Aggressive Prolotherapy
LC became one of our patients following continued pain after surgical procedure. This is not uncommon, most Prolotherapy patients turn to Prolotherapy because of failed surgical procedures.
LC had already undergone two arthroscopic surgeries. His meniscus was removed in 2002, a year after the initial injury to his knee back in 2001. LC had been on prescription strength ibuprofen, (an anti-inflammatory) for 10 years, and had stopped taking them for about 7 months before he came to see us. LC reported that he has rolled his feet outward since he was a kid. Synvisc and cortisone shots were offered but LC was looking for a more permanent solution. LC is an ER male nurse and on his feet for 12 or more hours per day. Being the father of two yound children and a history of fighting extreme obesity as a child made LC a dedicated exerciser. So when his chronic pain caused him to gain more than 40 pounds in two months time he began having physical difficulties. He could not even go up the stairs to get to his workout room in his house. He could no longer keep up with his two young children. He was determined to become pain-free and healthy again. He made a goal to go back to his passion: hockey. This led him to Caring Medical and Dr. Ross Hauser. Bone Marrow Prolotherapy (BMP).
On physical examination audible crepitation (clicking) whenever he moved his knee was observed. This led Dr. Hauser to determine that the cartilage was severely degenerated, and LC was given the diagnosis of chondromalacia patella which was confirmed by his surgery report as well. His cartilage would have to be re-grown. Because of this, Dr. Hauser added human growth hormone (HGH) as well as testosterone and extra procaine to the standard dextrose-based Prolotherapy solution. Dr. Hauser may add hormones to the solution to speed up the healing process of the articular cartilage behind the knee cap. LC received 40 cc of dextrose based solution in 30 separate injections.
LC was looking to advance his improvement in his knee function even further, so Dr. Hauser recommended direct bone marrow Prolotherapy. This procedure may sound painful, but be assured, we numb the area and the patients report that they feel little pain. BMP involves drilling into the tibia and extracting bone marrow to obtain stem cells for injection into the damaged joint.
Bone marrow contains stem cells that can turn into any kind of cell the body needs. In this case, the bone marrow was not centrifuged or concentrated. We used what is called “direct bone marrow Prolotherapy”. When the bone marrow is injected into the injury, the body knows what part of the body is injured, and makes the cells needed to fix it. We injected 10 cc of the bone marrow into the degenerated articular cartilage so that the stem cells will reproduce articular cartilage cells and meniscus cells, hopefully fixing the knee problems permanently. Keep in mind that these procedures were all done in one day at his first appointment! After we finished these procedures, he was given some instructions to follow until his next appointment. He was told to avoid stressing the knee to the point of producing pain. If the pain allowed him, Dr. Hauser wanted LC to bicycle for 30 minutes every day. This kind of exercise would strengthen his vastus medalis muscles, the weakness of which was causing the bad tracking of his patella, which caused the articular cartilage degeneration. Dr. Hauser predicted that LC would need 5-10 treatments of aggressive Prolotherapy, including bone marrow Prolotherapy to strengthen the severely degenerated articular cartilage. LC returned to Caring Medical a month later and had very positive things to say about his results thus far. He said that his knee was at least 50% better, the clicking in his knee had greatly decreased, and he was amazed by his improvement. This time we injected 1cc of 8% Procaine with 2 units HGH and 10 mg Testosterone where the bone marrow would be injected so it would work at full capacity. This visit he received 15cc of bone marrow rather than 10cc as he received in his last visit. Again, the bone marrow was extracted from his tibia, and injected directly. Neurofascial Prolotherapy Also during his second visit, Dr. Hauser wanted to address the nerve component of LC’s pain to speed the healing as much as possible. He added Neurofasical Prolotherapy, or NFP. This is the newest form of Prolotherapy done at Caring Medical. It is also known as Subcutaneous or Neural Prolotherapy. This type of Prolotherapy involves the injection of dextrose into the subcutaneous tissues to stimulate healing. This is different from dextrose-based Prolotherapy and PRP Prolotherapy because those solutions are both injected in the fibro-osseous junctions, or where the tendons and ligaments attach to the bone. Research into the healing effects of this type of Prolotherapy has primarily been done by a family physician from New Zealand named John Lyftogt.1,2,3
Dr. Lyftogt is the main proponent and teacher of this type of Prolotherapy which addresses the peptidergic sensory nerves. Peptidergic sensory nerves maintain the health of tissues such as ligaments and tendons. When ligaments and tendons become degenerated, the peptidergic sensory nerves are needed to “renew” them back to health. Peptidergic sensory nerves thus are involved in the health maintenance and renewal of joints and the soft tissue structures around the joints. Without nerve support, tissues such as ligaments and tendon degenerate. LC was given 10cc of 5% dextrose injected into the subcutaneous tissue of his knee. Because Neurofascial Prolotherapy and Hackett-Hemwall Prolotherapy treat different areas of the injured joint, they can be used separately or in combination for a very strong effect. Because of LC’s severely degenerated articular cartilage and the fact that he no longer has a meniscus, the strongest solutions and the most aggressive treatments are required. LC was also encouraged to stick to a diet that will maximize his healing, as well as to continue with his exercise regimen. We are happy to report that LC is now able to ride his bike with his kids and is on the road to a full recovery! Chondromalacia is an extremely common condition seen at Caring Medical and one that plagues the population at large. Even the most severe cases can be helped by Prolotherapy!
1.Lyftogt J. Subcutaneous prolotherapy for Achilles tendinopathy. AustraliasMusculoskeletal Medicine Journal. 2007;12:107-109.
2.Lyftogt J. Prolotherapy for recalcitrant lumbago. AustraliasMusculoskeletal Medicine Journal. 2008;13:18-20.
3.Lyftogt J. Subcutaneous prolotherapy treatmen of refractory knee, shoulder and lateral elbow pain. AustraliasMusculoskeletal Medicine Journal. 2007;12:110-112.
