Regenerative Injection Therapy

Listen to Dr. Hal Brown speak to particpants and volunteers at the 2015 BMO Marathon about Regenerative Injection Therapy

What is Regenerative Injection Therapy?

Regenerative Injection Therapies (RIT) involve the injection of solution into damaged soft tissue to promote your body to self heal and form new connective tissue like ligaments, collagen and tendons.

We primarily use RIT to treat chronic pain conditions and musculoskeletal injuries.

The Integrative Approach to RIT

Because we build our treatment protocols around each patient’s individual needs and are experts at using a wide variety of therapies we can optimize each stage of the healing process.

We often employ Regenerative Injection Therapies in conjunction with other proven techniques to resolve chronic pain conditions, such as:

For example, we can correct a misalignment in your spine with a chiropractic adjustment and complement this with RIT to “cement” the results.

“RIT has taken the treatment of injuries to an unprecedented level of successful recovery. By using the inflammatory reaction to our advantage we can cause regeneration and healing at a desired location.”Dr. Hal Brown, N.D., D.C., R.Ac.

Different Forms Of Regenerative Injection Therapy

Different Forms Of Regenerative Injection Therapy

What is prolotherapy?

Prolotherapy, short for proliferation therapy, is a nonsurgical regenerative injection treatment used to repair injured tendons, ligaments and joints. Tendons can be strained as they connect a muscle to a bone and involve joint movement. Ligaments can be sprained as they attach two bones and involve joint stability. Joints or articulations are the junction site or union between bones to allow movement. These structures generally are avascular or have a limited blood supply, meaning incomplete healing is common after injury is sustained. This incomplete healing results in a relaxed and inadequate tendon or ligament that can become a source of chronic weakness and pain. Prolotherapy stimulates healing and can be used effectively to treat musculoskeletal conditions and pain as a viable and less invasive alternative to surgery, pain medications, and anti-inflammatory injections such as corticosteroids.

How does prolotherapy work?

Prolotherapy is based on the principle of injecting a proliferant solution (mild irritant solution, usually 15-25% dextrose) directly into weak or damaged soft tissue where tendons and ligaments attach to the bone. This initiates an inflammatory response which promotes the body’s own tissue/wound healing mechanism by increasing the blood and nutrient supply to that area. The inflammation and subsequent proliferation of cells is localized around the joint and into the incompletely healed tissue to promote proper ligament and tendon repair and stability. Fibroblasts, endothelial cells and myofibroblasts are responsible for enhanced local circulatory activity, wound contraction, and collagen formation. The regenerated tendons and ligaments produced after prolotherapy are remodelled by the body in the final stage of healing, resulting in tissue that looks and functions very similarly to the original tissue.

What can prolotherapy treat?

Clinically, prolotherapy has an 85% success rate for most types of musculoskeletal pain, effective on areas of the body such as: neck, back, shoulder, elbow, hip, knee, ankle, foot or anywhere that a tendon or ligament may become strained, sprained, or overstretched. Prolotherapy can also be used to treat conditions such as: arthritis, carpal tunnel syndrome, degenerated/herniated discs, dislocations, fibromyalgia, headaches, sciatica, sports injuries, tendonitis, TMJ, and whiplash. The most notable signs of effective prolotherapy treatment are: improved function and movement, greater ligament, tendon and muscle strength, decreased pain, stiffness and muscle spasms, increased range of motion, and less clicking and grinding of joints. Ligament, tendon, and cartilage improvement after prolotherapy has also been documented on X-rays and MRI’s.

Prolotherapy Treatment Protocol at Integrative:

Treatment protocols for prolotherapy vary with each patient based on their individual needs, personal healing ability, immune health, and severity of injury. The average person requires 3-6 treatment sessions given at 2-6 week intervals, although many patients report experiencing relief after only one session. More serious or chronic injuries require longer courses of treatment, while proper exercise, dietary measures, nutritional supplementation, minimal stress, adequate rest/sleep, and physical manipulation are all factors that affect the healing process as well. Overall, prolotherapy is an extremely safe procedure, especially when compared to surgical interventions or long-term painkiller use. The risks and complication rates for prolotherapy are low, but do vary based on the area being treated. The most common side effects experienced by patients are temporary increases in pain, stiffness, and swelling (12-96 hours after due to the inflammatory response), as well as bleeding/bruising in the area.

PRP – Platelet Rich Plasma InjectionTherapy

What is Platelet Rich Plasma Injection Therapy?

Platelet Rich Plasma Injection Therapy (PRP) is a type of Regenerative Injection Therapy based on the same principle of stimulating the inflammatory response as prolotherapy. PRP specifically uses proliferative injections to prompt soft tissue and joint healing by applying concentrated platelets to the injured area. Platelets play an integral role in blood clotting and wound healing, as they are responsible for bringing white blood cells to the injured area to clean up the debris of dead and injured cells. This repair of injured tissue begins with the formation of a clot followed by platelet degranulation of the immune system, which releases growth factors that stimulate wound repair through secretory proteins. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote the development of new blood vessels, and stimulate the tissue healing cascade. Studies have shown that increased platelet concentration increases the level of secretory proteins, enhancing the amount of proliferation involved in the wound healing.

How do you extract PRP?

The process of creating platelet rich plasma begins with an autologous blood collection (20-60 cc of blood taken from the patient), plasma separation through a Platelet Concentrate System (blood centrifugation), and application of the plasma with concentrated platelets and growth factors (injection of the platelet rich plasma into the injured tissue). The only difference between dextrose prolotherapy and PRP injections is the solution that is being administered, and the resulting enhanced inflammatory effect with increased self-healing potential of PRP. Through the application of the body’s own concentrated platelets into areas of non-healing injuries, PRP stimulates an inflammatory response characterized by a mass influx of white blood cells and growth factors that act on fibroblasts causing proliferation and accelerating tissue regeneration. Enhanced fibroblastic activity increases tissue-healing processes of chemotaxis, proteosynthesis, reparation, extracellular matrix deposition, and tissue remodelling. Direct injections at the site of injury ensure that this inflammation and tissue regeneration is localized to the injured area.

What can PRP Treat?

PRP can treat all chronic and acute joint, ligament and tendon injuries including: tennis elbow, plantar fasciitis, Achilles tendonitis, rotator cuff tears, shoulder dislocations, meniscal tears, osteoarthritis and chronic low back pain, neck pain and any other areas of injured connective tissue, joints, tendons or ligaments. Prolotherapy and PRP can be used to treat the same conditions, but PRP is often indicated when the positive effects of regular dextrose prolotherapy have plateaued or are insufficient. Additionally PRP is sometimes preferred for serious degenerative changes or high performance athletes when the injury is very severe or complex, as with labral or meniscal tears.

PRP Treatment Protocol at Integrative:

Treatment protocols for PRP vary and are individualized to each person, but most people require 2-6 sets of injections at 4-6 week intervals. Positive development is usually evident after 2 treatments, but may occur after the initial treatment as well. The healing process is affected by diet, exercise, smoking, nutritional supplementation, stress, rest/sleep, and physical manipulation. Similar to prolotherapy, the risks of PRP are low and the most common side effects are temporary increases in pain, stiffness and swelling, as well as bleeding/bruising in the area.

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