In this article Ross Hauser, M.D. discusses the autoimmune disorders most likely to prevent Prolotherapy from attaining full healing.
The only diseases that cause inflammation for which Prolotherapy may not be appropriate is the autoimmune diseases, such as Rheumatoid Arthritis and systemic lupus erythematosis. Remember, however, that anyone with these conditions is much more likely than the average person to have poor healing, and thus, ligament and tendon injury and chronic pain. If someone with these conditions has a normal or almost normal ESR, erythrocyte sedimentation rate, which shows that the amount of inflammation is under control, then Prolotherapy is appropriate. This is assuming that the pain can be reproduced by palpation over a ligament or tendon on physical examination.
Low back pain injections
Ross Hauser, MD demonstrates Hackett-Hemwall dextrose Prolotherapy to the low back. This is a more comprehensive approach to get permanent back pain relief and is an alternative to spinal fusion, laminectomy, chronic chiropractic adjustments or unsuccessful physical therapy exercises. In our clinic, we treat nearly every type of back pain including sports injury or arthritis related.
Few doctors in the United States have treated as many patients with Ozone therapy as Ross Hauser, M.D., of Oak Park Illionis. But does he use Ozone in Prolotherapy?
Read what Dr. Hauser has to say:
I learned Ozone therapy from the then-president of the German Ozone Society (main organization utilizing ozone therapy at the time), Gerd Wasser, M.D. Besides teaching me major autohemotherapy, direct ozone gas insufflations, he taught me to inject ozone therapy into joints. I myself received Ozone therapy into my knee joint to try it and have utilized it on some of my patients.
Most folks know that I was taught Prolotherapy by Gustav Hemwall, M.D., the then (early 90’s) most experienced (or one of the most experienced) Prolotherapy doctors in the world. As such, I had and continue to have remarkable results with Hackett-Hemwall Prolotherapy. Some of the remarkable results we have published in scientific papers that are available the Prolotherapy research site at http://www.journalofprolotherapy.com. As I was able to compare my own personal experience with Hackett-Hemwall Prolotherapy to Prolozone, I chose Hackett-Hemwall Prolotherapy. This does not mean that Prolozone does not work. I respect the doctors who use it and look forward to seeing their results published using this technique, as myself and others using Hackett-Hemwall Prolotherapy have done.
I would like to make one more remark. What I try to do with Prolotherapy is simulate the mechanisms in which the body heals itself. When a person injures soft tissue like ligaments, sugar is released from inside the cells and fat is released as cell membranes are broken (during the trauma or injury). These simple substances then trigger the immune system to increase growth factors at the wound site. The solutions that are utilized with Hackett-Hemwall Prolotherapy, such as dextrose, are not only safe, but when properly administered do a great job. They simulate the mechanisms of how the body heals itself. To make solutions stronger, additives such as cod liver extracts, human growth hormone, and platelet rich plasma again simulate what normally occurs in the human body with healing an injury. So from an efficacy standpoint, as well as a safety standpoint, Hackett-Hemwall Prolotherapy has stood the test of time. I have been utilizing it in some 11,000 plus patients for over 16 years and have probably given 20 million Prolotherapy injections. One year we actually monitored these numbers and I had provided about 3000 patient treatments and gave over 2.4 million injections in one year, so I feel completely confident with and can highly recommend the Hackett-Hemwall technique of Prolotherapy for potential patients, as well as for physicians desiring to learn the technique to help their patients.
A 2002 study perfromed by The Baylor College of Medicine examined the effectiveness of treating knee pain with arthroscopic surgery. Patients were randomly assigned a surgery, and were not told which one they would receive. The three surgeries were arthroscopic debridement, arthroscopic lavage, and placebo. Arthroscopic debridement surgery involved removal of the degenerated cartilage. Arthroscopic lavage involves surgically washing out the joint of old blood, fluid, or loose particles. The placebo surgery performed included an incision and a simulated debridement without the insertion of the arthroscope.
The authors of the study found that the patients who received the legitimate surgeries did not report less pain or better function than the patients who received the placebo surgery. This led them to conclude that the outcomes after arthroscopic lavage or arthroscopic debridement are not better than the outcome from the placebo procedure – and this was back in 2002!
In 2008, the Center for Medical Consumers published a report that stated that arthroscopic surgery had been proven to have no more benefit for patients than conservative treatments. Their article states that this has been long proven, dating back to 2002. Another study mentioned stated that “Arthroscopic lavage and debridement do not alter disease progression, and should not be used as a routine treatment for the osteoarthritic knee. Even the American Association of Orthopedic Surgeons, in their suggestions about treating osteoarthritis (AAOS 2008), does not recommend arthroscopic lavage or debridement for the treatment of knee pain or OA.
Arthroscopy found to be ineffective
Simply put, arthroscopic surgery for knee pain has as little an effect as physical therapy. Meaning, it provides temporary relief, but after a little while, the pain returns.
Alternative to surgery
At Caring Medical, we perform a treatment called Prolotherapy. Prolotherapy is an injection with a dextrose solution as the base. The dextrose acts as an irritant that when injected stimulates a mild inflammatory response, which creates heavy blood flow to the area, stimulating the body to heal itself. The blood sent to the area helps the cartilage under the knee to repair, as well as strengthening the ligaments and tendons that are supporting the knee.
If a person is a candidate for knee surgery, the cartilage under the knee cap is most likely in poor condition, but not necessarily, as often surgery is recommended when other more conservative options have not been fully investigated. In more severe cases or those involving severely degenerated cartilage, we may strengthen the standard Prolotherapy solution with additives such as hormones, minerals, or even your body’s own growth factors in order to stimulate a greater inflammatory response.
We see from our patients every day at Caring Medical that Prolotherapy can relieve pain, even in some of the worst cases – even after surgery!
Ross Hauser, M.D. Visit my page or Contact Caring Medical. at 708-848-7789
New video Achillies Tendon Treatment
Osteoarthritis and injury to the ligaments. Recently published in the Journal of Prolotherapy, the relationship between ligament injury and osteoarthritis was explored. Says the Journal “When there is insufficient ligament support to stabilize joint motion, the resultant increase in joint laxity leads to the development and acceleration of articular cartilage injury.”
Further the article states that Prolotherapy is a very effective tratemnt for treating the ligament injury and preventing osteoarthritis development. “When it comes to greatly reducing or eliminating the pain and dysfunction from osteoarthritis due to ligament injury, no other treatment compares with Prolotherapy. It is simple, safe, and effective, affording both doctor and patient a satisfying long-term outcome. It is low-cost when compared to surgery or the long-term use of drugs. It deserves prominent recognition by the health care industry and the public alike. Prolotherapy truly is the natural solution for pain! “
You can read this Prolotherary and Osteoarthritis article at the Journal of Prolotherapy
From the pages of the Journal of Prolotherapy.
A 53 year-old patient turned up who complained of one-sided hip pains, especially when climbing stairs or when getting up from a seated position. To specify the area of pain, she put the fingers of her right hand on the large trochanter. She reported that she had gone through a whole series of unsuccessful specialized consultations. She vividly explained that imaging methods such as X-rays, nuclear spin tomography and bone scans did not result in any clinically relevant findings. Above all, there were no signs of wear and tear to be found in the hip region. A clinical function test did not result in any relevant negative findings either.
This is typical of many Prolotherapy patients seen in the Prolotherapy doctor’s office. You can read the reminder of the article for free at the Journal of Prolotherapy – Prolotherapy and Hip Pain
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.
Why are ligament injuries chronic? Long lasting? It depends on the ligament, patient, and doctor!
Ligaments have extremely poor blood flow. This results in very slow healing and recovery from ligament injuries. In a recent article from The Joint and Diseases Research Group at the University of Calgary in Alberta, Canada – the authors noted the following about ligament injuries.1
- Not all ligaments heal at the same rate, or have the same potential for healing. The ACL in the knee is recognized as the ligament which takes the longest to heal, if it fully heals at all.
If a person injures the ACL, the chances of more injuries and the eventual development of osteoarthritis have been published in many different studies. 3,4
In contrast to this, the MCL heals rather quickly, and has a better history for untreated injuries to be better than untreated ACL injuries. 5,6 This could be for any number of reasons, but there are suggestions that the joint mechanics are more favorable to the MCL than the ACL.
- Ligament healing is variable and unpredictable.
Since ligaments are so important to the mechanics of our body, the healing process is varied and unable to be planned. The doctor can make the assumption that the ligament will heal if the patient avoids x, y and z, but variables in the patient’s life that neither the doctor nor the patient can account for often exist. 5,6
- Ligament healing is slow and can fail late in the process.
Early successes in the treatment of injured ligaments are common, but not to be trusted. Complete failure of the ligament has been reported even after it was supposedly repaired. This failure has been shown to be late in the healing process, happening any time from three to five years after the “repair”.
- Prolotherapy – ligament repair
The fact is, someone who gets Prolotherapy for their ligament, tendon, or joint injury will not have to deal with the above problems explained here. It does not matter if you have one injury or five; Prolotherapy is able to address nearly every kind of ligament injury.
The healing stimulated by Prolotherapy is predictable. At Caring Medical, we do hundreds of treatments in very short amounts of time. We have seen complete healing in ligaments that have been failing the patient over and over again, for years. There is not a risk for chronic re-injury as there are for traditional treatments.
- How is Prolotherapy different from traditional treatments?
Prolotherapy works with the body to stimulate its natural healing processes. Dr. Hauser injects a dextrose-based solution into the injured areas and this stimulates a mild inflammatory response at the injection site(s). Because the body heals by inflammation, it signals the body that healing needs to take place. The body believes that because of the inflammation, the body is re-injured. The body increases the blood flow to that area, and heals the weakened ligament by creating new collagen. When collagen matures, it shrinks. As it shrinks, it tightens the stretched ligaments, repairing the damage. This is not a temporary solution, nor is it a pain management solution. Prolotherapy can be a permanent solution to your pain.
Contact Caring Medical. at 708-848-7789
1.Bray, R.C., Frank, C.B., Shrive N.G. Ligament Healing a Review of Some Current Clinical and Experimental Concepts. The Iowa Orthopaedic Journal. Vol 12: 21-28.
2.O’Donoghue, D.H.:Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee. J. Bone Joint Surg. 32A:721, 1950.
3.Bray, R.C., Frank, C.B., Shrive N.G., et al.: Joint Instability Alters Scar Quantity and Quality in a Healing Rabbit Ligament. Orthop. Trans. 14:322, 1990.
4.Fetto, J.F., Marchall, J.L., The Natural History and Diagnosis of Anterior Cruciate Ligament Insufficiency. Clin. Orthop. 147:29, 1980.
5.Ellsasser, J.C., Reynolds, F.C., Omshundro, J.R.: The Non-operative Treatment of Collateral Ligaments of the Knee in Professional Football Players. J. Bone Joint Surg. 56A:1185, 1974.
6.Hastings, D.E.: The Non-operative Management of Collateral Ligament Injuries of the Knee Joint. Clin. Orthop.
Problems with the sacroiliac joint including hypermobility or subluxation, is a widespread condition and a very common reason for someone to seek Prolotherapy.
Low Back Pain
A pateinet came in, a 34 year old man, for unrelenting low back pain that often referred pain into his left glut and leg. He had an MRI which revealed degenerative discs in the lumbar vertebrae. Unfortunately, the treatments recommended by other practitioners were not going to address the underlying issue. The patient had already consulted with an orthopedic surgeon, a pain doctor, a chiropractor, a naturopath, a physical therapist, and an acupuncturist. Each modality provided some temporary relief, but none of the specialists were able to help permanently resolve his pain.
The patient was not sure what caused his back pain, but prior to it starting, he was doing yoga 5-6 days per week for several months. During the physical exam, we discovered that he had benign congenital hypermobility syndrome. In these patients, ligaments, joint capsules and intervertebral discs are abnormally lax or flexible. It is an often overlooked in chronic pain cases, but is an extremely important cause of chronic body pain. Generalized joint hypermobility – loose joints in the entire body – is due to lax ligaments and occurs in about 5% of the people. Because these people are often pretty flexible, they are good at yoga and enjoy it.
Prolotherapy for Low Back Pain
It was determined that the majority of the patient’s pain came from loose ligaments in his left sacroiliac joint and estimated that he would need 3-6 Prolotherapy treatments to strengthen the joint and eliminate pain. Along with Prolotherapy, Abe was instructed to avoid bending and twisting and self-manipulation because such movements would inhibit the effectiveness of Prolotherapy. In addition, he was to supplement with Prolo Max and Prolo Support Pack to speed healing and help with tissue growth and repair. Dr. Hauser told the patient that it would be ok for him to start doing yoga again, but that he should avoid doing any positions that require bending while twisting.
After a total of six Prolotherapy treatments, the patient reported improvements in pain and stability after each treatment. After a few months of not seeing Abe, he returned for treatment on a completely different body area.
Contact Caring Medical. at 708-848-7789