Prolotherapy takes a jab at stubborn sports pains
It would be a devastating injury for any young man. Matthew Fisher was only 19 when he was almost forced into early retirement from the sport that he loves.
It was August 2006 and Fisher had been going hard all summer. He was playing baseball in Ladner’s minor league and many teams were short pitchers. “And I was the only lefty, so I was getting used a lot,” he told the Georgia Straight in a telephone interview.
“Pitching is what I enjoy most about the game, so I was hungry for the innings and I just kept going,” he said.
As that season drew to a close, Fisher was in a provincial tournament and began to notice a very bad pain in his shoulder. He gritted his teeth, but the pain returned during a game the next day. Fisher decided to take it easy and played first base instead of pitching. But a ground ball came his way and he had to tag first base and then throw to third before the other team’s man could get there.
“And I just let one rip to third base,” Fisher said. “I threw the ball as hard as I could, and ever since then the pain has just been unbearable.”
Fisher couldn’t sleep on his left side or even bring his arm above his shoulder. He said he thought he would never play baseball again.
A chiropractor’s treatments brought only temporary results, physiotherapy did nothing for the pain, and exercises recommended by a family doctor made no difference at all. “I was getting really tired of it,” he said.
Then, in December 2007, Fisher tried something called prolotherapy. With monthly treatments, his shoulder finally began to improve.
Heidi Rootes is Fisher’s naturopathic doctor. She practises prolotherapy at Vitality Clinic in Yaletown.
In prolotherapy (short for “proliferative therapy”), a sugar solution is injected into damaged ligaments or tendons, Rootes explained. The solution can create an acute and localized inflammation, which can stimulate the body to repair itself.
Ligaments hold bones to bones and tendons attach muscles to bones. With damaged ligaments or tendons, you get instability, Rootes continued. “So the instability is what creates a lot of pain.”
This, according to Rootes, is why treatments like physiotherapy often fail to offer long-term relief from chronic injuries. “You can keep strengthening your muscles, but you’re still using muscles for stabilization, so you are still going to have pain,” she said. Surgery is a more extreme option, but it’s invasive and usually doesn’t hold for more than 10 years, “being really generous”.
Alternatively, there is prolotherapy, which Rootes claimed usually bears long-term results in six to 10 sessions.
A first-time visit for prolotherapy begins with a standard assessment, Rootes said. “I’ll do some movement with a patient to see what range of motion they have and really trigger where their discomfort is.” She’ll also consult X-ray and MRI results, if they’re available.
Then, Rootes continued, she takes a “big needle” and injects a proliferative solution into the damaged joint, “right into where a ligament attaches onto the bone”.
She’ll then work her way down the damaged ligament, administering small injections as she goes. The idea is for the solution—usually a combination of dextrose, procaine, and vitamins—to induce inflammation that will trigger tissue repair. Patients can expect acute swelling for a few days, Rootes said. “But most people that come to me are in so much pain that the flare-up is not a big deal.”
Many studies contend that prolotherapy can be successful in treating chronic pain.
In October 2007, for example, the American Journal of Roentgenology published the results of a study conducted at Vancouver’s St. Paul’s Hospital that concluded that proliferative injections “yielded a good clinical response”. One year after the study’s completion, 67 percent of patients who could be contacted by researchers reported being free of pain, while a further 27 percent reported only mild symptoms.
Despite such findings, most Canadian insurance companies will not cover prolotherapy sessions under basic medical coverage.
Some medical doctors also remain unconvinced of the treatment’s benefits. Alex Scott is a physiotherapist at St. Paul’s Hospital. He told the Straight that prolotherapy has piqued doctors’ interest in Canada since the 1960s but has yet to produce a solid base of clinical evidence to support claims of its benefits.
Scott said that one reason for this could be a publication bias in the medical community against papers with negative results. “I would love to see a large-scale clinical trial comparing prolotherapy to other, more proven treatments,” Scott said, “because there is a lot of interest in prolotherapy and I know that there are a lot of people doing it.”
When Roy Giovanneli heard about prolotherapy, he didn’t wait for further study.
Now 43, Giovanneli lived with chronic back pain for 15 years. One day in 1993, while working in Toronto as a construction site supervisor, he went to lift a manhole cover “and my back just snapped,” he told the Straight. “From that day on, I’ve been screwed.”
Giovanneli said his back would go out from movements as simple as bending over to pick up a paintbrush. The resulting pain would leave him bedridden for as long as two weeks.
He saw a chiropractor, tried acupuncture for six months, even dropped 60 pounds in an attempt to take the weight off his back. Nothing helped, and two MRIs and a series of X-rays were unable to pinpoint the problem. Finally, Giovanneli said, he saw a surgeon, only to be told that his back problem was not serious enough to warrant an operation.
He turned to a steady regimen of painkillers, taking Advil, OxyContin, and even Vioxx. “I was popping pills left and right, just to feel no pain,” Giovanneli recalled.
Then, after they moved to Vancouver, Giovanneli’s wife heard about prolotherapy; the couple ended up in Rootes’s office.
Bothered by needles and somewhat skeptical of naturopathic medicine, Giovanneli said that everything else had failed and so he was willing to give prolotherapy a try.
By the third treatment, the change was like night and day, he claimed. “I just came back from Maui and I played five rounds of golf, one round every day, and never felt a pain.”
The results were the same for Fisher. In a later e-mail to the Straight, sent on one of Vancouver’s rare sunny weekends, Fisher, now 21, bragged that just the day before, he had played two baseball games back to back. “And I’m on my way to the gym in 20 minutes to do weights.”¦That’s how good it feels.”