For those doctors using ESWT, I wonder if adding 10% dextrose to the lidocaine injection will help....
Dr. Julian Whitaker (a popular alternative medicine doctor with a newsletter, books, and products) has endorsed and is using prolotherapy. A search revealed only two heelspurs.com visitors that have tried it (neither reported success). But I think it has merit. Osteopaths are using it. Dr Koop also supports it.
Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated.
prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.
(Published 2/26/99) prolotherapy has been around a long time but isn't widely known or accepted. It's based on the theory that in a significant number of patients, pain is caused by ligament dysfunction. Treatment involves injections of dextrose and sodium morrhuate -- extracted from shark liver -- or dextrose, glycerin and phenol into ligaments to promote new growth of fibrous tissue that might improve the attachment of the ligaments and tendons to bone. Sodium morrhuate and phenol are both tissue irritants, but proponents claim the injections trigger the growth of new, healthy tissue to stabilize bones and joints, thus relieving musculoskeletal pain and stiffness.
Advocates say that expert needle placement is vital to the safety of the procedure but insist that when performed by a well-trained clinician, the technique is safe and effective and can relieve pain arising from a wide variety of musculoskeletal conditions, from degenerative arthritis to carpal tunnel syndrome to jaw (TMJ) and chronic back pain.
From another website:
WHAT IS prolotherapy?
prolotherapy, also known and reconstructive therapy, is a permanent treatment for chronic pain. It involves injections of ligaments and tendons, considered to be the source of chronic musculoskeletal pain. The most common solution used is composed of Dextrose (sugar water) and lidocaine (anesthetic). After each series of injections a controlled reaction occurs, that causes the laying down of collagen. It is collagen that gives ligaments and tendons the necessary strength to endure the stress loads of every day life.
Reconstruction thus uses the body's natural healing process to releive pain, strengthen injured tissues and restore function. It is important to emphasize that prolotherapy is not a pain treatment -it's a strenghtening treatment that leads to reduced pain!
HOW DOES IT WORK?
Ligaments hold bones together at the joints, while tendons, being somewhat like ligaments in structure, hold muscles to bones. Due to injury or repeated use, the ligaments and tendons may become torn, stretched or loose, which causes pain, lack of endurance, loss of strength and perhaps arthritis. Contrary to popular belief, arthritis is the body's way of attempting to strengthen a joint. With prolotherapy, solutions like dextrose or a derivative of cod liver oil are injected into the lax or torn areas causing healing cells to migrate to the weakened area and create new, strengthened tissues. Studies have shown that the ligament that regrows is 30-40% stronger than the previous ligament and this is permanent.
We start with a thorough diagnosis of the patient's problem and an orthopedic, neurological and Osteopathic musculoskeletal exam accompanied with appropriate X-ray, MRI and laboratory studies if needed. Then a series of injections are given generally every 2-4 weeks for approximately 4 to 6 treatments. It takes about 6 weeks before a new ligament grows although sometimes a new ligament will grow earlier than that. As with any invasive procedure, there are risks associated with it. Even though the percentage is small, there are risks of infection, bleeding or hemorrhage.
Medline returned 6 hits, 2 had abstracts:
TITLE: Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy.
AUTHORS: Reeves KD; Hassanein K
AUTHOR AFFILIATION: Meadowbrook Rehabilitation Hospital, Gardner, Kansas, USA. email@example.com
SOURCE: J Altern Complement Med 2000 Aug;6(4):311-20.
[Record as supplied by publisher]
CITATION IDS: PMID: 10976977 UI: 20431489
ABSTRACT: OBJECTIVES: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints. DESIGN: Prospective randomized double-blind placebo-controlled trial. SETTINGS/LOCATION: Outpatient physical medicine clinic. SUBJECTS: Six months of pain history was required in each joint studied as well as one of the following: grade 2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were eligible. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls. INTERVENTION: One half milliliter (0.5 mL) of either 10% dextrose and 0.075% xylocaine in bacteriostatic water (active solution) or 0.075% xylocaine in bacteriostatic water (control solution) was injected on medial and lateral aspects of each affected joint. This was done at 0, 2, and 4 months with assessment at 6 months after first injection. OUTCOME MEASURES: One-hundred millimeter (100 mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint movement and pain with grip, and goniometrically-measured joint flexion. RESULTS: Pain at rest and with grip improved more in the dextrose group but not significantly. Improvement in pain with movement of fingers improved significantly more in the dextrose group (42% versus 15% with a p value of .027). Flexion range of motion improved more in the dextrose group (p = .003). Side effects were minimal. CONCLUSION: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.
TITLE: Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.
AUTHORS: Reeves KD; Hassanein K
AUTHOR AFFILIATION: Bethany Medical Center, Kansas City, Kan., USA.
SOURCE: Altern Ther Health Med 2000 Mar;6(2):68-74, 77-80.
CITATION IDS: PMID: 10710805 UI: 20176140
ABSTRACT: CONTEXT: Use of prolotherapy (injection of growth factors or growth factor stimulators). OBJECTIVE: Determine the effects of dextrose prolotherapy on knee osteoarthritis with or without anterior cruciate ligament (ACL) laxity. DESIGN: Prospective randomized double-blind placebo-controlled trial. SETTING: Outpatient physical medicine clinic. PATIENTS OR OTHER PARTICIPANTS: Six months or more of pain along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage radiographically in at least 1 compartment. INTERVENTION: Three bimonthly injections of 9 cc of either 10% dextrose and .075% lidocaine in bacteriostatic water (active solution) versus an identical control solution absent 10% dextrose. The dextrose-treated joints then received 3 further bimonthly injections of 10% dextrose in open-label fashion. MAIN OUTCOME MEASURES: Visual analogue scale for pain and swelling, frequency of leg buckling, goniometrically measured flexion, radiographic measures of joint narrowing and osteophytosis, and KT1000-measured anterior displacement difference (ADD). RESULTS: All knees: Hotelling multivariate analysis of paired observations between 0 and 6 months for pain, swelling, buckling episodes, and knee flexion range revealed significantly more benefit from the dextrose injection (P = .015). By 12 months (6 injections) the dextrose-treated knees improved in pain (44% decrease), swelling complaints (63% decrease), knee buckling frequency (85% decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic readings of 0- and 12-month films revealed stability of all radiographic variables except for 2 variables which improved with statistical significance. (Lateral patellofemoral cartilage thickness [P = .019] and distal femur width in mm [P = .021]. Knees with ACL laxity: 6-month (3 injection) data revealed no significant improvement. However, Hotelling multivariate analysis of paired values at 0 and 12 months for pain, swelling, joint flexion, and joint laxity in the dextrose-treated knees, revealed a statistically significant improvement (P = .021). Individual paired t tests indicated that blinded measurement of goniometric knee flexion range improved by 12.8 degrees (P = .005), and ADD improved by 57% (P = .025). Eight out of 13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion of 1 year. CONCLUSION: prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1-year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritis severity. ACL laxity, when present in these osteoarthritic patients, improved.
Other articles use higher concentrations (0.2% to 0.5%) of lidocaine but "pepper" injections only 0.1 to 1.0 ml at each point along a ligament. 10% dextrose seems to be the standard. This requires sedation because of the number of injections.
A list of doctors using it can be found at http://www.sonic.net/~nexus/listdocs.html
or you might find more by paying $20 at http://www.sonic.net/~nexus/ordtmp.html
prolotherapy.com has some research articles on it.
Here are some more:
Tammy Geurkink-Born, D.O.
Born Prevention Health Care Clinic, P.C.
3700 52nd Street Se
Grand Rapids, MI 49512 USA
Phone: (616) 656-3700
Type of Practitioner: Family practice, D.O.s
Type of Treatments: Chelation therapy, acupuncture, anti-aging, laser surgery, allergies, cellulite therapy, gynecology, prolotherapy.
Hemwall Family Medical Center
1740 Broadview Dr.
Glendale, CA 91208
Dr. Donna Alderman, Medical Director
San Francisco: 415-566-1000
A practitioner near you: 1-800-992-2063 or 302-996-0300