General ortho FAQ’s

Orthopedics (alternatively, orthopaedics) is a medical specialty focused on the diagnosis and treatment of conditions, disorders, and injuries of the muscles, bones, joints, tendons, ligaments, and nerves.

A doctor who specializes in this medical specialty is called an orthopedic (alternatively, orthopaedic) surgeon or orthopedist.

The word arthritis literally means “joint inflammation.” Arthritis refers to a group of more than 100 rheumatic diseases and other conditions that cause pain, stiffness, and swelling in joints.

Rheumatoid arthritis is a disease that damages the lining surrounding our joints while also destroying our bones, tissue, and joints over time.

Osteoarthritis is a progressive condition that slowly damages the cartilage surrounding the ends of bones and is common in the hip, knee, and spine.

Bursitis is an inflammation or irritation of a bursa, which is a fluid-filled sac located around joints. Bursitis causes a reduction in or a loss of motion at the affected joint. Bursitis typically occurs in the heel, hip, knee, shoulder, and thumb.

Cartilage is a soft, rubbery, gel-like coating on the ends of bones, where they articulate, that protects joints and facilitates movement.

Tendonitis, medically spelled tendinitis, is an inflammation or irritation of a tendon. Chronic strain, overuse or misuse of a tendon leading to a repetitive stress injury, or a serious acute injury can lead to a weakness, tear, or swelling of the tendon tissue, resulting in pain and stiffness near the tendon. Tendonitis usually occurs in the elbow, hip, knee, shoulder, thumb and wrist, but can occur in any tendon.

Prolotherapy FAQ’s

Prolotherapy also know as regenerative injection therapy(RIT).. It is a well recognized nonsurgical orthopedic procedure that stimulates the body’s natural healing processes by initiating a local inflammation cascade, which triggers release of growth factors and collagen deposition. Websters Third new International Dictionary defines Prolotherapy as “the rehabilitation of an incompetent structure, such as ligament or tendon by the induced proliferation of new cells”. This therapy technique involves an injection of solution to the site of painful and degenerated joints, ligaments, tendon insertions, and in adjacent joint spaces in order to promote growth of normal cells and tissues. The cause of a great deal of musculoskeletal pain is related to injuries(traumatic or overuse),age, degenerative changes, resulting in ligamentous laxity. Natural healing of tendons and ligaments is slow and most often than not, tendons and ligaments may not heal backgrounds their normal strength or endurance. Also they have poor blood supply. At the same time, they have reach nerve supply. These nerve endings signal the body regarding structural damage of tendons and ligaments usually causes a lot of discomfort, chronic muscle spasms, trigger points and pain. Such pain can often radiate to arms and legs, resembling radicular pain(Hackett ligament referral pain patterns). Healing can be additionally by anti inflammatory medications(pain killers) most often prescribed as a traditional treatment protocol. Prolotherapy, with its unique ability to directly address the root cause of the disability, can repair the weakened sites and resulting in restoration of proper function by proliferating new ligamentous tissue.

Prolotherapy promotes genuine, natural body healing and uses no artificial substances, no medications and nothing that can cause adverse future side effects. The great advantage of Prolotherapy is that it is Safe. In other words, Prolotherapy naturally promotes tissue Rejuvenation.

Research and scientific studies have shown that Prolotherapy is superior to the traditional consvervative treatments in relieving the root cause of problems of chronic musculoskeletal pain, sports injuries and arthritis. Prolotherapy is a effective, trustworthy, reliable and a viable alternative to noneffective conservative treatments including surgery.

Prolo stands for Proliferate.
Prolotherapy mimics the natural healing process by tricking the body into initialing a new healing cascade.(Prolotherapy promotes the three stages of healing and restoration: Inflammation, Proliferation, and tissue Remodeling. With a precise injection of a Prolotherapy solution directly at the damage site , creates a temporary, mild, controlled aseptic inflammation, which triggers the release of growth factors and new collagen deposition. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area. This results in a stronger or larger tendon or ligament that can hold body structures in place more effectively.(It has been shown that Prolotherapy sessions increase the tendons fibril strength by as much as 200%). The weakened area heals, and the patient’s pain is reduced or eliminated, increased range of motion, and improved function. The body continues to “remodel” the bond so that even more stability occurs over the year following the treatment. It is noteworthy that scar tissue does not form as a result of this procedure and the new tissue that grows in place has been proven to be smooth, strong, flexible and highly functional.

The prolotherapy injections contain natural substances, which stimulate the body’s healing response. There are numerous substances, We tailors the selection of substance according to the patient’s need. A local anesthetic is also used so there is minimal discomfort with the injections. Commonly used solutions are dextrose(in different concentrations), morrhuate sodium, phenol, glycerine, sarapine, magnacium sulphate, zinc, ozone, human growth harmone, etc. Biocellular Prolotherapy is simply a modern version of Prolotherapy, which uses power of patients own blood (PRP), Bone marrow or lipoaspirate (Stem cells); as a powerful regenerative solutions called as Orthobiologics.

Any pain involving an injection will vary according to patients tolerance, the structure to be treated, the choice of solution, and the skill of the physician administering the injection.

As many of my patients have said, “the pain from the injections was nothing compared to the pain that I was experiencing prior to Prolotherapy”. Most say after the Prolotherapy treatment, “It wasn’t that bad.” There are a few people, however, who may need help, for whom a prescription can be given for Tylenol tablet.This can be taken one hour prior to your Prolotherapy treatment. Additionally, patients can use stress balls or can listen calming music to help ease one’s mind during the treatment. Ninety-nine percent of our patients receive the treatments without pain killers and do just fine.

The great advantage of Prolotherapy is that it is extremely safe. Prolotherapy does not use any dangerous medications, reported local and generalized side effects are minimal and self resolving.The treatment may result in mild swelling and stiffness. This is because the injection is intended to produce irritation and inflammation in an effort to ultimately repair, strengthen, and heal the involved tissues. The mild discomfort passes fairly rapidly and can be reduced with pain relievers such as Tylenol. Anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the injection.The potential risk for infection is exceedingly low because of the use of careful technique, skin preparation, the solutions utilized and the nature of the induced inflammation, which is a natural infection-fighter. The risks are far less than taking pain killers for a lifetime to temporarily alleviate chronic pain.

Prolotherapy can substantially alleviate most of the muscular-skeletal painful conditions, including arthritis, sports injuries as well. With the recent advances, Prolotherapy indications significantly widened and are constantly opening new horizons for this technique.

Good outcome is typically reached after several  Prolotherapy sessions. The average person requires 4-6 treatment sessions given at 3-4 week intervals, but the number of treatments varies with each patient. Many patients feel relief of pain after the 3rd or 4th treatment. Sometimes, some of our patients have reported some relief of pain after only two sessions. In some complicated cases require as many as eight treatments. We suggest our patients to combine Lyftogts Perineural Injection Therapy(PIT/NeuroProlotherapy) to the traditional dextrose Prolotherapy. Simultaneous PIT treatment enhances the efficacy and success of traditional Prolotherapy and high likely to reduce number of sessions of treatment course. Our experience shows that amount of collagen growth required for restoration of function is different for each person. The important goal is to continue the Prolotherapy treatment. With continued treatment, there is an excellent chance of achieving total pain relief with the resumption of all previous activities, including athletics.

If no substantial improvement noted after 2-3 sessions, we evaluate these patients for poor healing response.(evaluation of hormonal status….etc). Alteration in the strength and type of solutions used(Biocellular Prolotherapy -PRP, BMAC, SVF as a potent stimulators for healing.), coupled with careful reassessment of the regions treated at each visit, will usually result in an improved outcome.

The practice of Prolotherapy is supported by positive outcomes in numerous clinical studies. The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used.

Numerous studies have been shown a success rate of over 80% over many thousands of patients, with success judged as at least 50% reduction in pain. (eg. In patients with low back pain with hypermobility, 85% to 95% of patients treated experience remission of pain with this form of therapy. In comparison, the Journal of Bone and Joint Therapy reports only a 52% improvement in patients treated surgically for disc involvement.) This is quite remarkable, given that the treatment has no to minimal side effects and cost compared to other surgical and non-surgical treatment.

Hippocrates( also known as father of medicine) himself practiced the theory of Prolotherapy in the 5th century BC by treating unstable joints by cauterizing the ligaments with a hot metal rod. Heat was used to irritate the injured ligaments to induce inflammation which will lead to self repair by body’s own healing mechanisms. If it was not for the process of inflammation, none of us would heal even the smallest cut. It is life-threatening if we lose the ability to react to injury by inflammation. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints with these newer injectable medicines (neoplasmoid) in the 1940s. In 1939, George S Hackett applied the concept of tendon pathology and ligament laxity to chronic musculoskeletal pain, coined the term Prolotherapy, and wrote a book entitled ” Ligament and Tendon relaxation (Skeletal Disability) treated by Prolotherapy (Fibro-osseous proliferation)”. His work is still used today in training physicians. In 1955, Gustav A Hemwall, a surgeon in private practice in Chicago met Dr Hackett at an American Medical Association meeting, and he refined the practice of Prolotherapy. In 1969, Dr.Hemwall, , established a foundation dedicated to providing medical care to needy people around the world. He named the foundation after his mentor, Dr. George Hackett. Later, Dr. Jeffrey J. Patterson, DO, professor at the University of Wisconsin Medical School, Department of Family Medicine, promoted Prolotherapy at various medical meetings. Their technique is known as Hackett-Hemwall-Patterson technique of Prolotherapy. Although initially known as the Hackett Foundation, the organization was eventually renamed as Hackett Hemwall Patterson Foundation (HHPF) in honour of their lives and services to provide high-quality medical treatment to needy people around the world. HHPF is an International premier organization for clinical Prolotherapy and collaborate with University of Wisconsin, Madison. Advances in medicines greatly improved on this process, and led to the modern techniques of strengthening the connective tissue to restore function.

Chronic pain is not well understood by most health care professionals and, therefore, is frustrating to treat. Thus the comment, “There is not much you can do about it… you just have to live with it”.

Prolotherapy is not something that is commonly taught as a part of a standard medical college curriculum,so even doctors are unfamiliar with it.
The technique of prolotherapy requires an in-depth knowledge of anatomy and the skill to place the injections accurately. It takes a great deal of study and training to become adept at the technique.

The procedure takes up to one hour of clinic time, and most busy clinics cannot afford to take this amount of time for one patient.
Many doctors and patients are looking for a “quick fix”, but prolotherapy results do not always occur overnight. Therefore the prolotherapy patient must be committed to the treatment because multiple sessions are often required. Most people are looking for the newest and high-end technology to treat their problem. However, relatively simple treatments are often discounted or overlooked.

Pharmaceutical companies are not promoting it because there is no money in it for them. Prolotherapy solutions contain natural and inexpensive substances. Drug companies cannot obtain exclusive manufacturing rights, so there is no investment potential and thus no profit to be made.
Because there are very few doctors who perform prolotherapy in India, patients typically just accept the pain or have surgery. While surgery has its place, many patients and doctors are not aware that prolotherapy may relieve their pain and delay or prevent the surgery they thought they needed.
Since prolotherapy is considered by most insurance companies to be “investigational” and “alternative” it is therefore not usually covered.
Prolotherapy is an effective treatment for a multitude of conditions. There is no other treatment that replaces prolotherapy for strengthening weakened ligaments and tendons. Healing occurs slowly but surely, and naturally. Multiple treatments are usually necessary to achieve maximum joint stability and long-lasting relief from pain.

I’m often asked “Why Aren’t Regenerative Treatments (Prolotherapy) Covered under Insurance?”
The fast answer to the question is that insurance limits our ability to help patients.The simplistic insurance company answer to this question is that these treatments are fairly new to the mainstream medical treatment and considered “Experimental/Inverstigational” and FDA is currently evaluating the efficacy of these treatments.Although over the past decades there has been a great deal of research and controlled randomized studies showing the effectiveness and safety of Prolotherapy. More than 80% success is better than most surgical outcomes yet still not covered by insurance. However many treatments including surgeries that are covered under insurance have been demonstrated to be no better results as promised. Some of them have noted to produce harmful effects. eg. non-steroidal anti-inflammatory medications, cortisone injections, etc. These treatments can also accelerate the degenerative process leading to the need for knee replacement surgery which is a fairly large surgery with surgical and post-operative risks and with some studies demonstrating that 20 % of patients STILL HAVE KNEE PAIN AFTER KNEE REPLACEMENT SURGERY!

As no new cutting edge designer drug here or fancy patent-pending device; Drug companies cannot make money off of this and the value is in the doctor’s skill and time. Prolotherapy solutions contain natural inexpensive substances. Drug companies cannot obtain exclusive manufacturing rights, so there is no investment potential and thus no profit to be made. If I were on their side, this would be a threat to their financial gain that they have set in place. Awareness is the most important process at this point.

The current healthcare climate is failing miserably, with the drug companies charging obscene prices for chemicals that may work to treat a symptom without any interest aimed at the root cause. I completely understand how expensive insurance policies are with high monthly payments. Furthermore, healthcare is neither concerned about care or health but rather the management of a disease.

Imagine how many people in India suffer from musculoskeletal and arthitis pain and the number of drugs and surgical procedures that are done every year to pacify or reduce pain. The numbers are staggering. Surgery itself can take a toll on your well-being. The question is whether you’d like to try a relatively inexpensive possible solution that maximizes your body’s natural healing system before trying more-expensive, more-invasive procedures. Given the promising research that has been done, it’s important for patients to have access to this treatment if they want it. When you are in pain, the hope of relief matters. Our job is to frankly explain all of the options and help patients make the decision that is best for them.”

Of course not. Few diseases and illnesses are not resolvable with Prolotherapy. Pain can originate in many tissues, and a complete, thorough history, examination, investigations etc are absolutely essential. We have a great deal of experience with the treatments of musculoskeletal disorders to ensure that your condition is correctly managed. Once treated, the problem should be fixed. Of course, if there is an additional injury or insult to the area treated, an additional treatment maybe needed.

While Prolotherapy is not for everyone or for every condition, it has helped thousands of people who might otherwise still be in pain.

Physical therapy(Exercising) is an important part of successful Prolotherapy and encouraged, but please do not over do it. Patients should activities they know by experience will aggravate their pain. The stress of movement helps to produce organized, normal, strong ligaments and connective tissues. Pay attention to what your body tells you. If it hurts, take a break! Do not push yourself just because you feel better. Manipulation should only be performed as needed.

You can drive after you receive Prolotherapy. You may feel a little stiff but will be able to continue with your activities of daily living. We do suggest walking for about five minutes before driving. You will also be capable of working. There are no work restrictions. You may choose not to work if your job involves a lot of standing or lifting.