Prolotherapy at Center for Pain Management Rubab Hospital Johar Town Lahore

"My name is Dr. Waqas A. Chaudhary MD, MS (England), I'm a certified specialist in Pain Management, Sports Medicine, Rehabilitation, Prolotherapy.  and I have seen incredible results using Prolotherapy in my practice over the last few years. It consistently provides results where other treatments have failed. I have treated thousands  of patients using Prolotherapy with positive outcomes. As a Qualified medical doctor , I have used Prolotherapy with thousands of my patients that struggle with back pain, hip pain, neck pain, ankle pain, shoulder pain, elbow pain, knee pain, ankle pain, heel pain, foot pain, headaches and more to help them avoid surgery and go on to live pain-free. Joint instability  in Dr Chaudhary experience is typically the underlying   cause of many  chronic painful conditions and arthritis . Prolotherapy can stabilize the joint and eliminate the pain and progression of degeneration..

WHAT IS PROLOTHERAPY ?

Prolotherapy is  a  medical procedure that many acute and chronic patients, as well as athletes with sports injuries, are turning to because it is used as an alternative to surgery, arthroscopy, cortisone shots, Non-steroidal anti-inflammatories, and/ or chronic use of narcotic pain medications. Prolotherapy stimulates the body to repair the painful injured area(s) when the body’s natural healing process is not able to do the job on its own. In most cases, commonly prescribed anti-inflammmatory medications and more drastic measures like surgery, joint replacements, cortisone shots, and other therapies may not help, and often hinder or even prevent the healing process.

The basic mechanism of prolotherapy is simple. What most people are surprised to find out is the body heals by inflammation!. In other words, we need inflammation to heal our bodies. Prolotherapy works because it actually stimulates an inflammatory reaction in the body. We inject prolotherapy solution into the affected ligaments, tendons, and or joints, which leads to local inflammation in the injected area.

Many people who find themselves in pain want to get rid of the pain as soon as possible – whether their painful condition is from a back  injury due to improper lifting, a work-related injury such as Carpal tunnel syndrome from Computer use, or Plantar fasciitis from a sports injury such as long distance running. Prolotherapy becomes a very safe, affordable option that allows the patient to keep working and/ or training during the recovery process. Prolotherapy is one of the few treatments that encourages movement after the treatment and actually movement aids in the healing process.

HOW DOES PROLOTHERAPY WORK?

Prolotherapy involves localized  injection of proliferants solution into the area where the ligament or tendon is damaged. The solution, a proliferants /mixture of dextrose  and  lignocaine, is injected at specific points where ligaments and tendons meet bones. This causes a localized inflammatory response which increases blood supply, immune cells and nutrients to the weak area. This is the first step in the wound healing process and the step that is inhibited by anti-inflammatories such as NSAID’S and cortisone. Basically, you are tricking your body into thinking that it has been injured. However, this “new” injury promotes a far greater immune response than the original injury because of the injection of the irritant solution. The end result is that your own immune system sends connective tissue building cells to the area causing the proliferation of new collagen, thereby strengthening damaged tendons and ligaments. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger.

PLATELET RICH PLASMA (PRP) PROLOTHERAPY

PRP or Platelet Rich Plasma Prolotherapy is very useful and effective in cases of severe labral and meniscal (knee) tears, chronic osteoarthritis of the knee and avascular necrosis of the hip. PRP or Platelet Rich Plasma is a fairly new technique that involves drawing some of the patient's own blood and then processing it and using the growth factors to do the Prolotherapy. We have also used it when a patient is not responding quite as well as we had hoped and has a more severe injury.

We occasionally use Human Growth Hormone (HGH) along with regular Prolotherapy solution, in knee joints and hip joint, but also in other joints to help with cartilage regeneration.

BONE MARROW /STEM CELL PROLOTHERAPY 

Another aspect of comprehensive Prolotherapy uses your own stem cells. When we administer this kind of Prolotherapy, we are typically trying to resolve cartilage concerns or severe osteoarthritis and degeneration. Like PRP, it is administered into the joint along with comprehensive Prolotherapy to address all concerns.

Bone marrow is extracted either from the iliac crest (hip bone) or the tibia (shin bone) and directly injected into the patient in the area of concern. The benefits of bone marrow Prolotherapy are that it is taken from the patient and immediately injected back into the patient. No additions, no growing, no processing in a petri dish, just your cells back into your body in order to increase cartilage repair and cell growth. We also administers standard Prolotherapy to strengthen the joint further and treat the surrounding ligaments and tendons.

WHAT KIND OF STRUCTURES CAN BE TREATED WITH PROLOTHERAPY?

Prolotherapy involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament.

WHAT HAPPENS TO LIGAMENTS AND TENDONS AFTER INJURY?

During an injury, the collagen fibers that make up the ligaments and tendons are torn. The body heals these tears through the process of inflammation which is characterized by redness, swelling, tenderness, and stiffness in the joint. During the first days after injury, white blood cells flood the area to clean up the tear. Over the next few weeks, additional white blood cells migrate to the junction of the ligament and bone to begin building news collagen fibers. If the inflammation process is successful the new collagen fibers wind about each other becoming shorter and tighter. This healing process can take several months.

WHY DON’T INJURED TENDONS AND LIGAMENTS ALWAYS HEAL PROPERLY?

Healing can be disrupted if the injury is too severe or painful, or if the inflammatory process is interrupted with medications or abnormal activity. In addition, a lack of blood supply to tendons and ligaments deprives them of nutrients needed to heal properly. Due to these interferences, the tendons/ligaments heal in an elongated and disorganized fashion leaving the ligament lax and the nerves irritated. This causes restricted movement, excessive pain, and leaves the area prone to re-injury. This incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.

HOW CAN LIGAMENTS AND TENDONS BE STRENGTHENED?

They do not respond to exercise in the same way muscles do. Medications and manipulations can help reduce the pain only temporarily. In some cases, surgery can repair some injuries but is invasive and leaves scar tissue. Prolotherapy stimulates the body’s natural healing mechanisms to repair tendons and ligaments to their original strength without scar tissue.

HOW PAINFUL IS PROLOTHERAPY?

In order to create the inflammatory response desired, there must be a certain amount of disruption of the ligament. This is done by inserting a needle at the point where the ligament comes into contact with the bones. There is pain involved with introduction of the needle and the contact of the needle and bone.

HOW MANY TREATMENTS ARE NEEDED?

Every person has a different healing time. That is, until pain and function have normalized and the signs of joint instability and dysfunction are no longer detected. For some people only one injection is needed and other people need several. Repeated injections are performed between 1 and 6 weeks depending on the healing process.

WHAT ARE THE RISKS ASSOCIATED WITH PROLOTHERAPY?

As with any injection, there are certain risks. However the true risks are relatively minor. Some of the risks are pain at the injection site, infection, temporary bruising of the nerve, dizziness, numbness, and pneumothorax (air on the outside of the lung). Most of the side effects will effects will subside over the 2 to 10 days following treatment.