What is Prolotherapy?
Prolotherapy treatment, the purposeful stimulation of the body’s innate capacity to heal wounds and repair injured tissues, dates back 2,500 years. In this treatment, dry needling and injection of a variety of solutions (hypertonic dextrose, hormones, inﬂammatory agents) stimulate the area that needs repair to start the healing cascade.
BOUNDLESS is a leading provider of prolotherapy in San Diego.
What does a typical treatment entail?
A typical treatment involves several points of injection, in the joint and/or around tendons and ligaments, using a small needle under ultrasound guidance when necessary.
How many treatments are needed?
Typically between 2-7 rounds of treatment spaced 1 month apart are necessary for adequate healing and symptom relief.
Our patients value their experience...
You’ve been going out of your way to help me–and I want to thank you.
Thank you just isn’t enough. You have no idea of the difference you have made in my life. I’ve gone from totally discouraged and completely worn down from chronic pain to optimistic, excited, and happy. YOU have made that difference in me.
I love your spirit and am grateful that [my partner] has you as his doctor. You are a caring guide on his path of learning to manage his pain.
Why do you think I am back? You are HONEST and I like you–and surgery is the last option.
There are not adequate words to thank you for what I feel in my heart, my mind, and my body. I have my life back! Each day is so very special. How do you find the words to begin to thank you for that? I could not have been more pleased with your personal sensitivity.
Who is a candidate for prolotherapy?
Patients who suffer from chronic tendon or ligament injuries, joint pain, back pain, neck pain, or arthritis can beneﬁt from a prolotherapy approach. Prolotherapy has been shown to increase the strength of ligaments, regrow cartilage, and stabilize joints. As prolotherapy works through the patientʼs own healing systems, general health, nutritional status/diet, and lifestyle factors such as exercise, smoking, and obesity do inﬂuence the success and number of treatments needed. At Boundless we are committed to help you optimize your health and will guide you through the selection, preparation, and treatment process during our introductory meeting.
Are the treatments painful?
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.
How many treatments will be needed?
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.
How will I feel after the Prolotherapy treatments and when can I return to exercise?
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.
Why choose prolotherapy rather than cortisone injections or surgery?
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.
Is prolotherapy covered by insurance? If not, why not?
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.
The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis
Full Text, 2018 (Jan. 4); Rahimzadeh, et. al.
Dr. Bunyak notes this text from the Conclusion, “Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL (prolotherapy). This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA.”
The Prolotherapy Research Site of Dr. Reeves
“Visit this site to review some of the latest research on prolotherapy.” – Dr. Bunyak
Prolotherapy for Groin Pain
“Prolo is a great option for groin pain and ‘sports hernia’ treatment.” – Dr. Bunyak