate local tissue to repair when injected at sites of acute or chronic injury. Local connective tissue damage is the most significant factor contributing to chronic pain including pain in the feet, knees, hips, low back, neck, shoulders, elbows, and even the hands.

Prolotherapy is a mixture of glucose and an anesthetic, such as procaine or lidocaine, also injected at sites of connective tissue damage to stimulate growth factors. Both types of injections induce healing and repair of injured tissue, returning the tissue to its original tensile strength or better, and both can be had at our Mesa AZ location.

What is the root cause of pain?

To understand how PRP and Prolotherapy work, we have to go back to the root cause of most pain in patients. To understand the root cause of pain, we need to know a little about the anatomy of the body. The frame or structure of the body is built on and around the skeleton. The skeleton is made up of many bones that approximate one another but do not touch. One bone adheres to the next by a ligament, and this juncture is called a joint. The body is made for movement and activity. Layered over the bones and crossing the joints are hundreds of muscles that act as pulleys. The muscles attach to the bones by tendons. Ligaments and tendons are the same tissue, with slightly different functions, the ligaments providing support to the scaffolding. Overlying the muscles, of course, is connective tissue, fat, and the skin. Some joints are contained within a fluid filled capsule. The fluid-filled capsules, as we see in the knees, hips, and shoulders, provide a cushion for weight bearing joints. These fluid-filled joints allow for extreme force to be applied without having the bones contacting or rubbing on one another.

Ligaments and tendons(aka connective tissue) are often described as the glue that holds all things together. Though this glue is living and has a blood supply, two obvious risks exist. One is, connective tissue is very dense, which is why it is also very strong. Due to its density, the blood supply is weakest in connective tissue compared to fat, bone, and skin. This equates to slow healing if connective tissue is damaged. It appears, for reasons we do not completely understand, that once a ligament or tendon is damaged, its recovery is limited to less than 100 percent.

Secondly, connective tissue as the glue is under constant stress whether we are active or not. The constant stress, or constant wear and tear, requires time to heal and repair. If the repair process is unable to recover from an activity or an injury, the tissue becomes weak and frayed. A rubber band can illustrate this concept well. Brand new it has elastic capabilities that restore it to its original shape when it is stretched or pulled. But stretch and pull it 1,000 times and see if it is any weaker than when we started. The joint at that moment becomes unstable. The muscles receiving proprioception from the locally damaged tissue, tighten in order to stabilize the local joint, so as not to let any further damage occur. Thus the second layer presents, sooner or later, with referred pain patterns from distal trigger points in associated muscles.

We fail to recognize in addition the normal process of aging in which everything begins to dry out. Ligaments and tendons and particularly capsule joints often just need a little rejuvenation to rebuild the normal fluids present in our youth.

The knee is an excellent example of how different forces act upon it to cause pain. The bones of the knee include the femur and the tibia. The approximate one another and are attached to the inside by ligaments called the anterior and inferior cruciate ligaments. They stabilize the knee from moving too far forward or backward. Along the medial and lateral aspects of the knee and crossing the joint from top to bottom are the collateral ligaments. These help the femur and tibia from moving too much too inside or outside. Over the ligaments, a connective tissue capsule surrounds the knee joint. Another layer called the menisci, lying inside the knee, serve as a non-liquid cushion keeping the bones from rubbing on one another.  In addition, our body creates and maintains fluid as found inside the joint.

Pain then arises when one of the following occur. First a tear in one or both of the cruciate ligaments, or menisci, strain or sprain of the lateral or medial collaterals, loss of fluid within the capsule joint, and development of trigger points as a result of unstable joints. Even when pain is difficult to isolate, joint and muscular pain are intimately connected by the joints they serve and thus are nearly always associated with one another.

Ligament and tendon damage, along with the second root cause of pain, known as trigger points, are found in under trained and even in overtrained or tight muscles. These two conditions most often coincide simultaneously to produce the localized and referred pain patterns which contribute to 80% of all chronic pain. This pain is 100% curable. The cure comes from knowing the exact injury location and the subsequently referred pain patterns that have developed because of localized tissue injury and treating accordingly.

PRP and Prolotherapy are localized injections at the site of the ligament, tendon, or capsule joints in order to restore the tissue to its original tensile length and strength, or restore the fluid within capsulated joints. As connective tissue and fluids are restored to their youthful states, pain reduces at the local site. Trigger points, which developed to stabilize the nearby joint, are allowed to release through stretching, trigger point injections, massage, and acupuncture. Pain reduces and function increases.

What is the difference between Prolotherapy and PRP?

Prolotherapy has offered non-surgical relief for chronic joint pain for over 5 decades. Long before our ability and understanding of PRP,  doctors Hemwell and Hackett discovered that glucose or sugar had the ability when injected into ligaments and tendons, to cause new growth or proliferation of new tissue. The end result after a stimulated healing was greater tensile strength in the ligaments or tendons, and a reduction in localized and even referred pain patterns.

In addition to the glucose which is used, they would add a local anesthetic such as procaine or lidocaine. These three ingredients are three of the safest ingredients to inject, with their risk profile in normal doses nearly non-existent. Over the years other ingredients have been added to enhance proliferation of new tissue, but the core formula has not changed.

Platelet Rich Plasma (PRP) is concentrated platelets and leukocytes (white blood cells) derived from a patient’s own blood. The platelets and leukocytes act as growth factors that stimulate local tissue just the same as glucose would, but with what appears to a much more enhanced response.

Many people wonder why Prolotherapy has not gained more popularity over the last 5 decades when it has become an amazing tool of regeneration. A few possible reasons exist and are worth stating in case one questions the value of Prolotherapy and its lack of becoming mainstream . The first reason is, it has never been taught in medical schools. All doctors trained have been trained in programs outside of medical school. They have carried the burden of expense and risk in something fairly unknown. Their first exposure probably came from another doctor, who had been trained, or a patient asking about prolotherapy. My first exposure was from a fellow doctor, by whom I was treated, with tremendous success.

Another reason possibly is due to the fact that it is fairly inexpensive as a procedure. The supplies required to do the procedure mainly are lidocaine, glucose, and a syringe. The majority of the cost is in the labor itself. I think most insurance companies probably were unwilling to reimburse adequately for the doctor’s time and expertise. Most doctors probably felt their patients were unwilling to pay out of pocket for these procedures. If they had only known how effective it had been, patients would have gladly pay out-of-pocket as they do now.

Although not completely understood, the lack of recognition, on the whole, from the medical community, Prolotherapy has withstood the test of time. More doctors are trained more than ever before. The techniques and experience have improved upon the delivery methods and overall success of individual treatments. Even as Prolotherapy appears to take second seat to PRP, it still stands as the first truly anti-aging and regenerative therapy available to the world. A sufficient treatment ligament or tendon of a 60-year-old is difficult to differentiate from that of a 20-year-old. Prolotherapy is likely to be viable for years to come. Even with the advent of many newer and more advanced therapies, Prolotherapy still stands as the most efficient and affordable treatment for chronic pain, and what can be said about PRP can be also said about Prolotherapy.

How exactly do PRP and Prolotherapy work?  

Platelet Rich Plasma(PRP) and Prolotherapy stimulate the bodies own bioactive proteins, also know as growth factors, to replace, repair and regenerate connective tissue. PRP differs slightly from Prolotherapy in that it delivers a concentrated dose of growth factors directly to the pain initiating site in addition. PRP is produced from a small volume of the patient’s own blood plasma, by drawing a sample of blood from the patient and removing the red blood cells and plasma. The process of extracting the PRP yields a high concentration of platelets and white blood cells that are 5-7 times normal. Tissue injury normally results in platelets collecting at the site and beginning the clotting cycle. These activated platelets release numerous growth factors that are directly responsible for tissue regeneration or healing. By increasing the concentration of these platelets, we deliver a concentrated and effective mixture of growth factors directly to the injured tissue which dramatically enhances the body’s natural healing process. Treatment with PRP or Prolotherapy leads to a more rapid, more efficient, and more thorough restoration of the tissue toward its original healthy state. In addition, the action of small needle injections create an orderly trauma resulting in additional local growth factors being excreted. The end result is a complete recovery from injury leading to the elimination of pain.

What to expect from PRP and Prolotherapy?

Platelet Rich Plasma (PRP) and Prolotherapy have been used for many decades to improve healing, reduce infection, and eliminate pain. Patients have received injections for tennis elbow, plantar fasciitis, Achilles tendonitis, rotator cuff tears, meniscal tears, osteoarthritis, knee pain, hip pain, and chronic low back and neck pain. Injections are given with a local anesthetic, using the smallest gauge needle possible, to minimize pain at the injection site. On occasion, an “achy” soreness is felt at the site of injury, just a few hours following the injection. This “soreness” is a positive sign that the healing response has been set in motion.  This effect can last for several days and gradually decreases as healing and tissue repair occurs. Often acupuncture is also performed in the local region of the injections, which improves healing response and begins to reduce pain in local tissues.

It is important that anti-inflammatory medications such as Ibuprofen, Naproxen, and Aspirin be avoided following PRP or Prolotherapy treatments.  These medicines may block the effects of the intended healing response, facilitated by the injection itself.  It is acceptable to use Tylenol and apply ice and elevation as needed.  You will be permitted to resume normal day to day activities and light exercise following injection.  We suggest that you avoid strenuous lifting or high-level exercise for at least several days after the injection.

This treatment is not a “quick fix” and is designed to promote long-term healing of the injured tissue.  The regeneration of connective tissue can continue for months and may require multiple injections.  For most cases, 1-5 injections are required at 2-4 week intervals. Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Research suggests that PRP also has an antibacterial property which protects against possible infection. Treatments are completed usually within an hour with the patient able to return to work or home without any consequences.

When should I have surgery over PRP and Prolotherapy?

The main benefit of PRP and Prolotherapy is that they provide pain relief and healing while eliminating the need for surgery or a prolonged recovery. The benefits of proliferative injection therapy include lower risks, lower costs than surgery, and can be used on patients, that are not candidates for surgery. PRP and Prolotherapy are a low-risk minimally invasive procedure. The concentrated platelet rich plasma (PRP) or Prolotherapy solutions injected into and around the point of injury, immediately start and magnify the body’s natural healing process. Recovery with PRP and Prolotherapy is much faster than with surgery. PRP and Prolotherapy should be utilized when a patient is not an absolute candidate for surgery, when pain is associated with normal wear and tear of living, and when it affects any joint particularly those joints that are weight bearing such as the feet, knees, hips, and low back, and neck. In essence have surgery when it is absolutely necessary, for everything else try PRP and Prolotherapy first.

How well known are PRP and Prolotherapy?

Prolotherapy has been in use for over 50 years and PRP in use for 20 years. Recent headlines have featured the amazing results of professional athletes experiences with PRP Therapy. Pro football players Hines Ward and Troy Polamalu of the Pittsburgh Steelers received PRP Therapy after injuries that should have sidelined them for months, but they returned to play in a matter of weeks, winning the Super Bowl.  Los Angeles Dodgers pitcher Takashi Saito received PRP Therapy for an elbow condition and returned to play in just a few months, versus up to 14 months that recovery from surgery would have taken. Unprecedented results have also been reported for other professional soccer, baseball, and football players. Although PRP Therapy is relatively new to the field of orthopedics, it has been used for more than 20 years in dentistry and has been used to promote healing, following jaw reconstruction, and for patients with cancer. Many thousands of patients have been treated with Prolotherapy successfully over the last 50 years in countries all around the world. PRP has been utilized for the last 20 years and has been proven to be an effective regenerative force.

Dr. Jason Porter

Dr. Jason Porter

Dr. Porter is a graduate of the Southwest College of Naturopathic Medicine in Arizona, and a member of the American Association of Naturopathic Physicians (AANP), the Arizona Naturopathic Medical Association (AzNMA), the Naturopathic Association of Therapeutic Injection (NATI), and the American College for the Advancement of Medicine (ACAM) where he is certified in chelation therapy. Dr. Porter is also a supervising physician at Southwest College of Naturopathic Medicine where he teaches Naturopathic Medical Students methods for treatment of chronic pain conditions and disease prevention for longevity and improvement in quality of life.

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