What is Prolotherapy?

Although each person experiences the treatments differently, we at Boundless do everything we can to make the injections as manageable as possible. We us the smallest gauge needle possible, numb the skin prior to and during the injection, use ultrasound guidance to minimize trauma to the deeper tissues, and offer topical creamsand anti-anxiety medications prior to treatment for particularly sensitive patients. Most patients find the pain from the procedure to be brief and mild to moderate at its worst. Even the most needle-phobic feel the discomfort well worth it as their chronic pain begins to improve.

The number of treatment varies with each patient and depends on many factors such as the health of the patientʼs immune system, the extent of the injury, and the quality of rehabilitation. Typically, 2-8 treatments are required, although some patients report excellent pain relief and healing after just one, and others with more severe and chronic injuries will need many more. The treatments are typically performed every 2-6 weeks to allow for natural healing to occur. It is natural to experience waxing/waning pain response as treatments continue. The most challenging aspects of prolotherapy are the patience and faith needed to see the treatment through to the completion of natural healing and knowing when to switch to a more powerful biologic therapy option. The staff at Boundless will help to guide you through this process.

As prolotherapy works through the inflammation process, you can expect to feel some soreness, achiness, and stiffness in the treated area for a day or two, and sometimes up to 2 weeks after the therapy. During this period of increased inflammation, we recommend continuing gentle range of motion and daily activities as tolerated. As the  healing progresses and inflammation improves, patients are advised to return to exercise, starting at 1/4 – 1/2 of their usual intensity, and increasing gradually. Overexertion can slow healing and further damage the injured area – patients are advised to avoid any activities which significantly increase pain levels above baseline.

Many patients choose prolotherapy because they are seeking long-term natural healing for their injuries rather than the temporary relief and weakening of tissues related to cortisone injections and without the risks, costs, and downtime of surgery. Prolotherapy is a safe, minimally invasive approach – the published risks are low and limited to those associated with any injection – infection, needle trauma, etc. Patients seeking to avoid the loss of work hours, prolonged pain and recovery time, and the costs and risks of surgery and anesthesia, as well as those with a more holistic approach to medical care, frequently find relief with prolotherapy. While surgery is necessary for a portion of the sports, spine, and arthritis patients – 5-10% – prolotherapy can help to avoid or delay surgery for the majority. This is especially true of patients with tendinopathies, partial tendon or ligament tears, and non-deforming arthritis. Unlike surgery, prolotherapy is not irreversible – if it doesnʼt work for a particular patient, surgery is always an option.

Unfortunately, as with most regenerative treatments, most insurance carriers do not cover prolotherapy. The reasons for this are several: research has been difficult due to study design (it is difficult to do a controlled study on a therapy that relies on individual technique, multiple monthly treatments, and effectiveness with dry needling alone), and
lack of funding (pharmaceutical companies do not benefit financially from this research). Most physicians are not aware of the research supporting prolotherapy and training for this procedure is not typically covered in medical school. Medicare still considers prolotherapy experimental despite a recent slew of studies supporting this and other regenerative treatments, and most insurance companies follow suit. Despite this, the cost of prolotherapy is frequently less than the copayments and deductibles patients pay for covered surgical procedures and more effective and long-lasting than cortisone injections, limiting costs associated with lost work, medications, and continued suffering.