What exactly is prolotherapy?

medical-on-the-runProlotherapy – not a familiar term, is it?  In fact, it’s obscure enough that the computer dictionary tells me it’s misspelled.

Since my doc is recommending it as something that might help cure my Achilles pain, I figured I’d better look into it before making a call on it.  Either way, I’m probably going to seek a second opinion, just because I’m tired of messing around with this, and I want to know the chances of success.

The Definition

Prolotherapy is the commonly-used term for proliferation therapy.  First developed in the 1950s, the treatment uses an injection of an irritant (in this case, dextrose solution) into the affected area.  Once injected into the tendon, the irritants spur the body’s healing process, ideally generating new tissue in the place of the damaged tissue.  The treatment is most commonly used for lower back pain, osteoarthritis, and tendonitis.

There currently is some ongoing discussion as to whether or not prolotherapy is effective.  The answer depends on who’s asked.  Most major insurance providers consider it an experimental or investigational  therapy, and do not provide coverage for the procedure.

One example is Aetna.  The health insurance company does not cover the treatment, because they consider it to be “experimental and investigational for all indications…because there is inadequate evidence of its effectiveness.”

The procedure’s defenders say otherwise.  The American Association of Orthopaedic Medicine claims prolotherapy is not experimental, citing a small number of studies, and the fact that the therapy is taught as an acceptable method of treatment by one or more approved post graduate programs.  Prolotherapy is also listed as one 24 ‘official specialities’ recognized by the American Osteopathic Association.  Finally, the AAOM says dextrose prolotherapy specifically has been proven effective in several level-one and level-two studies, published in medical journals.

One such study, published in the British Journal of Sports Medicine, suggests that prolotherapy, when combined with eccentric exercises, results in quicker improvement in symptoms.  That said, the long-term outlook is similar to improvements made with eccentrics alone.


The Take-Home

So, if I’m reading that correctly, studies suggest that prolotherapy, along with eccentric stretching and strengthening, helps speed recovery from Achilles tendonitis.  That said, the same recovery could be had through eccentrics alone, over a longer period of time.

Maybe that’s worth it to a person who’s looking to get back on track quickly.  But I’ve heard that before, and here I am, still scheduling doctor’s visits after three-plus years of treatments.

An Alternative?

During my research, I came across this article, which brought my attention to the polidocanol injection.  The piece was written by Håkan Alfredson, Johannes Tol and Robert-Jan de Vos.  Alfredson is widely-noted as one of the leading authorities on Achilles tendinopathy.   My understanding is that the treatment involves injecting polidocanol (a anesthetic) into very specific areas, guided by ultrasound and Doppler.  The targets are the neovessels in the tendon that cause the inflammation and pain.  Early studies are promising.

I wonder how widely-practiced this is in the US, and what the likelihood is that the military will let me go outside its system to seek the treatment.

It never hurts to ask….


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