What is Prolotherapy/RIT?
RIT is a highly effective, yet little known, method of treating chronic ligament and tendon weaknesses. Ligaments are the structural “connective tissue bands” that secure bones to bones. Ligaments can become weak from overuse or can become injured. With the blood supply to ligaments, tendons and bone being very limited, healing without prolotherapy is often slow, not always complete and the ligaments may not heal back to their original strength or endurance. Ligaments have many nerve endings including proprioceptors to show us where our joint is in space (i.e. whether it is bent or extended). There are also pain receptors that are present for our protection to share with us when tissues are getting close to or are being damaged. Tendons are the tissues which connect muscles to bones and tendons may also become injured and cause pain. When tendons and ligaments become strained or injured the joint no longer articulates properly resulting in pain, stiffness, inflammation, crepitus (cracking) and various levels of discomfort.
RIT works by stimulating localized precision inflammation. The basic premise of prolotherapy is that a substance (called a proliferant) is injected into the affected or weakened ligaments or tendons. The solution is usually made up of dextrose and normal saline. This leads to local inflammation which turns on the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligament and tendon tissue which forms as a result of RIT is significantly thicker and stronger than normal tissue. This healing response occurs for up to 6 weeks but during the first week after the treatment the connective tissue fibers that form are quite small and may break when put under stress. So it is advisable not to exercise for the first week after treatment.
RIT is painful, but the pain from treatment is comparatively insignificant versus the everyday chronic pain experienced by the patient. For those who fear needles, as one patient so eloquently said “if I would have known it was going to be that many injections, I would have never done it”. In the same breath “If I would have known it would give that much relief I would have done it a lot sooner”. To assist patients with low pain tolerance the Naturopathic Doctor may give the patient topical freezing (cool spray), local anesthesia or homeopathy. Most patients receive the treatments without pain killers.
How many treatments?
Four to six treatments is the average for an area treated. Treatment response varies with each individual and the patients healing ability. Historical research suggests RIT should be performed every 2-6 weeks as most of the healing of ligaments occurs over a 2-6 week period. As healing progresses, the quantity of injections in volume and number required per treatment decreases. The pain will continue to diminish with each treatment.
You should continue your treatments until you are healed. After treatment commences, your response to therapy will give a more accurate estimate as to how many injections may be needed.
Are you a good candidate for RIT?
RIT strengthens specific areas, eliminating pain by stimulating the growth of healthy, strong new tissue by your body’s own immune system.
What is the success rate with different joints?
We cross referenced research on prolotherapy for the feet, hands, knees, hips, low back, and shoulders to answer these questions.
I am too old, it will not work for me!
The average age for the studies conducted on the above joints is between 54 and 62.
How does this help my pain?
Average pain levels went from between 5.6-7 (10 being the worst) to between 2.3 - 2.9 after prolotherapy.
I have had this pain for a long time, it will not work for me.
Average years of pain included in these studies range from 4.5 to 5.3 years. 33-38% of participants were told no other treatment options were available.
My walking is compromised how much can my walking improve?
For patients with:
- Foot conditions, 37% before prolotherapy were either wheel chair bound, used a cane or walker or could walk less than 3 blocks. After prolotherapy, only 5% were so compromised. 32% were now able to walk more than 3 blocks. Another 32% were able to walk without restriction after the treatment.
- Knee issues, 42% before prolotherapy were either wheel chair bound, used a cane or walker or could walk less than 3 blocks. After prolotherapy, only 9% were so compromised. 33% were now able to walk more than 3 blocks. Another 65% were able to walk without restriction after the treatment.
- Low back, 32% before prolotherapy were either wheel chair bound, used a cane or walker or could walk less than 3 blocks. After prolotherapy, only 5% were so compromised. 27% were now able to walk more than 3 blocks. Another 21% were able to walk without restriction after the treatment.
- Hip issues, 27% before prolotherapy were either wheel chair bound, used a cane or walker or could walk less than 1 block. After prolotherapy, all participants were now able to walk more than 1 block. Another 20% were able to walk without restriction after the treatment.
I want to get back into sports!
Athletic ability went from:
- Foot issues, 42% of participants could perform athletics for less than 10 minutes prior to prolotherapy. Only 5% could after. Another 11% were able to exercise without restriction.
- Shoulder issues, 43% of participants could perform athletics for less than 10 minutes prior to prolotherapy. Only 12% could after. Another 20% were able to exercise without restriction.
- Knee issues, 50% of participants could perform athletics for less than 10 minutes prior to prolotherapy. Only 12% could after. Another 38% were able to exercise without restriction.
- Low back, 45% of participants could perform athletics for less than 10 minutes prior to prolotherapy. Only 12% could after. Another 21% were able to exercise without restriction.
- Hip issues, 37% of participants could perform athletics for less than 10 minutes prior to prolotherapy. Only 11% could after. Another 24% were able to exercise without restriction.
I am depressed. Will this help me get my life back?
51-59% of participants were not depressed prior to receiving prolotherapy, this improved to between 84-90% of participants not being depressed after prolotherapy. 25-39% regained a life free from depression.
Is RIT safe?
In the Journal Of Orthopaedic Medicine 1993;15:28-32
T. Dorman wrote: Prolotherapy A Survey. 494,845 patients surveyed, 343,897 for low back, only 66 minor complications: 24 allergic reactions, 29 pneumothorax, and 14 major complications: defined as a patient hospitalization or transient or permanent nerve damage.
This is a complication rate of .016%.
In order to optimize your response to prolotherapy you need a good strong immune system (so their body can lay down the collagen necessary to heal), a willingness to comply with recommended treatment protocol, a positive mental outlook and a healthy diet that will promote healing.
Prolotherapy will not get an optimal result when the patient has a depressed immune system (their body cannot respond to the proliferants), nutritional deficiencies or even nutrient allergies, hormonal deficiencies or excess (increased cortisol from stress can negate healing). The body may be slow to heal especially in our older patients who may need IV vitamins, minerals and other nutrients to augment therapy. At times the wrong area is treated (could be ankle causing knee pain, low back pain caused by knee pain, etc.). The cause of hip and low back pain can be hard to differentiate. It possibly be from the hip, low back or both.
For the person who has many other health challenges, these typically need to be addressed first for RIT to be successful. Note: patients who are taking Blood thinners cannot be treated.
Will insurance cover these treatments?
This depends entirely on the coverage your insurance provides.
For more information please refer to the Journal of Prolotherapy http://www.journalofprolotherapy.com