Dr. Tim is invited to speak at the Ehlers Danlos Syndrome Learning Conference on Prolotherapy: A Holistic Approach to Pain Management
Prolotherapy is a practice of restoring function and structure, thereby reducing pain, to ligaments and joints. It is administered best by those in the field of Osteopathy, as they have the most intensive, specialized training in the structure of the human body (joints, bones, muscles & ligaments). A Doctor of Osteopathy, or DO, goes thru the same medical training as a doctor, but also takes additional curriculum in anatomy, nutrition and may have training in mental health fields as well. Dr Speciale was invited to speak in Buffalo by his own patient, who taught the aqua therapy classes, so he had experience and insight into the EDS issues.
The theory of Holistic Medicine is that health is dependent on many aspects of our lives: Physical, Spiritual, Mental, Financial, Occupational, Family, Nutrition and Hormones. Imbalances in one area can cause stress in others, leading to illness and away from “optimal health”. Optimal Health is also a holistic concept that states that we can not be “cured” or perfect in health, but we rae capable of working TOWARDS what represents Optimal Health for each of us. What is optimal for one person, may not be attainable for someone else….but each of us can continue to strive to be “the best that we can be”.
Some PEARLS OF WISDOM:
1) Be Patient
2) There is a time to be aggressive and a time to be conservative.
3) Allow the human body to heal itself; it does a marvelous job if we allow it to heal.
4) Do not harm
5) We want to heal everyone…it’s just not possible. Some people don’t want to be healed. It has no bearing on your abilities.
6) Be open minded. Certain techniques, modalities and treatments work well for one patient, but not on another.
7) We are always looking for panaceas..for something or some treatment that will sure all; we should realize that there never will be just one cure-all.
8) Treat all disease as if it had the same cause..a lack of optimal health.
9) Don’t get someone healthy too fast.
10) Do not make anyone healthier than they want to be.
11) Be thorough with the basics
12) The longer is takes to acquire an aliment, the longer it takes to get rid of it
13) Know the boundaries of your knowledge. This requires great wisdom and perception. Know when you are helpful and know when directing someone to another therapy would be more helpful.
14) Treat the individual & not the disease.
A clean body (like we have at birth) starts with no toxins and optimum healing ability. A state of OKness exists when toxic load is contained within the body’s storage areas. No overt symptoms are noticed. When Toxic load capacity is exceeded, the result is illness.
Myths of treating injuries:
1) rest if good
2) Inflammation is bad
3) Ice is nice
4) Anti-inflammatory medication is good
5) It just takes time
6) Cortisone shots will help
7) The MRI will show the problem
8) They are just going to scope me
9) Surgery will fix the problem
10) After a bit of rehab, you’ll be back to playing
11) If I wear my knee brace, I’ll be fine
12) The trainer has my best interests at heart
13) My coach is looking out for me
14) The team physician is an orthopedist
15) You have pain because you aren’t doing your exercises
16) Athletics, especially running, will give you arthritis
17) No pain, no gain
18) Just quit, you are never going to get any better
19) Stretching prevents injuries
20) Carbohydrates fuel fitness
HEAT VERSUS ICE
ICE: Arterioles Dilate
Vasoconstrict Blood Supply to Connective Tissues
Metabolic Rate Increased Decreased
Number of Immune Cells to Injured Area Increased
Decreased Joint Collagen Effects Relaxation
Stiffness Net Affect: Anabolic Catabolic
Conclusion…..Heat BETTER than Ice to Heal!
Ligament….a short, fibrous band which connects one bone with another or supports an organ. He showed us pics of various areas where ligament strength is important and areas where damage often occurs….pelvis, shoulder/scapula, elbows, wrist, hips, knee, ankle/tarsus.
Another chart showed the areas of the head and neck where a weakness translates into referral pain in other body areas! For instance, a weak ligament in the Cervical Vertebrae 4-5 area will cause pain and weakness in the lateral arm & forearm & into the thumb, index and middle finger! One set of vertebrae lower (6-7) will affect the medial arm & forearm into lateral hand, ring and little finger. Additional charts called HACKETT REFERRAL PATTERNS showed the related areas in pelvis, lumbar region, hip, & low back.
The next groups of pages showed what an MRI sees in a spine, versus how a prolo practitioner can locate the source of the pain with mild finger pressure. Then there was a chart that compared the costs, false positives, time involved and more of MRI versus that handy thumb diagnosis:
FALSE POSITIVE RATE (Conservative estimate)
MRI positive in Asymptomatic Middle-Aged Athlete
Area: MRI THUMB
Lower Back 64
He then discussed some of the history and development and the pioneers of prolo and went into the mechanics. In simple terms, prolo stimulates the body to repair painful areas. He charted how the NORMAL inflammatory response of the body to injury involves the formation of Prostaglandins, started at the cellular level. When cortisone is used (as well as many other anti-inflammatory drugs), it interrupts this cycle, disrupting the production of “Arachidonic Acid”. The pain may be gone temporarily….but the body’s attempt to heal itself is also stopped! There was a graph of the time and stages of normal healing, where inflammation lasts about 5 days, cells proliferate in the injured area for 42 days, and then the whole area remodels and recreates itself for up to 300-500 days, depending upon severity. He had slides of what normal muscle tissue looks like before and after prolo treatments, showing increased fibroblasts in response to various strengths of injections. There was also a progression graph of time & response to treatment: 2-3 days of possible soreness and inflammation after treatment, possible additional response 2-4 weeks later if healing stages are still increasing, then the real strengthening takes place in the 4-6 week period after treatment, after which time pain is re-evaluated. Depending upon the person or injury, he indicated the average number of treatments varied from 2-10 in his patient population.
The solutions used were described, as well as the needles (30 gauge, VERY fine) and why stronger solutions might be used….in patient is in worse shape, needs faster relief, is far from the treatment office, etc. The most common, mildest solutions are Osmotics (Dextrose), next are Irritants like P2G (Phenol, glucose & Glycerin), then Particulates (ie, pumice) and Chemotactic (Sodium Morrhuate). Eventually, Growth Factors might be useful in injections, but they are still being studied for future clinical trials.
The following table showed the respective increase in strength between prolo injections and a saline-injected control group:
PROLO SALINE % CHANGE
Ligament mass (mg) 132.2 89.7 44 Ligament thickness (mm) 1.01 .79 27 Ligament Mass Length (mg/mm) 6.45 4.39 47 Junction Strength (N) 119.1 93.5 28
CONCLUSION: Prolotherapy causes a statistically significant increase in ligament mass and strength as well as bone-ligament junction strength.
Next, he illustrated with charts how weak ligaments lead to Arthritis. A ligament weakens. leading to excessive joint movement (We KNOW that feeling!). The joint bones start colliding, crunching & popping is heard, bone may overgrow in some areas in an attempt to stabilize it, arthritis sets in & we start taking the NSAIDS for the pain, which contribute to more ligament weaknesses. The cycle keeps increasing…..prolo given in the area of the weakness stops the cycle! (In my case, the bones/joints are too far gone….so catching the process early IS imperative to save your joints!).
Additional comparison charts for possible treatments:
PROLO versus Arthroscopy:
PROLO ARTHRO Stimulates repair yes no Increases Collagen Strength yes no Arthritis risk Decreased Increased Return to activity Quick Slow Rehab time Short Long Exercise Encouraged Cautious Costs Hundreds Thousands Time in Procedure Minutes Hours Instruments used Thin needles BIG scopes
PROLO VS Cortisone:
Effects on healing Enhanced Inhibited Effect on Repair Enhanced Inhibited Effects on Collagen Growth Enhanced Inhibited Effects on Tendon Strength Enhanced Inhibited Effects on Ligament Strength Enhanced Inhibited Effects on Cartilage Growth Enhanced Inhibited
He had photos of surgery (YUCK!) versus prolo treatment & the results after…the prolo looked MUCH nicer! He had tons of charts & illustrations of how stuff like an unstable neck, shoulder, spine or knee causes problems with other body parts. He showed the progression of an unstable back to a completely degenerated spine….and how exactly prolo could prevent such. His charts showed the areas of injections, technique & angles in various body parts. He covered the safety of prolo versus effects of degenerative conditions versus risk of surgery, especially in EDS patients were surgery poses a higher risk. The cost of traditional rehab methods was compared in an example to prolo…..traditional PT & rehab over 4 months could be as high as $25,320, versus 2-10 prolo visits in the same period for $175-$350 a session. He discussed one of his case studies, a patient named Tim Doyle, one of the top-ranked racquetball players in the world. Tim had injured his sacroiliac joint in a fall & NSAIDS and PT hadn’t helped after 2 years (and was not able to compete). After 6 sessions of prolo, he was 100% fine & playing again. Then he discussed a patient with EDS who was confined to a wheelchair. She visited his mentor, Dr Hemwall, and treated virtually every joint in her body. She is now not only able to walk, but to run. She takes periodic tune-up treatments to maintain her condition, because the connective tissue doesn’t heal itself properly otherwise.
After the presentation, Dr Speciale answered individual questions for an hour more AFTER the session was over. I was impressed especially with his handling of a patient who had prolo elsewhere & had a temporary adverse reaction. After intensive questioning, he determined that the practitioner probably used an overly deep and straight-in angle of injection in an area where a shallow, angled approach would have been best. But it illustrated that even a “goof” in prolo can heal easily, versus a major slip-up in surgery. Also, it was noted that medical insurance for a prolo is 100s of times LESS than that of other specialities due to the lack of damage suffered by patients over its 66+ year documented history. I believe Dr Speciale mentioned having about 16 years in practice in prolo, without a single adverse effect in a patient.
For more information, he invited us all to visit his website for info on the board he is a member of and info on referrals to a practitioner in your area.