PROLOTHERAPY AND CHRONIC BACK PAIN

By Regenexx at New Regeneration Orthopedics

What is Prolotherapy?
Prolotherapy is a cutting edge form of medical technology also termed “Regenerative Medicine.” These types of procedures are designed to improve acute or chronic injuries ranging from: ankle sprains, knee osteoarthritis, hip pain, low back pain, radicular disc pain in the neck or back, and shoulder injuries, to name a few.

Prolotherapy is a general name that can suggest several different types of injections that are intended to promote healing within the body. Even though Prolotherapy is a specific type of injection often referred to in isolation (more on that as you read on), serves as the most commonly-used blanket term for all regenerative injections, and is based on the presumed “proliferative” effects these injected materials have on acute and chronically injured tissue.

Some other terms that have popped up in the lexicon associated with Prolotherapy or Regenerative Medicine include:
• Platelet-rich plasma (PRP) therapy
• Regenerative injection therapy
• Sclerotherapy
• Nonsurgical ligament reconstruction

What Does Prolotherapy Do?
Prolotherapy is defined as an:
Injection-based procedure designed to help resolve any injury, tearing, chronic or acute pain in the tissues of the musculoskeletal system. Prolotherapy is a non-operative and non-steroidal alternative to help with orthopedic pains in the tissues and/or joints that may not be responding to conservative care, other natural remedies, and/or medications.

How prolotherapy works is by stimulating an intentional and mild inflammatory response in a targeted area that needs repair. So, although the term inflammation usually has a negative connotation associated with it, causing us to think of injury or pain, inflammation is actually the body’s inherent mechanism designed to stimulate repair. Even in the case of an acute sprained ankle, the body’s inflammatory response is an attempt to repair the injured tissue.

Now, in the case of acute injury, like the ankle sprain example, the inflammatory response is a generalized inflammatory response. Conversely, a prolotherapy treatment is targeted injection since the physicians at Regenexx at New Regeneration Orthopedics use a combination of ultrasound and fluoroscopic guidance to place the prolotherapy substance precisely into the damaged area. In a targeted injection, the needle is guided with precision to the area of injury with the help of imaging so the procedure is as specific as possible.

Prolotherapy in these cases can refer to a spectrum of substances, including ones that originate from outside of the patient, e.g. dextrose or saline. Prolotherapy injections with dextrose and saline stimulate the mild inflammatory response as described above, but a more modern gold-standard of the “proliferative” prolotherapy injections includes substances derived from the patient being treated.

Platelet-Rich Plasma (PRP) is a great example of this and is a super-concentrated dose of platelets isolated from the patient’s blood. The PRP has a little extra as compared to the dextrose/saline versions of prolotherapy because it includes biochemical substances like cytokines and growth factors that give a boost to the proliferation of new, healthy tissues.

Further, another version of prolotherapy is called Bone Marrow Concentrate (BMAC), and is derived from the patient’s bone marrow. This patient-derived substance is the most-potent version of prolotherapy because it contains cytokines and growth factors, but also pluripotent cells that can be signaled by the body to even more effectively repair the area being treated.

How Can Prolotherapy Help Chronic Low Back Pain?
The list of people who are candidates for medicine injections is long and includes (but isn’t limited to) those suffering with:
• Acute or Chronic Neck and Back pain
• Shoulder pain
• Rotator Cuff Injuries
• Shoulder Impingement
• Achilles tendonitis
• Plantar fasciitis
• Ankle Sprains
• Knee pain
• Meniscus Pain
• Bursitis
• Chronic Ligament Sprains with instability
• Elbow Pain and tendinosis
• Degenerative Cartilage
• Those who take NSAIDs regularly to manage pain
• Those who have been doing physical therapy without significant reduction in pain or symptoms.
• Those wanting to decrease any musculoskeletal pain while also avoiding surgery.

From this expansive list, we wanted to zoom in on the benefits prolotherapy can provide chronic low back pain, specifically. The back is a very complex network of bones, tendons, ligaments, nerves and muscles. The anatomy of our back is very complex because it is our base of support structurally, as well as from where all force is transmitted outward from our core to our limbs.

Based on the veritable cornerstone our spine is for every movement we perform, it also is vulnerable to repetitive stress. The repetitive stress on our backs makes back pain one of the leading health care costs annual in the US.

At Regenexx at New Regeneration Orthopedics, back pain is a very common area of concern we treat with prolotherapy. Here you can visit our Regenexx Physician Network Registry of data demonstrating patient-reported outcomes from receiving some version of prolotherapy in the spine.

Prolotherapy can be used to treat many components of the spinal complex. The areas commonly treated include:
• The ligaments in the spine to support the overall spinal stability.
• The discs between the vertebrae of the spine.
• The nerves exiting between each of the spinal segments.

These areas, if treated, bring our patients tremendous relief because the targeted injections can decrease chronic inflammation, decrease instability, and improve strength.

The Takeaway
Prolotherapy is an industry-standard term referring to any injection-based procedure designed to help resolve injury, tearing, chronic or acute pain in the tissues of the musculoskeletal system. Prolotherapy is a non-operative and non-steroid alternative to help with orthopedic pains in the tissues and/or joints that may not be responding to conservative care, other natural remedies, and/or medications.

If back pain affects you or someone you love, please come in and let us perform a detailed evaluation on your spine and make our best clinical recommendation to get the results you seek.

James Leiber, D.O. – is the founder and medical director of Regenexx Tampa Bay. He is a former officer, physician, and educator in the Air Force, including personal physician to the vice president and president at the White House. He is triple board certified in Neuromusculoskeletal Medicine (AOBNMM), Pain Medicine (CAQPM), and Family Medicine (ABFM), as well registered in Musculoskeletal Sonography (RMSK).In 2012, Dr. Leiber was the first to offer Regenexx in Florida and began offering the nation’s most advanced non-surgical stem cell and platelet treatments (PRP) for injuries and arthritis under image guidance utilizing ultrasound and fluoroscopy (X-ray).

Ronald Torrance II, D.O., FAOASM – Fellowed in Sports Medicine and co-author of Exercise 2.0 for Regenexx and author of the 2018 best paper of the year on The Concussed Athlete. Dr. Torrance has achieved semi-professional ranking as a beach volleyball player and trains as a competitive CrossFit athlete. Dr. Torrance spends time with his wife and two children as well as lecturing and instructing throughout the country.

Ignatios Papas, D.O. – Specializes in Physical Medicine and Rehabilitation. He is a research collaborator with Columbia and Cornell University on multiple projects. Dr. Papas enjoys spending time with his wife and son, playing soccer, practicing guitar, and listening to historical podcasts.

Lisa Valastro, D.O. – Specializes in Physical Medicine and Rehabilitation with a focus on regenerative medicine via orthobiologics. She received her medical degree from Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania, and her Physical Medicine and Rehabilitation training at Albany Medical Center in Albany, New York. In her spare time, she enjoys hiking, kayaking, weight lifting and volleyball.

Regenexx at New Regeneration Orthopedics:
813-296-2614

2401 University Parkway, Sarasota

8600 Hidden River Parkway, Tampa

100 2nd Avenue South, St. Petersburg

1412 Trovillion Avenue, Winter Park