The science behind PRP and Prolotherapy for knee pain
May 14, 2012 by admin
Filed under Dr. Darrow's Blog, Platelet Rich Plasma Research, PRP Knee Pain
Two alternative solutions we offer for knee pain in our Los Angeles office is Prolotherapy and Platelet Rich Plasma Therapy performed under ultrasound guidance.
These are injection techniques that do exactly the opposite of surgery. They rebuild and strengthen damaged tissue as opposed to removing them.
UPDATE: Platelet Plasma Therapy BEFORE Cortisone!
Research in the International Journal of International Orthopaedics say Platelet Rich Plasma therapy BEFORE ethoxysclerol, cortisone, and/or surgical treatment!
Researchers in the Netherlands evaluated the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) and whether certain characteristics, such as activity level or previous treatment affected the results.
What they found was: “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.” (1)
The Use of Ultrasound
Research in the Journal of Clinical Rheumatology says that “(Ultrasound) Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.”
The researchers found that ultrasound guided injection over conventional palpation-guided methods resulted in 48% reduction in procedural pain, a 42% reduction in pain scores at outcome, 107% increase in the responder rate and with higher accuracy, less need for procedure, significantly reducing patient cost. (2)
The Use of Prolotherapy
Recent medical studies on both treatments support that articular cartilage and meniscal tissue can regrow with treatment. (3,4)
The Use of PRP
New research suggest PRP can be a very effective treatment for knee defects: Researchers writing in the International Journal of the Care of the Injured wrote: “(this treatment) is a simple, low-cost, minimally invasive way to apply PRP growth factors to chronic patellar tendinosis…20 male athletes with a mean history of 20.7 months of pain received treatment, and outcomes were prospectively evaluated at 6 months follow-up. No severe adverse events were observed, and statistically significant improvements in all scores were recorded. The results suggest that this method may be safely used for the treatment of jumper’s knee, by aiding the regeneration of tissue which otherwise has low healing potential. (5)
In the medical journal International Orthopaedics, researchers noted: “Histological examination and study of angiogenesis showed that the application of PRP enhances and accelerates the tendon healing process.” (6)
Prolotherapy works as an irritant using dextrose (a simple sugar) is introduced in the knee. This causes the immune system of the body to accelerate the inflammatory process. More inflammation? The body’s natural healing response is inflammation. Only when complete healing does not occur does inflammation become chronic and problematic.
What this new inflammation does is bring fribroblast and condrocytes, those cells necessary to rebuild the collagen matrix of the tissue, strengthen and restoring them to preinjury form in many cases.
In Platelet rich plasma therapy, blood is drawn from the patient and is used instead of dextrose. The principle is the same except PRP is usually reserved for patients with more damage to the knee area or for high level athletes needed for a big game.
1. Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.Int Orthop. 2012 Apr 27. [Epub ahead of print]
2. Sibbitt WL Jr, Band PA, Kettwich LG, Chavez-Chiang NR, Delea SL, Bankhurst AD. A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee. J Clin Rheumatol. 2011 Dec;17(8):409-15.
3. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Canacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18(4):472-479.
4. Reeves KD Hassanein K Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Hlth Med 2000;6(2):37-46.)
5. Kon, E. et al. Platelet rich plasma: New clinical application. A pilot study for treatment of jumper’s knee. Injury, International J. Care Injured 2009;40:598-603.
6. (Lyras D, et al. Immunohistochemical study of angiogenesis after local administration of platelet rich plasma in a patellar tendon defect. International Orthopaedics 2009;11 February: online.)
On a waiting list for knee replacement?
May 13, 2012 by admin
Filed under Dr. Darrow's Blog
It is not unusual for a patient to be put on a long waiting list for their knee replacement surgery. We see patients frequently on lists that are 3,4,5,6 months to a year long. Seemingly the older the patient, the longer the wait as well.
Research indicates that “Longer pre-surgery waiting time had a negative clinically important impact on quality of life and contralateral knee pain 6 months after surgery.” (1)
So the longer you wait, the greater the chance for pain before and after surgery.
More reasons not to wait for treatments
You can try Prolotherapy and PRP will waiting
Unless you are elderly and have advanced osteoarthritis and knee deformity, there are many reasons NOT to consider total knee replacement. In this economic setting, one especially valid reason is that many cannot afford to take nine weeks off from the job.
Recent research published in The Journal of Bone and Joint Surgery says that on average it takes about 9 weeks to return to work following total knee replacement. Of course for people worried about their job, or are self-employed, or did not have complications returned sooner, four to five weeks post-operation.
Even so, in these days of job worry, can most employees consider taking themselves out of the work place for two months or more? If they rush themselves back too soon, will they do it at the expense of long-term recovery or will it come with the assistance and reliance on pain management medications including narcotics?
Do I live with the pain or get the surgery and risk more pain? What are my options?
Most patients we see in our joint pain and sports rehabilitation practice visit us because they have already been given the surgical ultimatum – live with the pain or get the surgery. These patients want another choice to their knee replacement prognosis and diagnosis that include osteoarthritis (bone-on-bone caused by cartilage disintegration), weakness or tears in the meniscus and the ligaments. Supportive of this diagnosis will usually be a long history of MRI images, failed physical therapy and other conservative treatments.
Sometimes they bring in a shopping bag filled with prescription pain-killers and anti-inflammatories and the long-list of over-the-counter and natural remedies they take.
Two options they have usually never tried or been informed of are Prolotherapy and Platelet Rich Plasma therapy. Both of these treatments are injection therapies designed to rebuild cartilage, repair torn meniscus and ligaments, and reduce swelling and pain.
Both work similarly. First a proliferant, something in the injection that will cause tissue to regrow is introduced. In Prolotherapy, which is usually the first option we choose because it is more conservative approach, simple sugar (dextrose) is introduced. In Platelet Rick Plasma Therapy (PRP) it is blood platelets drawn from the patient and reintroduced in the knee.
The treatments work at growing new cells, Chondrocytes, the cells that comprise knee cartilage, and fibroblasts, the most common cells in the connective tissue (those that make up ligaments and tendons.)
Prolotherapy and PRP therapy works fast in many cases. Single sessions once a week over the course of 4-6 weeks can show significant result in many. Ideal for the employee or active lifestyle individual is that treatments can be received at lunch time and in the afternoon you can be back at the office.
Is Prolotherapy or PRP Therapy right for you? Finding the right doctor is your first step. Marc Darrow, M.D. is one of the Nation’s foremost experts in the field of Prolotherapy and PRP injections. Featured in Newsweek Magazine and on ABC News, Dr. Darrow has treated thousands of patients who suffer needlessly from chronic joint pain.
To learn more about Dr. Darrow, PRP Therapy, and Prolotherapy, as well as the Darrow Sports and Wellness Institute, call our office at 310-231-7000.
1. Desmeules F, Dionne CE, Belzile EL, Bourbonnais R, Frémont P. The impacts of pre-surgery wait for total knee replacement on pain, function and health-related quality of life six months after surgery. J Eval Clin Pract. 2012 Feb;18(1):111-120. doi: 10.1111/j.1365-2753.2010.01541.x. Epub 2010 Oct 12.
Tendon Tears, PRP, and Prolotherapy
May 12, 2012 by admin
Filed under Dr. Darrow's Blog
You have a partial tendon tear. The doctor says you have two options: surgery or rest and rehabilitation. If you have surgery you will be shut out of training for months, perhaps even a year. If you choose rest and rehabilitation, in a few months the tendon injury will hopefully resolve itself and you can get back to training. What else can you do? You could work through it and risk further injury, but continued workouts can also throw off your symmetry.
Finally, an alternative method of pain relief and tendon repair has surfaced. This method could soon get you back to training at full strength. Using sugar (dextrose) injections in a technique called Prolotherapy, some doctors are getting their bodybuilders back to the gym faster than previously thought possible.
Many strength trainers and weightlifters know that they have damaged a tendon, either through acute injury or chronic wear and tear. They’ve found a noticeable weakness in muscle power, yet because they don’t understand the tendon’s function they try to work through the pain, unwittingly making their problem worse.
Tendons are small, strong, thick bands of connective tissue that connect the muscle to the bone. It is the tendon that converts the muscle’s strength into muscularskeletal movement by bending and straightening joints. When your tendon is weakened through wear and tear, fraying, or a partial tear, the muscle’s power cannot be fully converted into movement and you lose efficacy in your exercise routine. A weakened tendon will result in asymmetry. If a tendon in your right elbow is damaged, dumbell curls will give you a great left biceps and a noticeably poor right biceps. Equally, a weak right knee tendon will lead to an atrophied appearance of the right thigh when compared to your left. Trying to even things out by doing more for the weakened side will only backfire, because you will injure the tendon even further.
SO NOW WHAT?
Surgery is your only option for a complete tendon rupture; nothing else will allow you to eventually resume training During surgery, the tendon may be stitched back together, the entire tendon may be replaced, or if enough viable tendon is present it may be screwed back into position.
Lumbar Spinal Stenosis
May 12, 2012 by admin
Filed under Dr. Darrow's Blog
Lumbar Spinal Stenosis is a narrowing of the space between vertebrae where the spinal cord and the spinal nerves travel. It is a diagnostic term to describe lower back pain with or without weakness and loss of sensation in the legs. It is a very common condition brought on mostly by aging and the accompanying degeneration of the spine.
As we age, our spine loses a lot of its youthful vitality. Discs compress, muscles, ligaments, and tendons weaken. With the spine weakened, the boney structures of the vertebrae begin to overgrow (osteoarthritis) as a means to stabilize the structure. The new boney mass begins to encroach on the openings in the spine that the nerves and spinal canal pass through. As the openings begin to narrow, the spinal canal and nerves rub against the bone causing irritation, inflammation and the symptoms of stenosis mentioned above.
As a chronic pain specialist, many patients come into our office with a date for surgery or, and more unfortunate, a diagnosis of failed back surgery. For the patients who had put off surgery, they have explored their options and have discovered that surgery is not the answer for them. For the patients who had the surgery, they need more options than before.
In the recommended surgical procedures for spinal stenosis, two choices are the most favored. A Decompression procedure where the surgeon will shave and cut away the bone narrowing the spainal canals. The second, a fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves.
Surgery for spinal stenosis should always be considered only after other conservative therapies have been exhausted because it is usually not as successful as hoped and leads to a new diagnosis “failed back surgery syndrome,” where symptoms continue to deterioriate. It is important to note that in instances where stenosis is so severe that the patient has lost circulation to the legs or bladder control – a surgical consult should be made immediately.
Many “conservative” or non-surgical treatment options include the use of anti-inflammatories or epidural cortisone injections. We avoid the use of these treatments as they are temporary “quick-fixes.” The medical literature is now long in studies that have shown that these treatments are contributors to accelerated deterioration of spinal and joint degeneration.
In our practice we favor a multi-pronged attack to the problem of lumbar stenois that strengthens and stabilizes the spine naturally. First we use chiropractics to align the spine. Secondly we use therapies such as a the MedX spinal muscle exerciser to strengthen the core muscles. Thirdly we use Prolotherapy as our main weapon to stabilize the spine naturally.
As one of the leading prolotherapy practicioners, Dr. Marc Darrow, M.D. developed the Prolotherapy Institute to educate patients, their caregivers and the medical community about the benefits of Prolotherapy. Dr. Marc Darrow is a Board Certified Physiatrist specializing in Physical Medicine and Rehabilitation. He is also an Assistant Clinical Professor at University of California School of Medicine, Los Angeles, where he trained, and teaches Prolotherapy to the doctors in their residency training.
Golfer’s Knee
May 11, 2012 by admin
Filed under Dr. Darrow's Blog
Many golfers will go to great expense and effort to shave a stroke or two off their game. Yet the last thing many will do is visit the doctor to have their knee pain remedied for fear that surgery will be the only option.
Where does the golfer’s knee pain come from?
For most, golfer’s knee pain is a degenerative process caused by the repetitive motions of the golf swing and the twisting of the forward knee in the follow through. The force of continued impact on the knee is usually manifested as chronic, dull pain; cracking or popping sounds from the knee while walking; and, pain from swelling and inflammation. These symptoms can come on slowly or more rapidly depending on the technique of the golfer and the remedies they chose to administer to themselves.
Prolotherapy to the knee
The interior damage to the knee
The knee can be injured in many ways in golf including ligament damage. The ACL (anterior cruciate ligament), the MCL (medial collateral ligament) and the PCL (posterior cruciate ligament), are powerful ligaments responsible for holding the knee, the thigh bone (femur) and the shin bone (tibia) in their proper place in respect to each other.
When these ligaments suffer from excessive wear caused by a twisting golf swing, they become lax, they loosen up and a tight knee becomes a “wobbly knee.” When the thigh and shin bone are allowed to become hypermobile they can grind down and wear out the protective padding between them, the meniscus and the articular cartilage.
The articular cartilage is the protective padding covering over the bottom of the thigh bone and the top of the shin bone. The meniscus is the soft pad between the bones that absorb the impact of walking, running and jumping. When they wear down, bone-on-bone osteoarthritis occurs.
There are many treatment options available to the golfer. Most physicians will recommend a conservative route rich in anti-inflammatory medications, ice, pain-killers, and rest. When these options fail, as most times they do, the next conservative option is to “live with it,” or have the surgery.
Why do these treatments fail?
Because they all inhibit inflammation. Inflammation is the body’s healing mechanism. No inflammation, no healing. The problem with inflammation is excessive inflammation. The injured knee cannot heal itself and the body turns up the inflammatory response with its accompanying pain and discomfort.
The key to treating the injured knee in golfers, or any athlete or patient with chronic knee pain, is to control the inflammation.
Prolotherapy
Prolotherapy is an injection technique that helps concentrate inflammation and maximize its benefits in a controlled situation. Here is how it works. Dextrose, a simple sugar is injected to the exact spot of pain and deterioration in the knee. The dextrose irritates the surrounding tissue, mimicking a new injury. The body responds to the knee injury by sending collagen and immune system cells concentrated to the point of the injection, isolating on the damaged ligaments. The immune system response is to lay down a new layer of strong collagen fibers on top of damaged ones. The new collagen causes a tightening of the damage tissue and helps restores the ligament to its normal strength.
Many medical studies have now been published supporting the positive response of Prolotherapy even in knees severally damaged by osteoarthritis.
Treatments for the golfer can occur as frequently as once a week with treatments lasting 3 – 6 weeks generally.
The benefits to the golfer in choosing Prolotherapy is that there is no down time usually recommended and movement is encouraged during treatment to enhance the healing process through enhanced circulation.
What about Platelet Rich Plasma Therapy?
Need help? Call our office 310-231-7000 or email us