Many people with musculoskeletal pain are familiar with corticosteroid
(i.e. “cortisone”) injections, which are meant to reduce inflammation. However, inflammation is not necessarily a
bad thing, as it recruits the body’s own natural healing factors.
Another approach is to deliberately induce inflammation,
stimulating the body’s own healing mechanisms to repair damaged tissue. This is called proliferative therapy. This
method may be a longer-term method of musculoskeletal treatment, and may be a
great alternative to the more well-known cortisteroid injections. The subtypes of proliferative therapy that
Drs. Hyman and Chimes perform are prolotherapy
and platelet-rich plasma injections
(PRP).
Prolotherapy was originally “discovered” in the 1930s by
osteopathic surgeon Dr. Earl Gedney, who injected his own injured thumb with an
irritating solution, and in doing so promoted the healing and regeneration of
the tissue. This is based on the concept that lingering, chronic issues are
often because the collagen in the damaged tissue is poorly organized. However, because of the chronicity of the
injury, the person’s body has stopped attempting to heal the chronic
injury. Proliferative therapy aims to
re-stimulate the body’s natural healing response, either by inducing
inflammation (prolotherapy) or placing healing factors there directly (PRP).
During prolotherapy,
a sugar solution, usually dextrose, along with an anesthetic (such as
lidocaine) is injected into the affected area, resulting in low-grade
inflammation to the injured area, “tricking” the body into initiating a new
healing cycle cascade.
The other method of proliferative therapy that our
physicians utilize is platelet-rich
plasma injections. This technique is
based on the same principle as dextrose prolotherapy explained above, but
instead the solution used is a high concentration of a person’s own platelets,
which contain healing factors that stimulate the body’s healing mechanisms. Platelets, when activated, secrete a number of
different growth factors that stimulate and regulate inflammation in the
damaged tissue, resulting in a natural healing response. The blood is drawn from
the patient at the time of the visit, placed in a centrifuge where it is spun
in order to separate and concentrate the platelets from the rest of the blood,
and this “platelet-rich plasma” is then injected into the injury site. The aim is to inject healing growth factors
directly into the damaged area, providing the patient’s body with the tools
needed to naturally heal itself.
The two methods listed above are a means of strengthening
ligaments and tendons, providing longer-term relief for a multitude of chronic musculoskeletal
problems including, but not limited to, lower back pain, knee pain, hip pain,
shoulder pain, osteoarthritis, and different varieties of joint pain. We have had great success using proliferative
therapy in many of our patients, but because it is a newer class of injectable,
the scientific literature has not reached a consensus on which injuries do best
with proliferative therapy. Therefore,
insurance companies have deemed proliferative therapy to be “experimental” and
they do not cover either of the procedures listed above. Patients
who have invested money in their own care, however, find that
proliferative therapy may provide them long-lasting relief and help them to
avoid future visits, ultimately lowering their medical bills.
Because we respect the time and money of our patients at
Lake Washington Sports & Spine, we take several measures to optimize the
patient’s experience when having proliferative therapy performed. These
include:
1.
An initial consultation, to make sure that proliferative
therapy is the right choice for the patient
2.
A discussion about which form of proliferative
therapy (prolotherapy or PRP) is the best choice for the patient
3.
Always using ultrasound-guidance to make sure we
are placing the proliferative therapy in the correct location
4.
Coordinating the patient’s care team, including
physical therapists, chiropractors, personal trainers, physicians and other
clinicians
Drs. Hyman and Chimes hope that by utilizing these
cutting-edge, non-surgical techniques they can help their patients overcome
chronic issues that impede their ability to live an active and healthy
lifestyle!
