Regenerative Injection Therapies
Regenerative Injection Therapies involve the injection of a solution (dextrose, procaine or platelet rich plasma) into damaged soft tissue (ligament, tendon, joint or along a nerve) to promote the body’s self – healing response and form new connective tissue and decrease inflammation.
Regenerative Injection Therapies is a non-surgical treatment approach for chronic pain conditions and musculoskeletal injuries. Often, Regenerative Injection Therapies are performed alongside other Naturopathic Treatments such as: Acupuncture, Nutrition and Lifestyle Counselling, Supplementation and Structural Alignment Adjustments and Vitamin/Nutrient IVs.
Types of Regenerative Injection Therapies
- Neural Prolo (along a nerve to decrease inflammation)
- Neural Therapy (scar therapy to help break up adhesions)
Great treatment for:
- An acute or chronic injury that won’t heal in a timely manner
- Long-term degenerated joint that aches and feels unstable
- Improving ligament, tendon strength and tightening laxity
- Improving range of motion within a painful/stiff joint
- Decreasing pain and muscle spasm
- Improve function and movement
Conditions that Regenerative Injection Therapies Help Treat:
- Migraines/Tension Headaches
- Neck Pain
- Shoulder Injuries
- Back Pain
- Hip Pain
- Elbow/Knee Pain
- Ankle/Foot Pain
- Acute/Chronic Joint Pain
- Ligament/Tendon Tears
- Ligament or Joint Instability or Laxity
- Carpal Tunnel
- Disc herniation or degeneration
- Muscle Tear/Injuries
- Sports Injuries
- TMJ (Jaw pain)
- Rotator cuff injuries or labral tear
- Scar Tissue
- Nerve Pain Prolotherapy
A natural and effective treatment for chronic pain and arthritis
What is Prolotherapy?
Prolotherapy stimulates the body’s natural healing process and can be used effectively for chronic pain, strengthening injured tissues, treating musculoskeletal conditions and restoring function. It is a much less invasive alternative to surgery, pain medication and steroid (cortisone) injections.
Prolotherapy is a non-surgical regenerative injection therapy used to repair injured tendons, ligaments and joints. Joints, ligaments and tendons usually have a limited blood supply, meaning that incomplete healing is common after an injury.
These types of injuries can become a chronic source of pain and/or weakness.
How does it work?
Prolotherapy is both natural and non-surgical. It is based on the principle of injecting a mild irritant solution (dextrose) directly into the weak or damaged ligament or tendon (where it attaches to the bone). This irritant solution “tricks the body” into thinking the area is re-injured and this initiates an inflammatory response which promotes the body’s natural tissue/wound healing mechanism to increase blood and nutrient supply to the area. As part of this process, the body recruits connective tissue cells (fibroblasts) into the injured area to lay down new tissue in the weakened areas. This encourages growth of collagen and new ligament and tendon fibers, resulting in a tightening of the weakened structures. The regenerated tendons and ligaments produced after prolotherapy are remodeled by the body in the final stage of healing, resulting in tissue that looks and functions very similarly to the original tissue. Procaine is also added to the dextrose solution injection. Procaine is a short-acting anesthetic that helps to control pain and stop the constant pain signal to the brain. Procaine is also helpful in stopping muscle spasms, increasing muscle strength, helping to break up scar tissue and resetting malfunctioning nerves
What to Expect?
Patients can experience mild to moderate discomfort with this treatment, but the discomfort is manageable.
Treatment protocols for prolotherapy vary for each patient based on their individual needs, personal healing ability, immune health, and the severity of the injury. The average person requires 3-6 treatment sessions given at 2-3-week intervals, although many patients report experiencing some relief after 1-2 sessions. More serious or chronic injuries require longer courses of treatment, while proper exercise, overall health status, age, gender, hormones, inflammation, dietary measures, nutritional supplementation, minimal stress, adequate rest/sleep, and physical adjustments are all factors that affect the healing process as well.
Patients who are at risk of reinjuring the area may need to consider a maintenance schedule.
There are no guarantees, but sometimes a stronger therapy such as platelet-rich-plasma (PRP) may be needed to enhance the body’s healing response further.
Prolotherapy is NOT the same as a cortisone injection. Cortisone is used routinely for chronic pain to decrease inflammation and pain for up to 8 weeks, however, cortisone inhibits blood flow to the injured area and suppresses new blood vessel formation, suppresses growth of immune cells and prevents protein synthesis, fibroblast proliferation and ultimately collagen formation. This means that it helps stop the pain temporarily but does not aid the body in producing a healing response. Cortisone also inhibits the release of growth hormone, which further decreases soft tissue and bone repair. Cortisone weakens the collagen (including soft tissue such as ligaments and tendons).
Inflammation is a necessary first step that the body needs in order to start a healing response. If we suppress the inflammation, we inhibit the tissue repair. In contrast, prolotherapy helps direct healing factors that are part of the acute inflammatory process to help HEAL the old injury.
Cortisone injections can have a place when inflammation turns chronic and needs to be contained. Typically, this means that the underlying problem has not been addresses. Chronic inflammation can lead to collateral damage and cortisone injections can help prevent further injury caused by a runaway pathological process. If a doctor has told you that you need cortisone shorts, you should talk to a Naturopathic doctor or Medical doctor to see if prolotherapy is right for you.
Overall, prolotherapy is an extremely safe procedure, compared to surgical interventions or long-term painkiller use. The risks and complication rates for prolotherapy are low but do vary based on the area being treated.
The most common side effects experienced by patients are temporary increases in pain, stiffness, and swelling (12-96 hours after the injection due to the inflammatory response), as well as bleeding or bruising in the area. Extremely rare side effects include flu-like symptoms, infection, nerve injury or allergic reaction.
It is recommended to avoid NSAIDS (non-steroidal anti-inflammatories) during the course of treatment because NSAIDS interfere with the intended inflammatory response and proliferative process.
PLATELET RICH PLASMA (PRP)
Platelet Rich Plasma Injection Therapy (PRP) is a type of regenerative injection therapy based on the same principle as Prolotherapy, by stimulating an inflammatory response.
PRP injections prompt soft tissue and joint healing by applying concentrated platelets (from the patient’s own blood) to the injured area. Platelets play an integral role in blood clotting and wound healing, as they are responsible for bringing white blood cells (WBC) to the injured area to clean up the debris of dead and injured cells. This repair of injured tissue begins with the formation of a clot followed by platelet degranulation of the immune system, which releases growth factors that stimulate wound repair through secretory proteins. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote the development of new blood vessels, and stimulate the tissue healing cascade. Studies have shown that increased platelet concentration increases the level of secretory proteins, enhancing the amount of proliferation involved in the wound healing.
How do you extract PRP?
The process of creating platelet rich plasma begins with an in-office blood collection (20-60 cc of blood taken from the patient), plasma/platelet separation through a Platelet Concentrate System (blood centrifugation) to concentrate the platelets and growth factors. The red blood cells are separated from the serum platelets and other growth factors and then injected into the injured area which is a powerful regenerative medicine. The only difference between dextrose prolotherapy and PRP injections is the solution that is administered, and the resulting enhanced inflammatory effect with increased self-healing potential of PRP. Through the application of the body’s own concentrated platelets into areas of nonhealing injuries, PRP stimulates an inflammatory response characterized by a mass influx of white blood cells and growth factors that act on fibroblasts causing proliferation and accelerating tissue regeneration. Enhanced fibroblastic (connective tissue) activity increases tissue-healing processes of chemotaxis, proteosynthesis, reparation, extracellular matrix deposition, and tissue remodeling. Direct injections at the site of injury ensure that this inflammation and tissue regeneration is localized to the area.
What to expect?
Treatment protocols for PRP vary and are individualized to each person, but most people require 2-6 treatment sessions at 4-6-week intervals. Positive development is usually evident after 2 treatments but may occur after the initial treatment as well. The platelet rich plasma (PRP) stimulates a healing process that helps the body in tissue repair. PRP is using the body’s own healing potential for maximizing recovery from an injury or degenerative/age related conditions. The healing process is affected by diet, exercise, smoking, nutritional supplementation, stress, rest/sleep, and physical manipulation. Patients are usually able to return back to normal activities within a couple days after the injections. Similar to prolotherapy, the risks of PRP are low and the most common side effects are temporary increases in pain, stiffness and swelling, as well as bleeding or bruising in the area. Rare side effects include infection, but the doctor will do their best to minimize all risks for every patient.
What can PRP Treat?
PRP is one of the best non-surgical methods for pain control and injury recovery in joints. Using physical exam findings and previous imaging reports- this can help to determine the specific areas of the body that need to be targeted/treated. It is used by many professional athletes (such as NFL, NHL and NBA players).
PRP can treat all chronic and acute joint, ligament and tendon injuries including tennis elbow, plantar fasciitis, achilles tendonitis, rotator cuff tears, shoulder dislocations, meniscal tears, osteoarthritis and chronic low back pain, neck pain and any other areas of injured connective tissue, joints, tendons or ligaments. Prolotherapy and PRP can be used to treat the same conditions, but PRP is often indicated when the positive effects of regular dextrose prolotherapy have plateaued or are insufficient. Additionally, PRP is sometimes preferred for serious degenerative changes or high-performance athletes when the injury is very severe or complex, as with labral or meniscal tears. PRP is not only used for orthopedic injuries and sports medicine, but also for aesthetic medicine to promote collagen formation- and it is 100% natural!
Therapy used for scars, pain and injuries. Neural refers to nerves. When a nerve is impeded, the regulation of its connected body parts is also compromised. This can result in poor function, pain, disease, and disability. The purpose of neural therapy is to unblock the interference to normal functioning by using injections into the specific areas of disturbance. The injections often contain local anesthetic (procaine), 5% dextrose, homeopathic medicines, or vitamins such as B12. The sites of injection are determined by the history of trauma, location of symptoms, and connected dysfunctional areas.
Any stress on the body, whether physical, psychological or toxic, will activate the nervous system and create what is referred to as “a fight or flight response”. This could be the result of a car accident, surgery, emotional distress, fear, toxic exposure or any threat or perceived threat to life or person. In an ideal healing response, once the stress is removed, the nervous system should reset itself. Unfortunately, for many people the modern stresses are so great and continuous, there may be no chance for the body to return itself to normal and heal as a result. A local area then becomes locked into a constant fight or flight state and can for many years interfere with the normal nervous system regulation in the body. A very common example of this is a motor vehicle accident causing a whiplash injury.
How does it work?
Specific vitamins, local anesthetics and occasionally other preparations are used in the injection solution. The injection solution is specific for the area being treated, whether it is for organ tissue, nerve, muscles and joints or trauma. An injected anesthetic will cause a nerve to be numbed by changing the positive and negative charges on the membrane of the nerve tissue so that no sensation can be passed along. This is similar to when your lips become numb after a visit to the dentist. In neural therapy the intention is not to anaesthetize or numb the nerve, but rather to change the membrane potential temporarily, with the expectation that when the anesthetic wears off, the membrane charges and nerve function will return to normal. Think about how your computer occasionally is overloaded with too many programs running or windows open in the background. It begins to malfunction, running slowly and freezing up. Usually the first thing you do is shut everything down and reboot the computer. After that, it begins to work fine again. In the same way, Neural Therapy is like rebooting the “body computer”, the autonomic nervous system, to reset regulation and normalize function. Different injection medications help assist in the local healing response.
Scar tissue is a common cause of disturbed communication between cells and organs. Any scar whether a small one from a childhood fall, from dental surgery or a major post-surgical scar will prevent with surrounding tissue from being able to communicate properly. A scar has an electric charge about 5x that of normal skin and can disrupt nerve flow. Scars that cross acupuncture meridian channels can block energy to those related organs and body parts. A scar will hold injured or cut fascia, muscles and skin together, but it is not as flexible as the original tissue, so the underlying tissues cannot move as freely. The treatment of scars with neural therapy, even decades old ones, has consistently been an important factor in increasing mobility, reducing pain and improving movement and function.
Trigger Point Injections for Pain
Frequently a major component of chronic pain is tight, contracted or spastic muscles that are resistant to stretch, massage or mobilization therapies. Muscles are held in contraction by nerve impulses to the local neuromuscular junctions. The result is that perpetual inappropriate impulses cause a continuous muscle contraction. By injecting the affected neuromuscular trigger point, it is possible to break the ongoing pattern of spasm, allowing muscle to release and eventually return to normal function.
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