This is the second part of a two-part article covering different, alternative treatments of chronic tendonitis or tendinopathies. In the first part, I discussed the use of low-level laser therapy, or cold laser therapy, and its effectiveness in providing relief and recovery in quadriceps knee tendonitis. For the second part, I will cover another type of treatment that is gaining popularity in the United States, but is still not fully supported by the medical community, known as prolotherapy.
“Prolo” is short for proliferation, or the hopeful growth and regeneration of new tendinous or ligamentous tissue in the areas affected. Prolotherapy uses a dextrose-based solution, which is injected into the tendon where it attaches in the bone. There are several other chemicals added to the solution including other proliferants, irritants, particulates, chemotactics, and growth factors.
After an extensive history and manual examination, the physician should be able to accurately pin point the site where the injection should go in the tendon or ligament. The proliferants inside the dextrose solution include minerals such as calcium, zinc, and manganese and help create an inflammatory response to the increased pressure gradient outside of the cell. The irritants alter the proteins and together with the chemotactics initiate the immune response. The growth factors are responsible for the laying down of new collagen and the “new” strengthened tendon is formed.
Like the last article I wrote about low-level laser therapy, whenever treating a patient, or suggesting a type of treatment to a patient, I like to know how effective it is and what the risks are, before going forward. A literature review of peer-reviewed journals showed that the procedure has mixed findings. Unfortunately, many of the studies had to do with chronic low back pain and not knee tendinopathy. But, the ones that did study knees, still found some positive statistically significant results. Of these, almost all showed an increase in range of motion and functional mobility, but only a couple showed statistically significant reductions in pain when compared to placebo (a solution that was injected with no active compounds).
So what can I conclude? The theory behind this type of treatment seems sound. Help the body, help itself. And while the pain may not be significantly reduced compared to placebo, it still did decrease. Furthermore, the increases in physiological function seem like they should be weighted more in chronic conditions. After taking a look at the minimal risks of skin and soft tissue irritation, this may be a viable alternative to surgery and/or multiple steroidal injections, such as cortisone. Unfortunately, the research only supports the use of prolotherapy for minor tears (up to 6%) in the tendon and was not effective in more severe tendinopathies. I would suggest bringing this up with your physician and discussing whether or not this is a realistic option and treatment choice for your particular case.