Regenerative Treatment: What is PRP & Prolotherapy?

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Any athlete with a long-lasting injury can attest that doctors are, often times, not your friends. You may leave an appointment feeling positive, but once you arrive home and hop on the treadmill, you realize that you know no more than you did before the $30 copay, $10 parking garage payment, and 90 minute office visit, and your body is still hurting. These doctors want to move you in and out as quickly as possible while doing as little as possible, and they do it with charm and a smile, so you don’t even realize that they haven’t helped you a damn bit until you’re sitting at home six months later, your muscles atrophying, your running shoes untouched, the walk to the Metro station making you short of breath due to your complete lack of cardiovascular activity. You’re out thousands of dollars, and just as bad off as you were before. And all the while your podiatrist is at home eating an expensive and carefully prepared meal with their family, fresh from the shower after a five mile run after work, because their feet are feeling fantastic. ACCURSED PODIATRISTS. I HATE THEM.

I learned a lot about how to go about managing your own healthcare throughout the last year, in which I have experienced injury after injury, going from a five-time marathoner to someone who hasn’t exercised in months. I saw a total of five doctors, all of whom gave me various suggestions of the same caliber: wear custom orthotics, see a physical therapist, rest, ice, medicate. Rest, rest, rest. So much time off from exercise can actually lead to some negative consequences, like muscle loss and joint instability, not to mention depression and insomnia (in some cases). After about nine months of no improvement (and three diagnoses of sesamoiditis, atrophied peroneal tendons, and a torn meniscus) my doctors ultimately threw their hands up and said they were “baffled,” and that running and impact activity were no longer advisable with my injuries.

So. Twenty-four years old, no traumatic or acute or overuse injuries. No discussion of surgeries, procedures, or any other treatments other than rest and ibuprofen, yet unable to run ever again? Seems unlikely. Seems a little fishy. With Olympic athletes who violently rip their ACLs in half and are able to do their sport again in a relatively short amount of time, I just didn’t believe that running was not in the cards for me ever again. So I decided to look elsewhere. And my search landed me in a Chicago-based alternative medicine clinic.

Prolotherapy

Stem cell therapy has been used more and more frequently for sports injuries, especially for professional athletes, and its success rates are unparalleled by other approaches, like surgery. But even now it remains unaffordable for a lot of people. Enter prolotherapy. Less well-known, but another form of injection therapy that, though still not sanctioned and not reimbursable by most insurance companies, boasts countless success stories and is much more affordable than stem cells.

Essentially, the procedure takes a dextrose solution and a local anesthetic and injects it right into and around the injured tendon/ligament again and again. As in about 30-50 times per joint. The purpose of it is to create a localized inflammatory injury to stimulate the body’s own natural healing process (for anyone who has had a tendon or ligament injury, you probably know that they never fuxking go away because of the lack of blood flow to those tissues. Blood flow equals healing cells. Without prolotherapy-type processes, these tissues may literally NEVER heal on their own, which, yes I know, freakish thought).

So when I say that the injury created by the prolotherapy injections is inflammatory, what I mean is it makes your joints swell to the point of uncomfortable deformity. I was actually getting repulsed looks from passersby as I hobbled through the airport in search of deep-dish pizza. I mean I was taught not to stare in disgust at other peoples’ disabilities, but it’s cool. I get it. It was pretty bad, so I would suggest foregoing sexy sleepovers with your sig other in the days following the procedure. I sent a picture to my friend and she said some things along the lines of “EW” and “WTF.” Don’t fret about it, though, as this inflammation is completely normal and all part of the plan. It means that it is working. Your body is freaking tf out and healing those pesky tissues, hopefully once and for all. Just be prepared to be alarmed.

Also go ahead and get prepared for a painful procedure. I kind of tend to float around through life not really thinking things through beforehand. That mental visualization you’re supposed to do in the weeks leading up to a marathon? Lol nah. I usually show up to the start line and have run a couple of miles before it hits me that I am running a damn marathon and why didn’t I think about how this was going to feel a little bit beforehand? Same with the prolotherapy. I flew to Chicago, fell into a bed that I rented for the night through Airbnb (I am obsessed with Airbnb) and then meandered into the doctor’s office. The first several injections were a bit of a shock. And it makes kind of a crunchy sound. Overall not pleasant at all. Just being honest. It is a bunch of injections with a huge pointy needle, so as long as you go in with this in mind you’ll make it through (just don’t take any ibuprofen beforehand for about a week; ibuprofen is an anti-inflammatory and taking it kind of misses the whole point of getting the treatment).

PRP

PRP, or platelet-rich plasma, is a procedure that I got done on top of the prolotherapy, something that prolotherapists will often decide to go forward with in order to maximize the rate of healing. For this, they had to draw a huge vial of blood, take it into the back, and spin it to separate the platelets from the rest of the blood components, which creates a really high platelet-concentration, much higher than any natural process will get you. Like the dextrose solution, the platelet-rich plasma is injected straight into and around the injured point, and it has been proven to heal injured tissues, including torn menisci, up to 800% faster than they would heal otherwise. Hello, hello, hellooo. Very intriguing. Very exciting. And since they are using your own blood, the risk of infection in this sort of treatment is very low. The doctor also injected me with a growth hormone to encourage the regeneration of my tendons and ligaments (she wanted to heal me as fast as possible to minimize the number of trips I have to make back to Chicago, which is much appreciated. Bedside manner can get you a long way, which is something the podiatrists of DC could learn a little about. Those animals).

Procedure Length & Cost

In total, I think I was in the office for about three hours, including filling out paperwork, talking in detail about my medical history, getting a physical exam with the prolotherapist, having my blood drawn and spun in the centrifuge, peeing a few times (they emphasize hydration before the procedure. Hydration is so important for your cartilage health, trust me), getting the injections, and recovering under heating pads afterwards. A visit without having all the paperwork and introductory aspects may take less than an hour. It is a quick procedure, and you can walk right out of there afterwards like a normal person (albeit a swollen one). So it is relatively non-invasive.

The office I went to is the leader in prolotherapy and has patients coming in from around the country and around the world. They have offices in both Florida and Chicago, but flying to Florida at this time of year is a bitch. Visit their website for more information about who they are, what they can offer you, and their treatment prices. I have nothing but good things to say about my entire visit and everyone I met while there (but yeah, it was expensive and I died a little bit as I handed over my credit card. But even a few thousand dollars would be a bargain to get rid of the chronic 24/7 pain).

Outlook

It has officially been over two weeks since my visit to Chicago to try this next-generation therapy in an ultimate attempt to address the source of so many of my issues over the past year. I am still a little bruised around my knee and ankle, and have not been exercising really at all (save the walking between bars on Halloween weekend in Philadelphia). The really bad swelling and pain and stiffness subsided after about five days, and I am not yet worried about the residual discomfort, as it is understood that the procedure does cause injury, and collagen, which is what tendons are made up of, doesn’t start to generate for about three to four weeks following the procedure.

I am going back in three weeks again for another treatment, and am hoping that by next summer I can start to run again without pain. My prolotherapist said she hopes for me to have regeneration and for my pain to go away within three to six treatments. Nothing is guaranteed, but these types of treatments have a 80-90% success rate, as opposed to 50% in surgical cases. I would expect that in several years more insurances will start to cover it; the medical field is surprisingly slow to accept any new approaches as next steps.

I think my biggest issue throughout the entire process is that no one was addressing the underlying issue of my pain. If my tendon is atrophied or my meniscus has a giant gaping tear in it, no, I don’t want to strengthen the muscles around the injured tissue in the off-chance that that might relieve a little bit of pain. I don’t want to just wear custom orthotics to redistribute the weight when I walk. I don’t want to take a prescription pain-killer every time I feel pain, Doc. I WANT IT HEALED, GUY. I want my damn ankle to be a normal ankle and my damn knee to be a normal knee. And I want to run again. Prolotherapy and PRP have been the first options I have found in over a year that have offered some hope for actually getting back to normal one day. Fingers are crossed.