Prolotherapy Pulley Injury Question

Posted: 03-08-2012

Hi Timy,

What has been your experience with prolotherapy on pulley injuries?

Thanks,
-Kyle
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RESPONSE:

Kyle,

I have had extensive personal experience with many emerging modalities of injury treatment including acupuncture, meso-therapy, prolo-therapy and PRP for the past 20 years. Overall, I have had positive results with this type of treatment and I am an advocate of such methods. I have been fortunate enough to have chosen the right practitioners and my body seems to be very receptive to these treatments. I have also recommended this type of therapy to many friends and athletes for whom I have provided private coaching. For ethical reasons, I have not overtly advocated such treatments for youth athletes without the deliberate request of their parents.

I was first introduced to meso and prolo while I was living and training in France during my participation on the world cup circuit ’95. To the best of my knowledge, I may have been the first US climber to receive some of these treatments. I was treated by a French sports Kinesiologist who serviced the French Olympic Judo, Tae Kwan Do, fencing, gymnastics and track and field teams. Apparently, this French sports doctor was formally trained in the US (NYC), but due to medical practice regulations in North America at the time these modalities (like so many other medical advancements) were first proliferated in more progressive European countries like France, Switzerland, Germany, Austria, Spain, Slovenia (go figure!). The fighting sports and gymnasts were the first ones to explore the benefits of these types of treatments. Then Ski Racing, professional cycling (of course). Now it seems that all major league sports teams in the US are using some form of prolo for not only injury treatment, but career prolongation as well.

Depending upon the severity of the injury, strained pulleys generally require 3 rounds of injections spaced 10-15 days apart (anyone who is willing to inject at a higher frequency is not to be trusted). Also, remember that although this type of treatment will speed up the healing process, it is by no means a free meal pass to continue business as usual. The patient must still accept that a reasonable recovery period, decrease in training intensity and rehab program following each round of injections must be observed. A partially torn pulley will require at least twice as much time. A fully separated pulley will not usually respond to injection therapy and will most likely require complete immobility or surgery to re-attach. In some rare cases, I have seen it help what were believed to be full separations, but any such benefit is inconclusive as the diagnosis may have been incorrect. However, in this extreme case a re-attached pulley can be more effectively and quickly rehabilitated to full strength with prolotherapy. This is why an accurate diagnosis is crucial before seeking any type of treatment.

Meso and Prolotherapy are simply methods of delivery – their effectiveness are highly dependent upon the specific cocktail of substances being administered (and the accuracy of the needle technique). I have responded more favorably to certain substances better than others. And likewise, I have responded more favorably to certain needle techniques than others. Certain individuals have not experienced a noticeable gain from this type of therapy because they make the common mistake of either pushing themselves too hard to soon (because the immediate sense of relief is mistaken for a full return to strength which is totally irrational) or not completing multiple successive rounds of treatments. Unlike many other forms of soft tissue treatment, it is actually preferable to engage in some type of low-level activity approximately 72 hours after treatment to facilitate proper healing by moving the injected substances through the treated tissue. This also aids in avoiding loss of range of motion. The most commonly encountered problem is that most rock climbers tend to lack the self-discipline to maintain the appropriate level of rehab intensity without succumbing to the temptation to over test the capacity of the newly relieved injury area.

PRP (platelette rich plasma) therapy, a newly emerging subset of prolotherapy, is currently replacing conventional prolotherapy injection substances. PRP is being widely implemented by orthopedic surgeons to help speed recovery. My experience with PRP has been convincing. It generally requires only 1 round to achieve what conventional prolotherapy could achieve. It is more expensive, time consuming and uncomfortable/painful to undergo. It also seems to be more difficult to access as there seems to be fewer practitioners nationwide and the patient access to this type of therapy varies greatly depending upon state law and the licensure of the practitioner due to the fact that blood must be drawn from the patient during this process.

I recommend that you read the following (out of print) book regarding climbing injuries:

One Move Too Many…How to understand the injuries and overuse syndroms of rock climbing (2003)
by Thomas Hochholzer & Volker Schoeffl

You may also want to read the following article for which I was interviewed along with one of my sports doctors, Harry Adelson, founder of Docere Clinics:
Rock & Ice Issue #132
Muscle Training Section By Matt Samet
Sugar Methods: Are prolo therapy and meso therapy alternative miracle cures for busted tendons?

This is a very interesting and potentially useful topic of discussion in an area of medicine that is rapidly evolving that needs to be more thoroughly explored for our sport. I hope that this information helps you.

TF

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