KNEE BLOG

REST, ICE, COMPRESSION, ELEVATION
Q. I have severe knee pain and swelling caused by osteoarthritis, you don't recommend the RICE treatment?

A. We don't recommend the RICE treatment. The method we recommend is called MEAT. This stands for Movement, Exercise, Analgesics (pain relievers), and specific Treatments that increase blood flow. To speed up recovery from an injury, an athlete or patient should put weight on the area, move the injured limb, take pain relievers that do not decrease inflammation, and then receive specific treatments that encourage healing. These include physical therapy, massage, ultrasound, electrical stimulation, magnetic therapy, and Prolotherapy.

OSGOOD-SCHLATTER DISEASE: APOPHYSITIS OF THE KNEE
Chronic knee pain may develop in young athletes, especially teenagers, and is often due to Osgood-Schlatter Disease, a condition whereby the tibial tubercle becomes painful where the patellar tendon attaches to the tibia. Pain occurs because there is tendon weakness at the same area of the tibia that is growing. The pain is exacerbated by physical activity, especially running and jumping, and often limits participation in sports, resulting in the young athlete’s physicians recommending cessation of playing sports. Needless to say, this advice is not popular. In my opinion, better treatment is to strengthen the fibro-osseous junction of the patellar tendon onto the tibial tubercle, eliminating the problem. In a small study published in 1993, Prolotherapy was 83 percent effective in eliminating the pain of Osgood-Schlatter Disease. In this study only one to two treatments were needed to resolve the problem.

Kidd, R. Recent developments in the understanding of Osgood-Schlatter Disease: A literature review. The Journal of Orthopaedic Medicine. 1993; 15:59-63.

Article by Ross Hauser, M.D.

Can Prolotherapy improve a medial inner tear of the meniscus
A. Would I get Prolotherapy if I had a Meniscal Tear? Most definitely I would. Unfortunately there have not been long term studies to prove or disprove that Prolotherapy helps heal meniscal tears. Anecdotal evidence is there that meniscal tears typically do very well with Prolotherapy. We have many patients, who over the years healed completely and did not need any further care.

Typically it takes 4-6 visits of Prolotherapy to heal a meniscal tear. Meniscal tears typically cause very discrete pain on the medial or lateral knee joint line and it increases with running, squatting, and cutting. Sometimes there is a 'catching' sensation. These symptoms usually decrease with each Prolotherapy session.
 
Answer by Ross Hauser, M.D.
 

Scar Tissue
Q. I have a lot of scar tissue in my knee, (adhesions), I am concerned that Prolotherapy, along with building good tissue will also build scar tissue.

A. Prolotherapy will not interfere with adhesion or scar tissue. The Prolotherapy solution is injected at the fibro-osseous junction to stimulate production of the collagen matrix which does not create or promote adhesion formation in the body.

Completely torn Ligaments and Prolotherapy
Q. Will Prolotherapy work on a ligament that have become completely detached from the bone?

A. No, if your ligament injury is a complete tear, you would need to have the ligaments surgically reattached before we could treat that part of your body.

Tendonitis
I have diagnosed with tendonitis from running. More specifically, I have sharp pain in the back my knees. Is Prolotherapy an option to minimize tendon inflammation and reduce pain?

Dear Knee Tendonitis: I would definitely recommend going to a Prolotherapist, but specifically one that runs or exercises a lot. You need someone who can evaluate your condition as a tendon, ligament, or running mechanical problem. Proloing the tendon or ligament to make it stronger will help but if your running mechanics are off the condition will continue to plague you. At Caring Medical we seek to cure you of the problem so you don't have to get Prolo in the area again!

Answered by Ross Hauser, M.D.

I want to get Prolotherapy for osteoarthritis of the knee what exercises would you recommend during treatment?
A. Typically, we recommend that our patients with knee pain or knee arthritis avoid pounding exercises such as running and opt more for low weight/high rep weight training to strengthen the quad muscles. Swimming is a good activity as well.
 
You need to let pain be your guide to any activity…if it causes pain for more than an hour after the activity, you should probably avoid it.

I have a pin in my knee and have developed osteoarthritis.
I was told that there is a possibility of joint infection if you inject a site that has foreign object (metal pin) implanted.  Is that true?

Theoretically that could be possible but our experiences here at Caring Medical do not show that people with pins in their body are any more at risk for infection than the average person. I can tell you though that many of our patients who have pins in their bodies usually feel improvement after getting Prolotherapy to that area because of the added healing and stabilization that the area gets from Prolotherapy.

I have had many Prolotherapy treatments over the last two years for my knee but I still hear a "popping" sound when I stand. I do not have pain and I run frequently, but the popping concerns me as it happens everytime I stand up.

It is possible that you still have some weakness in your knee but in another area of the knee that was possibly not treated. This is why we typically do the entire knee joint when doing Prolotherapy. Not all Prolotherapists treat the entire joint but only treat the area that you are having pain. If the popping bothers you that much then you should get it treated.

One of the worse 'crunching' knees is Dr. Hauser's right knee. He was born with a crooked right foot. There is nothing he can do about. When you see him (if you do) let him show you just how crooked his right foot is. When he runs it looks funny. But Dr. Hauser still has completed the grueling Ironman three times and is training for a fourth. He has no pain in his right knee but when and if he does get pain he gets Prolotherapy. What you may want to do is get an xray on your knee and look at the cartilage. If the cartilage is fine then you have a patellofemoral tracking problem. You may want to get a few visits with a sports physical therapist to strengthen the muscles or stretch the muscles that are causing the imbalance in your knee. If cartilage is the issue or pain then by all means get Prolotherapy.

My cartilage is non existent and has forced me to stop jogging. How effective is Prolotherapy on new cartilage growth?

Dr. K. Dean Reeves published a couple of studies that suggest Prolotherapy can induce cartilage repair.  Ross Hauser, M.D., has cases that have shown it.  Some of which he is currently writing up.  All we can say is many folks who have been told they need knee replacements don't need them because of Prolotherapy.  Whether Prolotherapy induces cartilage repair or ligament repair does it really matter if a person's pain goes away and they don't need surgery.  If you still have reasonable range of motion of your knee then by all means get a Prolotherapy evaluation, it could save you from a surgery.   In one study soon to be published, 10 patients were told that knee surgery was their only option.  The 10 patients chose Prolotherapy of the knee instead.  9 had complete or almost complete pain relief.  1 did not get a lot of pain relief.   What we found in this study was the key factor of people who did well with Prolotherapy for degenerated knees was range of motion.  Those who had decent range of motion did great, those who didn't didn't do as well.

Related article Prolotherapy Regenerates Knee Cartilage

Disclaimer: The physician you are visiting has had the benefit of performing medical examinations and laboratory tests to determine the degree of your symptoms. Important tools in not only prescribing a treatment plan but also in determining your response. If you have concerns about your treatment, please direct your questions to your physician because that is the proper course to take. Prolotherapy may not be effective for every individual and there are risks involved, these risks should be discussed with your physician. Results achieved with some may not be typical of all. Please consult a physician.