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Prolotherapy for Tendinopathy: It Makes the Most Sense!
Ross Hauser,
M.D.
I recently came across a very interesting article that I wanted to
comment on for those of you who read the Prolotherapy e-newsletters.
Some of the biochemical information that I am quoting in this short
newsletter comes from Clinical Orthopaedics & Related Research,
Volume 443, February 2006, pp 320-332, from an article entitled
Biomechanical Basis for Tendinopathy by Wang, J. Iosifidis, and
Freddie, H.
Some of the main points the authors discuss regarding tendinopathy are
these:
• It affects millions of athletes and workers.
• It is a nemesis for patients and physicians (not this physician
however!)
• Tendonitis and tendinosis are diagnoses that should only be made after
biopsy, so
tendinopathy
is a better term to use than tendonitis.
• After as little as 2% strain, the tendon configuration microscopically
changes.
• Between 4 to 8% strain, there are collagen fibers microscopically
rupture.
• Beyond 8% strain, tears in the tendon appear macroscopically.
• Complete tendon rupture occurs at 12% strain.
To summarize this article, with up to 4% strain, the tendon can return
to its original length. After 4% strain it can not return to its
original length. It is lengthened because of the tears which occur
microscopically between 4 and 8%, and macroscopically (can see with the
naked eye) between 8 to 12%. After 12% strain, complete tendon rupture
occurs and the surgeon is needed to put it back together. Between 4 and
8% strain, you need to call the
Prolotherapist.
The Prolotherapist will
inject
substances into the tendon to stimulate repair and get those tendon
tears healing and the tendon length and strength back to normal and
hopefully stronger than normal.
Some other interesting points about tendons:
• Running places anywhere from 5 to 15 times the force on tendons of the
lower extremity than standing does. This includes the Achilles and
Patellar Tendons.
• Squat jumping can increase the force on these tendons to 100 times the
force on them while standing.
• In general, endurance training increases tendon strength and
immobilization makes the tendons have less weight, strength, and tensile
strength.
• Too much training however, can cause tendon degeneration
The point of the above is that exercise places tremendous stressors on
the tendons. As such, recovery is as important to the athlete as
exercise. If you are not in that great of shape, don’t start doing jump
roping or walking lunges, as most assuredly you will get injured. Ease
your way into training. Every athlete has to maximize recovery to help
tendons continue to get stronger with exercise. This means plenty of
rest, healthy eating according to the appropriate
Hauser Diet
Type, and
supplements. Don’t forget warm up and cool down as well!
The article goes on to say:
• Tendon
fibroblasts
are a dominant cell type in tendons.
• Tendon fibroblasts are responsible for the tendon’s physiologic or
pathologic changes in response to mechanical loads.
Prolotherapy causes fibroblastic proliferation. That is why it is called
Prolotherapy or proliferative therapy. Fibroblasts make or break the
tendon. We want the fibroblasts proliferating and thus making more
collagen to make the tendon stronger. A stronger tendon can handle more
stress and more training. This not only gets rid of tendinopathy pain,
but makes the tendon more resistant to future injury!
Some other interesting points in the article:
• Some observers have shown that injections of corticosteroids into
tendons have led to tendon cell death, tendon atrophy, and negative
mechanical effects (reduced tensile strength and loss of viscoelasticity).
I’ll take a pass on getting a steroid shot into any of my tendons.
Thanks anyway, though. I’ll get Prolotherapy instead. I don’t want any
of that cell death, you know?
Okay, the nitty gritty of the article:
Effective protocols for treatment of tendinopathy must be developed.
Current nonsurgical treatment regimes for tendinopathy , including
NSAIDS,
corticosteroids, and
physical therapy,
offer only largely temporary relief of symptoms (pain). Some surgical
techniques for tendinopathy have been proposed, but none offers
consistent results. Bottom line traditional treatment doesn’t work.
(Last line was my synopsis.)
You want a good protocol that works for tendinopathy:
• If you or a loved one is diagnosed with tendinopathy, run if you can,
to get Prolotherapy.
• Get Prolotherapy into and around the area. It generally will take
three to six visits for a full recovery.
• Continue to exercise at the appropriate level.
• Emphasize recovery between workouts. This means get
Hauser Diet Typing and take
nutritional supplements that help with healing.
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