An Athlete’s Guide to Prolotherapy and PRP for Sports Injuries
Growth Factors: Harnessing the Body’s Regenerative Potential
Whether you are an athlete or train athletes, An Athlete’s Guide to Prolotherapy and PRP for Sports Injuries will give you the added confidence to train even harder.
As an athlete, you understand the body’s potential to heal and to strengthen itself. You can gain weight or lose weight, build muscle mass, makes yourself faster and more flexible, and improve agility and reaction time. You’ve tested this potential before each new season starts, and again as it’s winding down, in those last tense matches or meets. Even if you’ve never suffered a major injury, you’ve tested your own recovery time after difficult workouts, and following smaller injuries like bruises, sprains, scrapes, sore joints, and other aches.
Prolotherapy is based on a principle that you already understand: rest may be essential to recovery, but healing is active. The body has great potential to heal and to grow, but you need to tap or trigger that potential.
If you’ve injured a joint in a game or in training, your life might be on hold. You can try to “play through” the pain of minor injuries, but you risk do much more damage. If it’s bad enough, a doctor might suggest surgery, which could keep you from your team or your career for weeks while you recover. But surgery isn’t the only option.
Prolotherapy is an injection technique for damaged or weakened ligaments and tendons. Ligaments and tendons do not heal very well, or very quickly, on their own. Surgery is an option, but you risk doing more harm than good. Instead of performing surgery on a joint, a prolotherapist will inject the area with an irritant solution – often dextrose (sugar water), or another benign solution like saline or hyaluronic acid. This mild irritant sends a signal to the brain to send “help” to the area. This triggers a mild inflammation, which causes the weakened or damaged connective tissue to strengthen itself. The joint will generate new cellular tissue, which gives us the name: prolotherapy comes from “proliferate.”
This is a very old concept. According to ancient accounts, Roman physicians inserted hot needles into gladiators’ shoulders to tighten the joint capsules. While this may have been a primitive practice, both elements remain in use today. Orthopedic surgeons still heat up joint capsules to contract the joints (though they use copper wires instead of needles). Prolotherapists, meanwhile, use needles, albeit with a more “pointed” purpose: delivering solutions that encourage natural healing and growth.
Prolotherapy is an effective treatment for injuries sustained in car accidents, repetitive movement injuries, and even the natural joint deterioration that comes with aging. One of the most popular uses of prolotherapy, though, is for sports-related injuries.
Benefits of prolotherapy include:
- “Honest” Pain Relief – Pain is a signal that something isn’t well, or that something is in danger of further injury. Medications only mask pain; they come with negative side effects, and could even pose a risk of addition. Prolotherapy doesn’t mask pain, but it is a very effective form of pain relief. It reduces pain quickly because it speeds up healing.
- Minimally Invasive – Besides the prick of the needle – a pain minimized with local anaesthesia and an experienced prolotherapist’s skill – prolotherapy is minimally invasive. If you choose prolotherapy you aren’t risking the damage, pain, and additional recovery time of surgery.
- Short Recovery Time – Prolotherapy will have you back to training and competing more quickly than surgery. You might see results after one treatment. Depending on the injury, you should be ready to return to strenuous physical activity after three to four treatments. If successful, you could be feeling better than before your injury after as few as six treatments. Also, athletes are particularly well-suited to prolotherapy: they are motivated and conditioned to get better, and stronger, as soon as possible.
- Long–Term Healing – Surgery might fix an issue in the short term, but it could leave your joint weaker than when you were at your peak performance level. Prolotherapy encourages natural growth, and as such is often a better long-term solution to joint injuries.
As an athlete, you might use prolotherapy for:
- Back Pain – Prolotherapy will encourage injured ligaments and tendons to heal. You’ll probably think first of shoulders, knees, ankles, and elbows, and prolotherapy is an effective treatment for all these areas. But pain in other areas, including the back, is often the result of damage to ligaments.
- Head and Neck Pain, Including Migraines – Some chronic migraines stem from the craniocervical junction, the point where the skull and cervical spine meet. Ligaments here can be stretched and weakened – as, for example, from a car accident or a blow to the head in any sport. By strengthening the craniocervical ligaments, prolotherapy could reduce or end your migraines. Other head and neck pains also stem from ligamental laxity in the region.
- Arthritis – Whether you’re already suffering from serious pain or know you’re at risk because of genetic or occupational reasons, prolotherapy can help prevent or relieve joint pain, stabilize joints, and increase mobility.
- Hip Pain – Overstretched and damaged ligaments might be causing hip pain. Too many athletes try to treat pain like this with a “wait and see” attitude, using over-the-counter pain relief and anti-inflammatory drugs, and hoping it goes away. Prolotherapy could thicken hip-ligaments and increase tensile strength, relieving pain, improving performance, and reducing the likelihood of future injury.
- Shoulder and Back Injuries – Many kinds of shoulder and back pains trace to ligament and tendon damage. These could include:
- Dislocation and subluxation (minor dislocation)
- Rotator cuff injuries
- Lumbar spine (lower back)
- Thoracic spine (upper back)
- Bulging discs
- Foot and Knee Injuries – Foot and knee injuries are some of the most common athletes face. As an athlete, you’re on your feet constantly, which means you have to take extra precautions during the healing process. Instead of undergoing surgery on a foot or knee injury, which could keep you away from training and competing for several weeks, you could speed up your body’s natural recovery process with prolotherapy. Surgery will leave you weaker than before, and while you might be able to play, you’ll never regain your peak level of strength and performance. In contrast, prolotherapy could leave your weakened joint stronger than it was before the injury. Common prolotherapy treatments for foot and knee injuries include:
- ACL Tear
- Meniscus Tear
- Plantar Fasciitis
- Sprains – If you’ve suffered a sprain, your first line of defense is usually treatment with ice to reduce inflammation. Though it might seem paradoxical, prolotherapy is a second treatment option. By temporarily encouraging inflammation you can speed up the healing process and return to full mobility sooner.
- Post–Surgery Recovery – If you’ve had surgery to treat an injury or other condition, you might be left with ligamental laxity – lose joints. This can seriously impact your performance. Prolotherapy can return you to your peak performance level sooner by strengthening joints left loose and sore after surgery.
- Joint Degeneration – Prolotherapy can be a preventative measure to strengthen joints that you know are weak and more susceptible to injury.
- Preventing Further Injuries – As a rule, for every unit of increased ligamental thickness, strength increases by the fourth power. Because injured joints are more susceptible to additional injuries later on, an experienced prolotherapist can safely “overshoot” in treatments and encourage a joint to heal “past” its original strength, reducing the likelihood of future injuries.
>> Is prolotherapy natural?
Prolotherapy does not involve steroids or any other performance-enhancing drugs. Instead, prolotherapy triggers your body’s natural process of growth and regeneration.
>> How long will treatments last?
The number of treatments necessary depends on the location of the joint treated, the extent of the injuries, and the lifestyle and health of the patient. A young, healthy, active patient will recover more quickly in every (comparable) case. However, age and lifestyle don’t necessarily preclude a person from treatment.
You could see improvement after only one treatment – and for a minor concern, that might be all you need. If you have a head or neck injury, and are suffering from tingling, numbness, loss of sleep and mood instability, general mental function, and chronic migraines, you need immediate relief. If your head or neck injury is the result of damage to ligaments, as is often the case, prolotherapy can give you that immediate relief after one session, though you’ll need to undergo further treatments to return to full functionality. For most sports-related injuries, an experienced prolotherapist will probably aim for full recovery within three months.
>> Can prolotherapy work alongside physical therapy?
Prolotherapy can work hand-in-hand with physical therapy. By reducing pain and increasing mobility, it can speed up the physical therapy process. Stronger ligaments will be able to support more advanced exercises. Prolotherapy can also work alongside chiropracty.
>> Are there risks to prolotherapy?
For most common injuries or concerns, you will have little risk of sustaining further injury or worsening your condition if you seek treatment from an experienced prolotherapist. One exception is treatment of the thoracic spine (upper back). As with any intervention near the chest cavity, there is some risk of causing a pneumothorax – a collection of air inside the pleural space, causing the lung to detach from the chest wall. This condition may resolve itself, or a doctor can treat it in surgery. However, you should try other treatments for back pain – like massage, myofascial release, spinal manipulation, chiropractic, or physical therapy – before resorting to prolotherapy.
There’s a good chance you’ve heard about PRP already. PRP – an advanced prolotherapy of platelet-rich plasma injections – made international headlines back in 2009 when Hines Ward and Troy Polamalu opened up about using the treatment to recover from injuries before they won the Super Bowl. Soon newspapers everywhere were getting other major league and even recreational players to talk about using the treatment, fueling its popularity as an alternative to surgery, alongside speculation that further research could help end some of the most stubborn athletes’ injuries, like tennis elbow and tendonitis.
Like normal prolotherapy, PRP involves an injection to an injured part of the body. Instead of dextrose or another simple solution, though, PRP therapy uses an injection of a patient’s own blood, drawn and then concentrated through a centrifugal process, to isolate the platelets that release powerful proteins involved in the body’s healing and growth processes. These growth-encouraging substances are called growth factors. Rarely do these commonly injured parts of the body come into contact with such high concentrations of growth factors. Like prolotherapy, PRP can stimulate growth in ligaments and tendons, but unlike prolotherapy, it can even stimulate growth in bones.
Other benefits of PRP include:
- Little chance of rejection or allergic reaction because the platelets come from the patient’s own body.
- Low chance of infection.
- No scarring, unlike surgery.
- The injection procedure takes only about 20 minutes.
>> Does PRP hurt?
Like regular prolotherapy, you only have to fear the needle – and even that shouldn’t be so scary with a local anaesthetic and an experienced prolotherapist administering the procedure. An injection of pure PRP will hurt, but an admixture of PRP and a small amount of a non-toxic anaesthetic can make the procedure much more comfortable. The only other difference is that PRP requires the initial drawing of blood.
>> How long does PRP take to work?
Like all types of prolotherapy, the amount of time it will take for a patient to see results varies by the location and extent of the injury and by the health of the patient. It would take between two to four weeks to regenerate tissue, compared to four to six weeks of recovery time after a surgery – one reason why major league sports managers have been so keen for their athletes to try this.
>> Is PRP more expensive than regular prolotherapy?
Yes. The machines required to separate platelet concentrations from a patient’s whole blood are expensive. Depending on health insurance, these costs could be translated to the patient. Still, PRP injection therapy is much cheaper than surgery. With greater public awareness and clinical research, health insurance providers may change their policies regarding PRP, making the procedure available to more patients.
>> What are the advantages of PRP over regular prolotherapy?
One of the most obvious advantages of PRP over regular prolotherapy is that the patient doesn’t need as many treatments. Regular prolotherapy encourages the body to stimulate growth; PRP delivers those growth factor-carrying cells directly to the injured area.
As an athlete, you know how to listen to your body better than most people. It doesn’t take an injury for you to know when something’s wrong. You might have a “weak” knee, or an elbow that doesn’t hurt, exactly, but starts to feel different after a hard day’s use. You know that this part of you is at risk, and some day, some hit, step, twist, or fall will end in injury.
Don’t wait until that happens. You do have the option of undergoing prophylactic prolotherapy. A series of injections could stabilize and strengthen your joints, help to prevent injury, and even lengthen your career.
Also, many athletes elect from prolotherapy after they retire. Your body could start to deteriorate after relax your old regimen, and prolotherapy could ensure that you can continue to enjoy an active life even as you take up other pursuits off the field or court.
If you or a loved one is an athlete and has injured themselves, contact Sports Medicine Doctor, Dr. Mikhail Strut at RES Physical Medicine and Rehab for a thorough examination of your injury and pain.