Platelet Rich Plasma (PRP) and Prolotherapy Injections are new age treatments for old age pains.
Platelet Rich Plasma (PRP) and Prolotherapy are injections in and around joints that cause accelerated repair from an acute injury or chronic wear and tear.
The most common injury is a strain or tear of a ligament or tendon. This connective tissue has a limited blood supply, and so it heals slowly and in many cases incompletely. 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.
To understand how PRP and Prolotherapy work, we have to go back to the root cause of most pain. 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, with 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 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 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 local 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.
Trigger points are also known as “knots”. These are tense ball like structures within the length of muscles. They are easily palpated and cause more intense pain when isolated or pressed upon, than normal tissue above or below the trigger point. Trigger points can also cause pain which can be relieved through acupuncture and injections of lidocaine, a local anesthetic.
The third common cause of joint pain is dryness. We fail to recognize 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. As the ligaments and joints are hydrated from the inside out, mobility can improve and pain reduce.
When we treat ligament and tendon damage, reduce trigger point activity, and improve joint hydration, pain departs, function returns, and the quality of life is enhanced. There is no need to endure chronic pain. This can be particularly helpful for those who may require surgery, but have to wait years before qualifying, for a complete joint replacement.
