John Trister specializes in prolotherapy treatment at his office in Massachusetts. Prolotherapy is a non-surgical treatment designed for various musculoskeletal disorders, including osteoarthritis, tendinitis, tendinosis, ligament laxity, and the aftereffects of musculoskeletal injuries. This method harnesses the regenerative potential of connective tissue in response to injections of a 15-20% dextrose solution. In certain cases, activated platelets (PRP) or autologous blood may also be utilized. This procedure stimulates specialized cells, particularly mesenchymal stem cells, which play an essential role in the healing of damaged or diseased tissues.

Not every patient will benefit from this treatment. Careful clinical and diagnostic evaluation is necessary to select suitable candidates.

Please contact our office for an evaluation regarding prolotherapy.

FAQs

About Prolotherapy

Prolotherapy is also known as nonsurgical ligament reconstruction, and is a treatment for chronic pain.
First, it is important to understand what the word Prolotherapy itself means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.
Ligaments are the structural “rubber bands” that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose.

Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons may also become injured, and cause pain.

Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally. Of course, we don’t use hot pokers today, but the principle is similar—get the body to repair itself, an innate ability that the body has.

Prolotherapy is helpful for what conditions?

The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ and sciatica.

How long will it take to complete a course of treatments?

The response to treatment varies from individual to individual, and depends upon one’s healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. The best thing to do is get an evaluation by a trained physician to see if you are an appropriate candidate. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate.

Here is a list of conditions that can be treated with Prolotherapy:

Pain secondary to degenerative disease and injuries of  following locations: (Neck, TMJ dysfunction, Shoulder, Acromioclavicular joint , Elbow, Wrist, Fingers and Thumbs, Thoracic spine, Scapular and Ribs pain; Lumbar pain, Sacroiliac joints pain, Pelvic pain, Hip, Knee, Ankle and Feet. Heel spurs Barre-Lieou syndrome, Carpal tunnel syndrome, Headache, Fibromyalgia. Pain secondary to osteoporosis.)

Dear Patient:

Thank You for your interest in Prolotherapy, to make an initial consultation effective and informative please follow the steps below.

* Read all available information about Prolotherapy online, and the information provided in this packet

* Prepare a list of questions you may have for the doctor.

* Please obtain a copy of any radiological images (XRAY, CT SCAN MRI). You should be able to request a copy of the radiology imagines from the Radiology Department.

* Please obtain a copy of your latest blood test results including complete blood count (CBC) & Basic metabolic panel (BMP)

* Please provide a list of current medical conditions including any allergies and/or food sensitives.

* Please provide a list of current medications along with the dosage and frequency. Along with any over the counter medication/supplements you may be taking.

What You Can Expect:

The initial consultation will be focused on taking detailed history and conducting a musculoskeletal physical exam to assure the appropriateness of Prolotherapy. Your diagnostic test/s will be reviewed and taken into consideration along with any medications and/or supplements you are taking. Patients are encouraged to bring a family member or friend to the consultation to ensure that all possible questions have been addressed during the consultation.

*PLEASE NOTE: Treatment will not be performed the day of consultation.

*The cost of the initial consultation is $375.00. Insurance does NOT COVER PROLOTHERAPY.

Absolute Contraindications for Prolotherapy:

1. Hardware from prior surgical procedure in the affected area
2. Currently undergoing treatment for cancer
3. Currently undergoing treatment for autoimmune condition and taking “immune modulating therapies”
4. “Full thickness” tendon tears
5. Any evidence of infection
6. Pregnancy

Facts Regarding Prolotherapy:

Prolotherapy (Regenerative Injection Therapy) was originally used by Hippocrates over 2500 Years ago to heal a javelin’s shoulder injury. This concept was investigated, utilized, and refined by Dr. George Hackett, MD over 70 Years ago.

The cause of a great deal of musculoskeletal pain is related to chronic laxity or relaxation of the connective tissues (ligaments and tendons), which normally control joint movement and provide support for standing, sitting, and locomotion. These tissues are moist commonly damaged by trauma and overuse and the initial healing response may not adequately “weld” the structures back together.

Furthermore, anti-inflammatory medications (Ibuprofen, naproxen) also interfere with the body’s natural healing process, which may result in chronic weakness/ laxity of these ligaments. These once elastic ligaments and tendons “lose” their elasticity. Other contributing factors to ligamental laxity are hormonal changes, such as pregnancy. This is physiologic in preparation for childbirth. However often times the ligaments and/or tendons do not restore their elastic properties fully. Other individuals are predisposed because of genetic variations such as Ehlers Danlos Syndrome or other connective tissue disorders resulting in joint hypermobility or “double jointedness.”

The result of reduced structural stability is a chronic sprain of the ligament and tendon fibers which are connected to the extremely sensitive periosteum of the bone which through nerves sends pain signals to the brain. To compensate for the instability, the corresponding muscles go into spasm resulting in pain and stiffness. There lies the paradox: muscle stiffness is the result of joint hypermobility.

Prolotherapy Injections contain dextrose, local anesthetic, and sterile water. Injections are targeted into the joint space as well as around the joint space (where ligament/tendon connect to bone – enthesis). The solution is hyperosmolar, causing a controlled injury and healing response, which results in growth (Proliferation) of the tissues. In other words, we are injuring the area to stimulate your body to heal. Over time, the weakened tissues get stronger resulting in increased stability, less muscle tension/spasms, improved range of motion and eventually less pain.

Numerous studies have shown a success rate of 80-90% over thousands of patients with success judged as at least 50% reduction in pain.

Typically, injection treatment sessions are administrated 4-6 weeks apart with an average number of 4-6 injection sessions required per patient. This is very much a case by case basis. It is important to remember that everybody heals differently and we will go into your specific situation during the consult. However, the response is directly related to the speed of healing within our bodies. Generally, young, healthy people who good nutritional status will heal faster than someone in poor health.

Publications Describing Prolotherapy

1. Hackett, George A., and Henderson, Donald G., “Joint Stabilization: An experimental, Histologic Study with comments on the Clinical Application in Ligament Proliferation” American Journal of Surgery, 89 (May 1955), PP.968-973.
2. Klein, Robert G. Proliferation Injections for Low Back Pain: Histologic Changes of Injected Ligaments and Objective Measures of Lumbar Spine Mobility Before and after Treatment”, Journal of Neurology, Orthopedic Medicine, and Surgery, 1989, 10:141-144
3. Klein, Robert G., Mooney, Vert, ET AL “A Randomized Double-Blind Study of Dextrose-Glycerin-Phenol Injections for Chronic Lower Back Pain”, Journal of Spinal Disorders, 1993, 6:23-33.
4. Lui, Y Kinget Al., “An in-Situ Study of The Influence of Sclerosing Solution in Rabbit Medical Collateral Ligaments and it’s Injection Strength”, Connective Tissue Research, 11 (1983), PP 95-102
5. Ongley, Milne J., “A New Approach to the Treatment of Chronic Low Back Pain”, The Lancet (July 18, 1987), PP 143-146
6. Dorman, Thomas A, Editor, Prolotherapy in the Lumbar Spine and Pelvis Spine: State of Art Reviews, Volume 9 Number 2, Philadelphia, Hanley and Belfus, Inc., 1995
7. Hackett, George S., and Hemwall, Gustav A., and Montgomery, Gerald A., “Ligament and Tendon Relaxation Treated by Prolotherapy”, 5th Edition, 2nd printing, Oak Park, Illinois 1993
8. Houser, Ross, “Prolo Your Pain Away”, Curing Chronic Pain with Prolotherapy”, Beulah Land Pres, Oak Park Illinois 1998.
9. Reeves, K Dean, “Technique of Prolotherapy”, Psychiatric Procedures, Lennard, Ted A., Editor, PP 57-70, Philadelphia, Hanley Belfus, 1995
10. Wilkinson, Harold A., “The Failed Back Syndrome: Etiology and Therapy”, New York, Springer-Verlag, 1992, PP 147-169.

Patient Preparation for Injections:

1)Read the Prolotherapy handout and make sure you have ALL your questions answered before beginning treatment.

2)You may have a light meal the day of your treatment, however, please do not consume any food within 2 hours of your treatment. The weeks leading up to treatment you want to eat a lot of foods rich protein and vitamin C; this will help with healing. Lots of high quality grass fed beef, pasture raised chicken, wild caught fish, organic vegetables and fruit. You also want to make sure you stay adequately hydrated; at least 64 fluid oz water/day.

3)For your safety it is highly recommended to have someone drive you home after your treatment, mandatory if you are having treatment on your Neck.

4)Please STOP Aspirin and Non-Steroidal Anti-Inflammatory Medications. It is Okay to continue taking “BABY-ASPIRIN” (81MG) unless otherwise told by your doctor.

5)STOP ANTI-PLATELET AGENTS (PLAVIX, TICLID) for 7 days prior. With approval from your doctor.

6)STOP COUMADIN (WARFIN) for 5 days prior to your injection with PRIOR APPROVAL from your DOCTOR and obtain STAT BLOOD

TEST (PT, INR AND PTT) on the morning of your injection. Have any results faxed to our office.

Please contact us prior to your appointment if:

1)You have a significant change in your medical history.
2)You have any questions about your medications.
3)You are taking antibiotics, are being for an infection or are feeling ill.

Thank you and we look forward to seeing you at your next visit.

Jon Trister, MD Diana Trister, DO