Prolotherapy for Achilles Heel Third Visit

It has been several months since my last injections into the achilles heel area of my right foot and lately I have been in considerable pain. Of course, some days are worse than others and it always seems to be the case when I go for the injections that the pain is not as bad as on other days. Perhaps hat is to make me think twice about having the prolotherapy treatment.

Of course once the injections begin there is no thinking twice. At the moment the needle is piercing a sensitive spot, even though it has been numbed with lidocain, it is not pleasant. In that moment the idea that this will hopefully eliminate the chronic pain in the foot goes away and there is instant regret. Within seconds my thoughts return to the idea that it is worth any and all fleeting to return to the pre-injury pain free days, and it all is worth it.

In order to find the right spots for the injection, the doctor presses hard on different places in the area around the most sensitive spot. Interestingly enough I am surprised to find that I have a number of sensitive spots other than the obvious ones at the insertion point where the achilles tendon enters at the bottom of the back of my foot. There are a number of sensitive spots moving up the tendon and even on the front of the ankle as well. The most sensitive spot is to the outside of the heel, where my foot rests as I press the accelerator on the car.

I lie on my back as the doctor cleans and then numbs the entire area with many shots of lidocain. These shots are with small needles and are just below the skin, so while they are not comfortable, they are not really painful either. Except the one into that sensitive spot on the side of the heel. Yowzer! We then 8-10 minutes for the medicine to work numbing the entire area.

One of the assistants said to me when I entered, “You love this stuff, don’t you?” I had to tell her that although I have had many shots, I do not like them. I like the healing they bring. “But if it was going to work, it would ahve already worked,” she says. I disagree, noting that there are many injuries that prolotherapy has already helped heal, and that I am working on the others hoping for the same relief and healing.

Still on my back, the doctor begins the prolotherapy injections into the different parts of my ankle and heel. The medicine has done its work and the area is numb so there is not that much pain from the needles. In some spots, I can feel the medicine as it is injected right on the bone where the ligament is attached. However when he injects the most sensitive spot it feels like there has been no numbing at all. The pain is intense, but the shot is quick and it passe quickly. Again, my thoughts return to the benefits and the healing that will come.

Because he has injected the area before and it is not yet healed, the doctor decides to use a stronger prolotherapy solution of 25% glucose instead of 15%.  This “medicine” is meant to stimulate the body to heal itself and to strengthen the ligaments in the area, so I assume a stronger solution merely causes more inflammation which brings more healing.  I am looking forward to that. I have been limping for months and the idea that pain can be cured is enticing and will worth any short term apin I might have had to endure during this visit.

I take a pain killer before bed the next morning there is not that much pain. There is always some pain the day after prolotherapy injection as the holes made by the needles are each a small wound that takes a few days to heal. I’ll limp a little today and by tomorrow I should be walking normally. And then… I’m looking forward to complete healing of the heel and foot..

Prolotherapy on Lower Back

It is now Monday making it four full days since receiving neuro-prolotherapy injections to relieve sciatica in both legs and nerve pain going down the front of both legs as well. By Thursday afternoon most of the nerve pain had subsided and now that intense pain that incapacitated me from Sunday through Thursday morning, I am pleased to say, is but an awful memory.

I had been scheduled for injections in my lower back as i continue to have sensitivity in the lumbar area of the lower spine. Deep injections help to heal the ligament damage  at the core of this type of pain, but I needed to postpone those injections last week due to the sciatica. I have had excellent success with Neuro-prolotherapy, or prolo injections just below the surface of the skin into the nerves, for relieving both nerve pain and whiplash. Today we were completing the treatments that I had been getting to my spine for several months.

As usual, the doctor starts by identifying the areas for treatment. He does so by pressing on different points and when I tell him it hurts, he marks the spot for an injection. He presses along all spots on either side of my lower spine into my buttocks. Today the pain is limited to an area of three or so vertebrae and spreads out on either side. All told he will do close to 15-20 shots.

After marking the area, the prolotherapy doctor cleans the area with an antiseptic and then injects the entire area with many shots of lidocain, to numb it. The needles are tiny at this point and the injections while unpleasant are not painful. In 5 minutes the area is numb and the Dr returns to begin the deep prolo shots. The needles are long and not small, as they must be placed all the way in against the bone where the ligament attaches to the bone.

As he injects one spot on my left side, a muscle in my lower right back spasms, but it is mercifully brief. Otherwise the injections are not too painful. While I can feel the needle penetrating, it is most often feeling the liquid being injected that causes discomfort. My doctor moves quickly and completes the shots within about 10 minutes. Other than feeling like a pin cushion, my back does not feel bad and a single vicodin in the evening will alleviate additional pain.

C. Everett Koop on Prolotherapy

Former United States Surgeon General, Dr. C. Everett Koop, was a proponent of Prolotherapy. In the preface to a book on the subject he wrote the following:

Prolotherapy is the name some people use for a type of medical intervention in musculoskeletal pain that causes a proliferation of collagen fibers such as those found in ligaments and tendons, as well as a shortening of those fibers. The “prolo” in Prolotherapy, therefore, comes from proliferative.

Other therapists have referred to this type of treatment as Sclerotherapy. “Sclera” comes from the Greek word “sklera”, which means hard. Sclerotherapy, therefore, refers to the same type of medical intervention which produces a hardening of the tissues treated – just as described above in the proliferation of collagen fibers.

Not many physicians are aware of Prolotherapy, and even fewer are adept at this form of treatment. One wonders why that is so. In my opinion, it is because medical folks are skeptical and Prolotherapy, unless you have tried it and proven its worth, seems to be too easy a solution to a series of complicated problems that afflict the human body and have been notoriously difficult to treat by any other method. Another reason is the simplicity of the therapy: Injecting an irritant solution, which may be something as simple as glucose, at the junction of a ligament with a bone to produce the rather dramatic therapeutic benefits that follow.

Another very practical reason is that many insurance companies do not pay for Prolotherapy, largely because their medical advisors do not understand it, have not practiced it, and therefore do not recommend it. Finally, Prolotherapy seems too simple a procedure for a very complicated series of musculoskeletal problems which affect huge numbers of patients. The reason why I consented to write the preface to this book is because I have been a patient who has benefitted from Prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients – but more on that later.

When I was 40 years old, I was diagnosed in two separate neurological clinics as having intractable (incurable) pain. My comment was that I was too young to have intractable pain. It was by chance that I learned that Gustav A. Hemwall, M.D., a practitioner in the suburbs of Chicago, was an expert in Prolotherapy. When I asked him if he could cure my pain, he asked me to describe it. When I had done the best that I could, he replied., “There is no such pain. Do you mean a pain?” And then he continued to describe my pain much better than I could. When I said, “That’s it exactly,” he said, “I can fix you.” To make a long story short, my intractable pain was not intractable and I was remarkably improved to the point where my pain ceased to be a problem. Much milder recurrences of that pain over the next 20 years were retreated the same way with equally beneficial results.

I was so impressed with what Dr. Hemwall had done for me that on several occasions, just to satisfy my curiosity, I watched him work in his clinic and witnessed the unbelievable variety of musculoskeletal problems he was able to treat successfully. Many of his patients were people who had been treated for years by all sorts of methods, including major surgery, some of which had left them worse off than they were before. Many of his patients had the lack of confidence in further treatment and the low expectations that folks inflicted with chronic pain frequently exhibit. Yet I saw so many of them cured that I could not help but become a “believer” in Prolotherapy.

I was a pediatric surgeon, and there are not many times when Prolotherapy is needed in children because they just don’t suffer from the same relaxation of musculoskeletal connections that are so amenable to treatment by Prolotherapy. But I noticed frequently that the parents of my patients were having difficulty getting into their coats, or they walked with a limp, or they favored an arm. I would ask what the problem was and then, if it seemed suitable, offer my services in Prolotherapy at no expense, feeling that I was a pediatric surgeon and this was really not my line of work. The results I saw in those many patients were just as remarkable as was the relief I had received in the hands of Dr. Hemwall. I was so impressed with what Prolotherapy could do for musculoskeletal disease that I, at one time, thought that might be the way I would spend my years after formal retirement from the University of Pennsylvania. But the call of President Reagan to be Surgeon General of the United States interrupted any such plans.

The reader may wonder why, in spite of what I have said and what this book contains, there are still so many skeptics about Prolotherapy. I think it has to be admitted that those in the medical profession, once they have departed from their formal training and have established themselves in practice, are not the most open to innovative and new ideas.

Prolotherapy is not a cure-all for all pain. Therefore, the diagnosis must be made accurately and the therapy must be done by someone who knows what he or she is doing. The nice thing about prolotherapy, if properly done, is that it cannot do any harm. How could placing a little sugar-water at the junction of a ligament with a bone be harmful to a patient?

C. Everett Koop, M.D., ScD
Former United States Surgeon General
Dr. Koop passed away February 2013 at age 96

Neuro-Prolotherapy for Sciatica Follow Up

It is late on Saturday night and it has been two and half days since my nuero-prolotherapy injections to alleviate my intense sciatica and nerve pain in my legs. I’m pleased to say that the pain has not returned at anywhere near the levels I was experiencing it before. neither the sciatica nor the nerve pain down the front of my legs has returned intensely and the there has been no pain in the front of the legs at all. The sciatica has returned slightly necessitating taking Vicodin during the day, which eliminates the pain.

Overall, I could not be happier with the success of the prolotherapy treatment to alleviate the sciatica. It pain was intense and unmanageable before the prolotherapy and after it has been very manageable. As my doctor noted, I ahve a fairly high tolerance for pain, so for me to complain it must have been bad. It was. And now I am pleased t say it is not. Let us hope the success continues a few more days.

Prolotherapy for Sciatica

I woke up on Sunday morning at 6:00 a.m. writhing in pain. It had been so long since I had nerve pain I had forgotten how painful it was. I didn’t even recognize it as sciatica at first. I didn’t have the usual spasm on my left or right side in the lower back which in the past had accompanied sciatic pain. Clearly this time something was triggering the nerve without triggering the spasms. Small comfort.

The good news was that the pain was equal on both sides. In fact, the pain started int he lower back and went down both the front and back of both legs. While that meant twice as much pain, it also meant that I was in balance. When I finally got to the doctor this morning, he confirmed that mechanically I wasn’t in bad shape. That of course didn’t help alleviate the pain.

With an important appointment in the afternoon, I told him I need something to alleviate the pain, that the vicodin just wasn’t doing it. He decided that neuro-prolotherapy was the answer. And it was.

Neuro prolo, unlike deep prolotherapy which uses long needles to inject “medicine” right at the bone, uses tiny needles to inject the medicine just below the skin. The “medicine” numbs the nerves which in time help calm the nerves deep below. It had worked on my whiplash months ago and I was looking forward to it working on my lower back and legs. And indeed it did.

The doctor injected my lower back, following the nerve pain right down into my buttocks and down my leg. The pain began to subside almost immediately and within 2 hours I was feeling fine. It is now 11 hours since the injections and the nerve pain is very slight. I’m looking forward to my first decent night sleep all week.

Neuro prolotherapy requires multiple treatments a week or so apart. But this time, it certainly solved my immediate problem. I’m hoping it lasts.