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Stem Cell Therapy

stem cell therapy tulsa hip knee shoulderWe see a lot of injuries and chronic joint pain in our Tulsa, OK clinic. Prolotherapy works great for many patients. PRP is definitely a little more potent and can help slightly more people. However, Stem Cell Therapy seems to be the coup de grace for some patients.

Patients have been told things like “you are bone on bone” or “your only option is surgery.” However, advances in regenerative injection techniques are proving these statements irrelevant in may cases. Countless patients are able to eliminate their pain and return to full function, without surgery in many cases.

Again, prolotherapy and PRP are excellent tools and very cost effective. The problem is that some patients have too much damage and degeneration requiring more aggressive therapy. The greater the injury or defect, the greater the need for a biological technique with a high regenerative capacity.

Why is Stem Cell Therapy so beneficial?

After an injury our body signals an inflammatory process in an attempt to repair damage. Inflammation is essential to this healing process. Unfortunately, we don’t always heal completely which may result in chronic pain and dysfunction. Prolotherapy and PRP do an excellent job at stimulating the inflammatory, healing process but they don’t provide any healing or regenerative resources.

The inflammatory process causes increased circulation, migration of regenerative cells into the damaged area, and a whole host of other effects. We want and need as many regenerative cells as possible into the damaged area. Fibroblasts increase collagen, osteoblasts increase bone, and chondroblasts increase cartilage. The problem is that we don’t always have enough of these blast type cells.

Many patients have simply degenerated too much through age, chronic injury, improper healing, and constant abuse. Patients where the knee joint is considered “bone on bone” is essentially the destruction of the intra-articular cartilage. This cartilage is extremely difficult to regenerate. Interestingly, Stem Cell therapy patients have experienced significant cartilage growth.

Stem Cell Therapy replicates and supplements the body’s natural response to trauma by stimulating revascularization and tissue regeneration. In fact, literature suggests that clinically successful healing can be achieved by concentrated bone marrow, particularly in healing impaired patients.

What is Stem Cell Therapy?

Stem Cell Therapy is essentially injecting concentrated stem cells into damaged areas in the body. These stem cells are a type of cell that are able to become different types of tissue. Injecting these undifferentiated cells gives the body that which it needs in order to optimize the healing process.

Basically, stem cell therapy helps stimulate the healing process as well as provides the building blocks needed for optimal tissue regeneration and healing.

Where do you get the Stem Cells?

There are actually several sources of Stem Cells. Amniotic stem cells are donated stem cells. They are harvested during c-section and processed. Amniotic stem cells have anti-inflammatory properties and various substances which provide lubrication to the joint.

Bone Marrow Aspirate Concentrate (BMAC)

Bone marrow is one of the richest sources of stem cells. One of the many benefits is that it is autologous. This means that they are your own cells so there is no risk of a reaction or rejection.

The procedure is very simple and tolerated extremely well. The harvesting of the bone marrow takes just minutes and is easily performed in the office. Local anesthetic is typically all that is required.

Adipose Tissue

Your adipose tissue (fat cells) also contains a good source of stem cells. But the type of stem cells are slightly different and the adipose tissue provides a ‘matrix’ for the stem cells. The matrix makes adipose an important component in a comprehensive stem cell therapy.

These cells are harvested quickly and easily, in most cases, in our office. This procedure is virtually painless.

How do you get the best results?

It is important to provide a comprehensive approach and give the body everything it needs in order to heal. Optimizing stem cell therapy requires making sure that you have the following:

  • A matrix
  • Insulin-like Growth Factor (IGF)
  • Increased blood flow

Adipose tissue provides a great source of stem cells in addition to a high scaffolding content (matrix) but the regenerative capacity is less than that of bone marrow. Bone Marrow provides a high concentration of stem cells as well as high levels of cellular heterogeneity and regenerative capacity. PRP provides a high level of growth factors as well as high signaling capacity.

Optimal effects are obtained by combining PRP, bone marrow aspirate, and adipose tissue stem cells into one procedure.

Call our clinic today to schedule your evaluation to see if you are a good candidate for stem cell therapy.

Tulsa Stem Cell Therapy For Knee Pain

Tulsa Stem Cell - ProlotherapySo you have knee pain. You certainly aren’t alone. Tulsa stem cell can dramatically improve your pain!

 

Here is a typical case:

Gerald is 63 years old and has been having knee pain for several years. He was a football player in college and had multiple knee injuries throughout his life. 8 years ago he started having pain so he went to his primary care physician. His doctor ordered xrays and he was diagnosed with arthritis. He prescribed motrin 3 times a day for his pain. The motrin did help with the pain.

A year went by and Gerald went to his doctor for a physical exam. Lab work showed that his kidneys were working as well as they had been in the past which was attributed to the motrin he had been taking. He stopped the motrin. Another xray revealed “bone on bone.”

At that point Gerald’s doctor referred him to an orthopedic surgeon. The orthopedist ordered an MRI which showed arthritic changes, osteophytes and loss of cartilage. Surgery was recommended but Gerald didn’t want surgery. The surgeon offered a steroid injection which Gerald accepted not knowing how damaging they can be. The shot helped for a while but the pain returned. At that point Gerald was again offered knee replacement surgery.

Many times that’s the end of the story and no other options are offered. That is a true shame!

The problem is, at least in part, inherent in the system. Primary care physicians are often inadequately trained in comprehensive therapy for osteoarthritis and there is often a very low threshold for orthopedic surgery referral. The medical community as well as many patients often assume that orthopedic surgeons offer the most comprehensive approach to musculoskeletal problems. Our experience is that this is direct path to surgery!

If you don’t want surgery then you shouldn’t see a surgeon!

Surgery doesn’t work for numerous patients.

Surgery risks: Every surgery has risks. Sure, surgeries are performed every day and most people do well but there are some significant risks. I recently saw a patient (for an unrelated issue) that had a left leg above-the-knee amputation. I asked her what happened and she told me that her knee replacement got infected and they had to amputate.

The problem is that you have pain and your primary care physician only has a couple of options for you.

So what are you supposed to do?

Don’t get surgery except as a last-resort!

The reality is that there are very effective, low-risk, non-surgical options. We offer these options in our Tulsa stem cell clinic. We perform standard dextrose prolotherapy, platelet-rich plasma (PRP), and Tulsa Stem Cell therapy.

Patients with knee pain and will often get an MRI. Many of these MRIs will be abnormal. MRIs are a “roadmap for surgery” and are looking for something that can be addressed with surgery.

Our approach to knee pain is extremely comprehensive. Prolotherapy works very well for many patients and focuses on damaged ligaments and tendons surrounding the joint.

PRP may be added to increase success. PRP contains growth factors which stimulate the healing process.

But what about damage to the meniscus, bones, and cartilage?

Tulsa Stem Cell

Tulsa stem cell is an excellent addition for damage to ligaments, tendons, and cartilage. There is observational data verifying the growth of new cartilage following Tulsa stem cell therapy.

For patients with significant damage to their knees we will use a comprehensive approach of Tulsa stem cell therapy, PRP, and prolotherapy in order to achieve the absolute best results.

Call us today to schedule your appointment. Don’t live with your pain for one more day!

References:

  1. Guermazi A., et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012; 345: e5339.
  2. Moseley J., et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med 2002; 347:81-88
  3. Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11; 347(2):81-8.
  4. American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. December 6, 2008.
  5. Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008;359:1097–1107.
  6. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ.2004;328:869–870.
  7. Uth K, Trifonov D. Stem cell application for osteoarthritis in the knee joint: A minireview. World J Stem Cells. 2014 Nov 26; 6(5): 629–636.

Prolotherapy for low back pain – a look at the studies

Once patients come in to our Tulsa clinic for prolotherapy they often ask “why don’t more doctors know about this?

There are several reasons but one of the primary is that there is a thought that there is no evidence that prolotherapy works. You have to understand that physicians are very busy and often don’t have or take the time to read the studies supporting or refuting the scientific evidence. Thus, we often rely on things like the Cochrane Database. the Cochrane Database reviews available literature and draws conclusions about a given topic.

In the case of prolotherapy the Cochrane Database states “When used alone, prolotherapy is not an effective treatment for chronic low-back pain.”(1) That makes it sound like prolotherapy isn’t effective.

However, I have seen the effectiveness of prolotherapy for years and I know just how well it works. The success rate of prolotherapy is in excess of 85%.

So we have a problem. The scientific review states that prolotherapy isn’t effective yet we know it is effective. So what is the real truth?

The answer lies in the studies that have been performed and those that were included in the Cochrane Database. Once you understand these studies it is clear how they came to the erroneous conclusion that prolotherapy doesn’t work.

The largest study on prolotherapy for the low back 110 patients were randomized to receive either saline injections (control group) or dextrose prolotherapy (test group).(3) At the end of the study they found that there was no significant difference between the control group and the test group so the Cochrane Database review inferred that prolotherapy didn’t work. That is typically the point of a randomized trial, to compare an intervention to placebo and see if it works.

The conclusion that prolotherapy doesn’t work based on this study brings up several issues.

First, you have to compare an intervention against a known placebo. Using saline injections cannot be a placebo because we know that there are potential effects. For example, we know that simply inserting a needle into the tissues has a therapeutic effect.(4) However, if you actually read the study you’ll discover that patients in both groups had pain for 14 years on average. You’ll also discover that both groups of patients were very happy with their results.

The authors of the study stated the correct conclusion about the results in the study: “In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises.“(3) In other words prolotherapy works but so do saline injections in this study.

If prolotherapy works and saline injections also work then why not just use saline? Because there are other studies showing significant differences between saline and dextrose prolotherapy injections.(5) Scarpone demonstrated the effectiveness of prolotherapy and these results were sustained for at least 52 weeks.

Another important component of the Yelland study mentioned above (3) is that they limited the amount of solution injected to 10 mL and the average patient only received 7.5 mL. One of the important features of Hackett-Hemwall prolotherapy is its comprehensive approach. It is not uncommon that we will use in excess of 100 mL of solution for a low back prolotherapy procedure. How can we compare a procedure that is only using 10% of what we are using? It is ultimately a very different approach. You simply cannot say one works and one doesn’t when there is such a huge difference in the way these procedures are performed. Tulsa Prolotherapy Testimonials speak for themselves.

George Hackett, MD published a monograph in the 1956 stating a 90% success rate in over 4000 patients without a single complication. These results are consistent with what we see in our clinic.

Physicians today are very “evidence based.” We look for the scientific evidence to support a given therapy. The problem is that many of my colleagues often “throw the baby out with the bathwater.” In other words, a common thought is that if there is no evidence to support the therapy they won’t do it at all. I can’t tell you how many times I’ve heard “well there’s no evidence it works.”

A lack of evidence is NOT evidence against. In other words, just because there isn’t enough evidence to PROVE something works does not mean that it doesn’t work.

Studies on prolotherapy are difficult for several reasons. It is nearly impossible to ‘double blind’ where neither the prolotherapist nor the patient know if they are getting prolotherapy yet make sure that there is absolutely no benefit with the ‘control’ injection. That point is discussed above.

Second, large scale studies of this kind are very difficult and expensive. The bottom line is that there is no money to be made by performing this study so nobody is going to pay for it. That means we don’t have many studies that prove prolotherapy works. But again, a lack of evidence isn’t evidence against.

In fact, there is danger in not using certain therapies simply because there aren’t sufficient studies proving their effectiveness. This point is well made by a study published in the British Medical Journal (BMJ). The authors reviewed studies on the use of parachutes to prevent death in sky-diving and airborne activities. They found no studies proving the effectiveness and stated:

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.“(6)

I think it is funny that the authors basically told those who ignore observational data in absence of randomized controlled trials to go jump out of an airplane without a parachute.

We have to do better than this. We simply cannot throw the baby out with the bathwater!

__________________________________________________________________

When it comes to chronic pain you have a few options. You can try physical therapy, medications, natural therapy, accupuncture, massage, chiropractic, surgery, and prolotherapy. There may be others not mentioned as well. Our recommendation is that patients seek the highest success procedure with the lowest cost and the least risk. We believe prolotherapy meets all of these criteria and is worthy of primary consideration.

Prolotherapy is very low-risk, extremely cost-effective, and it works. You have nothing to lose and everything to gain!

 

References:

  1. Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004059. DOI: 10.1002/14651858.CD004059.pub3
  2. http://www.ncbi.nlm.nih.gov/pubmed/15106234
  3. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine (Phila Pa 1976). 2004 Jan 1;29(1):9-16; discussion 16.
  4. Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry Needling: a literature review for clinical practice guidelines. Phys Ther Rev. 2014 Aug; 19(4): 252–265.
  5. Scarpone M, Rabago D, Zgierska A, et al. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clinical J Sports Med 2008; 18: 248-254.
  6. Smith G, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327:1459.

Tulsa’s ONLY Trained Prolotherapy Provider

Dr Edwards in Honduras with the Hackett Hemwall FoundationTulsa Prolotherapy is an excellent procedure to help reduce pain and improve function. Prolotherapy has helped countless patients eliminate their pain and it may be the ideal solution for you. Prolotherapy is a minimally invasive, in-office procedure which stimulates your body’s natural healing mechanisms.

Prolotherapy is a simple, safe, and straight forward procedure when administered by a trained prolotherapy practitioner. There are risks associated with virtually any medical procedure. Physicians who are well trained typically have the lowest risk of complication.

Did you know…

Any physician (and many other allied health providers) can say they perform prolotherapy? Also, there is no actual prolotherapy certification. Clearly you want the most qualified person performing your prolotherapy. While prolotherapy is very low risk in the hands of a well trained prolotherapist there is significant risk if not performed correctly.

In the words of C. Everett Koop, MD (former Surgeon General of the US) “The nice thing about prolotherapy, if properly done, is that it cannot do any harm.” The key words here are “properly done.” That is the key.

Dr. Edwards has been performing prolotherapy for several years and has performed thousands of procedures without a single serious complication. Because of that experience he understands how things could go wrong if done incorrectly. That is why he sought out the best training available through the Hackett Hemwall Foundation. He is the ONLY prolotherapist recommended by the Hackett Hemwall Foundation in Oklahoma, much less the Tulsa area.

When you are looking for someone to perform your prolotherapy here are some factors to consider:

  • What is their training in prolotherapy?
  • Do they do continuing education in prolotherapy?
  • How many procedures do they perform on a weekly basis? High treatment volume is generally a good thing.
  • Are there areas in the body that they do not treat? You want someone who is comprehensive in their approach.
  • What is their experience with complicated injections?
  • Do they know how to treat complications they may cause?

Dr Edwards has years of experience in the ICU, hospital wards, Emergency Room, and outpatient clinics. He has seen multiple complications from procedures and knows how to treat them. While you don’t want to be one of the ones with a complication it is important that your prolotherapy provider knows how to treat any possible complication in the low chance one occurs. Simply knowing this helps lower the likelihood that a complication will arise from the procedure because we know what to avoid.

We have seen numerous patients who were treated by other prolotherapy providers and did not improve. However, most of the time Dr Edwards has improved their symptoms if not resolved them all together. We’ve also seen other providers who do not have extensive experience in treating procedural and traumatic complications.

The bottom line

You want the most experienced prolotherapist you can find with the greatest breadth of experience with the prolotherapy procedure as well as identifying and managing potential complications. While these complications are extremely rare in the hands of an experienced prolotherapist the are much higher for inadequately trained providers.

Do your homework and make sure you find the best!

Tulsa Prolotherapy

Chronic pain? Sports injuries? Knee, shoulder, neck, or back issues?

These are common reasons people come to us looking for a solution. Tulsa prolotherapy is the solution!

What is Tulsa Prolotherapy?

Prolotherapy is a simply, minimally-invasive, in-office procedure that stimulates your body to heal itself. Prolotherapy has been in Tulsa for more than 10 years. Dr John Merriman was a cardiologist in Tulsa who suffered from neck pain which resolved with prolotherapy. He became an advocate for the procedure and treated hundreds of patients in Tulsa with prolotherapy.

We have found that many patients with pain and injury actually have damaged ligaments and tendons. Due to the relatively poor blood supply these tissues are notorious for not healing completely in many cases. Prolotherapy stimulates the body’s natural inflammatory healing mechanism which repairs these damaged ligaments and tendons.

It doesn’t matter how long ago the injury occurred and it doesn’t matter how long you’ve had pain. Tulsa prolotherapy re-stimulates the inflammatory process healing these damaged tissues. Once the tissues are healed the pain resolves.

How long does Tulsa Prolotherapy last?

If your pain is truly due to damaged ligaments and tendons then when the tissue damage is resolved the pain goes away. The idea is that we restore these tissues to normal. Just like the rest of your body that doesn’t hurt. The results last until you re-injure the area. Dr Hackett, the founder of modern day prolotherapy, performed studies from the 1930’s through the 1950’s. He noted an 85% success rate and these results persisted for over 14 years!

If we are truly healing these damaged tissues then the results last as long as you do.

Why not just have surgery?

Surgery is an excellent option when you know the exact reason you have symptoms. However, this often is not the case. I have seen countless patients with knee pain, neck pain, low back pain, shoulder pain, etc who have had MRIs showing some type of abnormality. The problem is that the abnormalities just don’t always correlate well with the patient’s symptoms.

That is one of the beautiful things about prolotherapy! We can usually identify the exact source of pain because of the way we perform the procedure.

Surgery has risks. I remember a patient who came to see me and she was in a wheelchair and had an above-the-knee amputation of the left leg. I asked her why and she said she had a total knee replacement that got infected and they had to amputate. Ouch!

The first dictum of medicine is “first, do no harm.” In other words do the best you can for the patient but above all don’t do anything to hurt them. We should always look for the fix that has the lowest risk of complications, the least invasive, and the lowest cost.

Prolotherapy is less expensive, has lower risk, is less invasive, and often has a much higher success rate.

Personally, I wouldn’t have surgery until I have maximized the benefit of prolotherapy. You may still need surgery if you aren’t getting benefit with Tulsa prolotherapy. But that is rare!

Can’t I just take naprosyn (or any other NSAID) for my pain?

Not if you want to get better! All anti-inflammatory medications inhibit the inflammatory process. In fact, anti-inflammatory medications (NSAIDs) can block the healing process. Inflammation is part of the healing process and you don’t want to slow or block your healing in any way. We recommend avoiding anti-inflammatory medications for any musculoskeletal issue.

If you have any pain or injury then you should strongly consider prolotherapy in our Tulsa, Oklahoma clinic. Our patients typically have excellent results (read their testimonials here).

 

References:

  1. http://ajs.sagepub.com/content/34/3/362.short
  2. http://www.ncbi.nlm.nih.gov/pubmed/23982408
  3. https://www.shoulderdoc.co.uk/news/view/295
  4. http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/sojc/07_08/Oct07/ferry.pdf

Prolotherapy for Shoulder Tendonitis

Revolution Tendonitis prolotherapy PRP TulsaTendonitis refers to damage to the tendons in the shoulder. Prolotherapy is particularly beneficial in these cases because it stimulates the healing process of these tendons.

The term ‘tendonitis’ refers to inflammation of a tendon. However, the term is often used inappropriately because there is not always inflammation despite the fact that there is pain. A better term would be tendonosis – meaning an abnormal condition of the tendon.

It could be due to over use. It could be due to a specific injury. Regardless, the shoulder hurts and it is due to something wrong with the tendon. So what do you do about it?

Tendonitis Treatment Options

Typical treatments of shoulder tendonitis include avoiding painful activities, ice or cold packs, anti-inflammatory medications (NSAIDs), physical therapy, and surgery.

If you’ve been reading my posts on prolotherapy for shoulder injuries then you’ll recognize those therapies listed above as the staple therapy for most shoulder injuries. Sometimes these therapies work. However, I’m not a fan of steroid injections for these conditions and I only recommend surgery as a last resort.

I’ve discussed the importance of good ligament and tendon health many times. You may recall that these ligaments and tendons are very densely innervated with nerves. When these ligaments and tendons are damaged they become irritated which irritates the nerves within them which are very susceptible to pressure and stretching.

After an injury we should heal.

We have a healing mechanism. It is called inflammation. The inflammation produces a number of chemicals and responses that initiate the process of healing. However, this healing process is often incomplete depending on the person and the injury.

The healing is incomplete for a number of reasons but one of them is the poor circulation inherent in these ligaments and tendons. Under normal circumstances they do not need a good blood supply. They are not metabolically active even during exercise. They are like steel cables. They don’t require energy, at least not very much.

If they don’t heal well then the injury persists and so does the pain.

Your options are listed above. Or you could consider prolotherapy. In many cases it is your best option for shoulder tendonitis.

Our success rate for shoulder injuries, including shoulder tendonitis, is very high. In excess of 90%. Prolotherapy has an excellent track record for improving pain and function with very little potential for complications if it is done correctly.

The success rate is not 100% (though it is very high) but it is certainly worth a try when you consider the down time, deductibles, physical therapy time, risks, and so on.

What have you got to lose?

Call our office today so that we can evaluate your shoulder for tendonitis and see if prolotherapy is right for you!

Frozen Shoulder (Adhesive Capsulitis) ‘Melted’ by Prolotherapy

prolotherapy for adhesive capsulitis (frozen shoulder)We treated a lot of shoulder injuries at our Tulsa clinic. Adhesive capsulitis, also known as ‘Frozen Shoulder’, is a cause of restricted range of shoulder motion and pain.

We aren’t exactly sure what causes a frozen shoulder (adhesive capsulitis) but we do know that it results in scar adhesions in the shoulder joint capsule reducing the ability of the arm to rotate in the shoulder socket.

In my experience, most of these frozen shoulders started with the onset of shoulder pain which made the patient not want to move their shoulder. This, coupled with the inflammation associated with the cause of the pain, results in these adhesions forming around the joint capsule.

A tell-tale sign of a frozen shoulder is that both active and passive range of motion are both equally decreased. This is fairly easily evaluated during the physical exam.

How do you treat adhesive capsulitis (frozen shoulder)?

There are 2 primary targets for treating adhesive capsulitis:

  1. Increase range of motion
  2. Reduce pain

There are a number of therapies commonly used to help with both of these. Physical therapy can be helpful for increasing range of motion. Anti-inflammatory medications (NSAIDs) are often prescribed. Some patients may get steroid injections which may be beneficial in some cases. Massage therapy and daily stretching techniques may help.

I don’t recommend steroid injections for musculoskeletal issues. Steroids are damaging to the tissues and make them weaker. I recommend avoiding steroids at all costs for these kinds of issues.

These adhesions can be broken under sedation in the operating room if they don’t improve. For really bad cases surgery could be considered to break down these adhesions.

I don’t recommend surgery very often. There are just too many risks most of the time. However, surgery certainly has its place and can be fabulous. It just needs to be used appropriately.

Prolotherapy for frozen shoulder?

There is another therapy that has been shown to be very beneficial but not well know. Prolotherapy can be a tremendous benefit for frozen shoulders.

While prolotherapy by itself won’t increase the range of motion it can have a dramatic and profound impact on the pain which can allow increased efforts on stretching and mobilization techniques.

We have treated numerous patients with adhesive capsulitis and prolotherapy has provided them exceptional benefit. Prolotherapy is my first recommendation for nearly all causes of shoulder pain but certainly with frozen shoulders.

There is next to no risk associated with prolotherapy. It is extremely cost effective and often very successful.

If you have a frozen shoulder then you should consider prolotherapy as it can melt away this painful condition.

Call our clinic today to schedule your evaluation.

Shoulder Impingement? Try Prolotherapy!

shoulder impingement prolotherapy revolutionShoulder impingement is one of many possible causes of shoulder pain.

Or is it?

Shoulder impingement, so the story goes, is caused by a narrowing of the subacromial space when the arm is abducted or lift your arm away from your body sideways.

This action raises the greater tubercle of the humerus and closes in on the subacromial space which, in theory, compresses the supraspinatus tendon causing pain and irritation.

I argue that the impingement has its roots in damaged ligaments and tendons. There are several of these structures in the area that could make it seem like impingement was the issue. Maybe it is impingement but WHY is it getting impinged. Because of weakened and/or damaged tendons and ligaments.

How do you diagnose shoulder impingement?

Shoulder impingement is typically diagnosed by the history and physical exam. It is a clinical diagnosis. 2 common tests used to evaluate for impingement are Hawkin’s and Neer’s signs. If symptoms are reproduced with these tests then it is suggestive of rotator cuff disease. MRI may or may not be helpful and I rarely order them for this type of shoulder pain.

How do you treat shoulder impingement?

Shoulder impingement is often treated initially with conservative therapy which consists of rest, physical therapy, taping, acupuncture, and avoiding doing anything that causes pain. If that doesn’t work then anti-inflammatory medications (NSAIDs) are often given and the patient may get a steroid shot. Sometimes the steroid shots work but they often don’t.

I vividly remember being taught how to do a steroid injection for shoulder pain when I was in residency. I was taught a single technique in a single location for the shoulder. That may work well when the painful or damaged area is the area I happen to inject the steroids. But it often isn’t.

Why did I learn a single injection and assume that it would fix all potential issues that a shoulder may help with? That makes absolutely no sense. I clearly wasn’t thinking!

If these techniques don’t work then surgery may be recommended.

Prolotherapy for shoulder impingement?

I strongly recommend prolotherapy for potential shoulder impingement issues. In fact, I can’t think of a shoulder that we didn’t help for shoulder impingement. It is just that good.

Prolotherapy stimulates your body to heal itself through its own natural inflammatory process. It can strengthen the weakened and damaged ligaments and tendons that are causing the problem to begin with. When these tissues are healed through the body’s normal healing processes then the pain goes away and full function is restored.

We treat a LOT of shoulders with prolotherapy. We’ve had good enough success with prolotherapy for shoulder pain, SLAP lesions, rotator cuff tears, and shoulder impingement that I just won’t recommend surgery until after the patient has failed prolotherapy. It is rare but it can happen.

Plus, remember that prolotherapy has very little risk. In fact, C. Everett Koop, MD, the former Surgeon General of the United States, stated “the nice thing about prolotherapy, if done correctly, is that it cannot do any harm.”

There is very little risk, basically no downtime, very cost effective. Why don’t you call us to be evaluated for prolotherapy for your pain?

Prolotherapy vs. SLAP Lesion

shoulder SLAP lesion tear prolotherapy PRP

“Gray328”. Licensed under Public Domain via Wikimedia Commons – http://commons.wikimedia.org/wiki/File:Gray328.png#mediaviewer/File:Gray328.png

SLAP lesions or SLAP tears are a someone common cause of shoulder pain. At least that is what the MRI tells us. We see it all the time.

The shoulder is the most frequently injected area (with prolotherapy) in our clinic. One reason is that the shoulder is somewhat commonly injured due to its structure. You can read more about the shoulder anatomy on our Prolotherapy for Rotator Cuff Injury post.

The typical course is that you start to get shoulder pain either from an injury or it just starts hurting for no apparent reason. You go to your doctor and get physical therapy, steroid injections, NSAIDs (anti-inflammatory medications), etc. These things sometimes help and that may be all you need.

But many people aren’t so fortunate. These people are often referred for an MRI and to the orthopedic surgeon. They find a SLAP lesion on your MRI and recommend surgery.

What is a SLAP lesion?

SLAP stands for Superior Labrum tear from Anterior to Posterior. You can see from the image above the ‘Glenoid Lig.’ This is actually the labrum. It is the cartilage in the shoulder which is somewhat analogous with the meniscus in the knee. You’ll also notice something coming off the top of it in that picture.

The structure coming off the top is the long head of the bicep. When the stress on the tendon exceeds its capability then something has to give.

There are several ‘sub-types’ of SLAP lesions depending on the specific location of the injury.

What can you do for a SLAP tear?

You have a few options for what you can do about your SLAP lesion. Traditional approaches involve physical therapy and/or surgery. Wikipedia states “Few with SLAP lesion injuries return to full capability without surgical intervention. In some, physical therapy can strengthen the supporting muscles in the shoulder joint to the point of reestablishing stability. For most others, the choice is to do nothing or some form of surgical repair.”

But when you overlay the information about the success of MRI in identifying these lesions we should certainly consider other options.

Prolotherapy for SLAP tears:

The goals of prolotherapy are to decrease pain and improve functionality. Prolotherapy is VERY good at doing that. There are no studies proving that Prolotherapy ‘cures’ SLAP lesions. In my opinion, there is no reason to do that study.

Why? Well, do you care if your MRI is ‘abnormal’ if you have full function, strength, and range of motion and you don’t have any pain?

Prolotherapy stimulates the body’s natural healing mechanisms and has a very high success rate for dramatically improving the pain and decreased functionality associated with SLAP lesions.

We have treated numerous patients with shoulder pain and MRI diagnosed SLAP tears with excellent results. We have returned numerous athletes to their game in record time without any down time. Several college athletes were able to keep their scholarship because of prolotherapy. They assured me that they were going to lose it if we couldn’t help them.

If you have been diagnosed with a SLAP tear or you have shoulder pain then you should be evaluated for prolotherapy by a qualified and trained prolotherapist.

Call our clinic today to schedule your appointment.

Read what our patients have to say:


 

  1. http://www.ncbi.nlm.nih.gov/pubmed/14567906
  2. http://www.ncbi.nlm.nih.gov/pubmed/25294682

Prolotherapy for Rotator Cuff Injury

Check out the Prolotherapy page for more information on how prolotherapy can help your rotator cuff injury and where you can get prolotherapy performed in Tulsa, OK.

rotator cuff tear shoulder pain Tulsa OklahomaOk, so your shoulder hurts. It is a common issue and we hear the stories every day. There are lots of reasons why your shoulder may hurt and rotator cuff injuries are only one of the many reasons your shoulder may have pain.

At Revolution Health & Wellness Clinic we use a different approach to get our patients back to full function without pain and we usually achieve these goals without surgery!

It is important to understand what is going on with the rotator cuff injury or rotator cuff tear so that prolotherapy makes more sense for this cause of shoulder pain.

What is the Rotator Cuff?

The shoulder joint is a ball and socket type of joint just like the hip. However, you’ll notice that the shoulder has a lot more range of motion than the hip. The ability for your shoulder to move like it does requires a different anatomy. The socket isn’t much of a socket really. This is one reason you can move your arm like you can.

This range of motion comes at a cost though. We lose some stability in the shoulder joint in order to achieve this increased functionality. Something has to try to hold that shoulder together.

Enter the rotator cuff

The rotator cuff is composed of 4 tendons which help hold the shoulder together. Many medical professionals call these tendons (attached to muscles) the SITS muscles:

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis

Each of these tendons provides additional support and structure to the shoulder while allowing this increased motion. However, these tendons are prone to damage and tearing due to the strain often placed on them.

The typical story is that your shoulder starts hurting. Sometimes it is due to a specific injury and sometimes your shoulder just starts hurting. Regardless, you go to your doctor who takes a look at it. You may get a steroid shot. Sometimes that helps and sometimes it doesn’t. If you don’t get better you may be sent to physical therapy or to an orthopedic surgeon. Sometimes you get an MRI. Yet your shoulder still hurts.

What is the deal with the rotator cuff and why does it hurt?

The rotator cuff is made of tendons as explained above. These tendons are very densely innervated with nerves. I talk more about this on the ‘How does prolotherapy work?‘ page.

When these tendons are damaged it irritates the nerves which are very sensitive to pressure and stretching. Sometimes this damage is due to a partial or a full thickness tear. Sometimes it is simply irritation of the tendons themselves.

It could be damage to any of the rotator cuff tendons that is causing the symptoms. Fixing the shoulder pain requires addressing all of the damage. Prolotherapy is very good at doing that. It is a very comprehensive procedure.

Prolotherapy is specifically designed to stimulate the healing process for these rotator cuff tendons. Animal studies have shown that prolotherapy can make the tendon 40% thicker and 50% stronger than it was.

That is great news for a condition that is due to tendon damage.

If you have shoulder pain or a rotator cuff tear or rotator cuff injury then you should strongly consider prolotherapy.

There is minimal risk. It is cost effective (>90% success rate in our clinic), simple, and well tolerated. Plus, there is no down time or recovery after the procedure. You don’t even have to take time off!

So what are you waiting for? Call our clinic so we can get you on the path to healing that damaged rotator cuff.

Here are a couple of people who wanted to share their story with their shoulder pain:

Shoulder Pain Testimonials:


 

 

 

Pain, Pain Go Away

Low Back Pain Tulsa Oklahoma ProlotherapyDo YOU have pain?

Did you know that 100 million Americans have pain?

This pain costs $600,000,000,000 per year!

100 people die every day from drug overdoses. 60% of those overdoses are due to prescription drugs.

This problem isn’t getting better.

If you have pain then you have 2 options

Your first option is to pursue management of your pain. That means you seek traditional medical care and will likely be prescribed medications or have surgery recommended.

You may already be on this path and it may be your only option. You may not be on this path yet and you may be searching for options. Either way, you need to understand that the use of narcotic pain medications can often come with a whole host of problems:

  • Dependence – your physiology needs these medications in order to prevent symptoms of withdrawal independent of the control of pain
  • Addiction – many people become addicted to their medications
  • Abuse – many patients will engage in inappropriate behavior in order to obtain their medications
  • Overdose – may be due to a need to decrease their pain and actually be an accidental overdose
  • Decreased functionality due to side effects of the medications
  • Tolerance – you can become tolerant to your dose of medication and need higher and higher doses in order to achieve the same results

These issues do not mean that these medications are always a bad idea. There are certainly times when this therapy is absolutely the best option.

However, there is another way

We routinely see patients who have tried everything in order to relieve their pain with minimal results. They may have good pain control but can’t function because of the therapy.

We advise finding the source of the pain and eliminating the pain at the source if at all possible.

We have been able to trace the roots of most causes of pain to a ligament or tendon problem. The issue with a ligament/tendon problem is that modern medicine doesn’t have a good therapy for it so they are forced to recommend things like medications, surgery, physical therapy, etc. Again, you may need these interventions but what if you don’t?

We want to provide the highest success interventions with the lowest cost and risk to the patient.

Prolotherapy & PRP can provide the solution to reduce your pain and improve your function. It has extremely low risk and is very cost effective. It has been around for nearly 100 years in its current form and can help heal the damaged structures that are causing pain.

Learn more about Prolotherapy & PRP here.

Contact us today to see if Prolotherapy is the best option for you!

________________________________________________________

References:

  1. http://www.webmd.com/pain-management/news/20110629/100-million-americans-have-chronic-pain
  2. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/
  3. http://www.popsci.com/science/article/2013-04/which-drugs-actually-kill-americans
  4. http://www.huffingtonpost.com/2013/02/19/drug-overdose-deaths-up-increase-11th-year_n_2719704.html
  5. http://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery

Prolotherapy – A Non-Surgical Alternative for Herniated Disks & Back Pain

prolotherapy low back pain herniated disk surgical alternative spine

Do you have low back pain or neck pain and been told that your pain is due to a herniated disk? Have you been told that surgery is your only option for treating your pain?

We have news for you… there may be another option that you may not have heard of before!

Prolotherapy can improve function and decrease back pain associated with herniated disk disease in many cases.

In order to understand how prolotherapy can help this problem we have to understand the problem itself. The spinal column is composed of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae (fused), and the coccyx. There is a bony joint called the facet which connects one vertebrae to the one below. There are 2 facets per segment. These joints are held together by ligaments that form the joint capsule.

In between these vertebral segments is an inter-vertebral disk. The disk is composed of a tough outer ‘shell’ made of collagen called the annulus fibrosis. Within the outer shell is the ‘jelly filled center’ called the nucleus pulposus. The disk serves as a shock absorber and cushion.

 

 

vertebrae disk nucleus prolotherapyThis structure is perfectly designed to provide structure, function, and flexibility to the human form. It allows flexion, extension, side-bending, and rotation. It is incredibly strong.

The weakest spot of the disk is the back side. There is a tough ligament, the posterior longitudinal ligament, that covers much of the posterior portion of the disk leaving the posterior corners the most vulnerable and this is exactly where disk herniation generally occurs.

Additionally, the spinal nerves leave the spinal canal through the intervertebral foramen. The weak spot of the disk generally corresponds to the area where this nerve exits the foramen and can compress it resulting in ‘radiculopathy’. Surgery for herniated disks involves surgically repairing the disk and decompressing the nerve resulting is elimination of radiculopathy.

One source states that the surgery SHOULD be 95% effective in eliminating the radiculopathy. However, they also state that 10% of patients will have a recurrence in the same area and require repeat surgery. They recommend a spinal fusion if this occurs repetitively.

I have a few issues with this approach.

First, not all “pain going down my leg” is due to a herniated disk, even if you find a herniated disk on MRI. Several studies have been performed that raise questions on whether or not we can accurately attribute an abnormal finding on MRI to the cause of the symptoms. Back pain should be evaluated by a trained prolotherapist before any surgery is considered (unless it is a true emergency) because there are other potential causes for pain going down the leg besides herniated disks.

Next, we need to evaluate the actual cause of the herniated disk. Have you ever wondered WHY these things occur in the first place? I don’t believe they ‘just happen’. Here’s how I believe these things get started…

Step 1: There is damage to the ligaments that form the facet joint capsule allowing excess movement and flexion.

Step 2: Excess flexion causes increased stress on the disk but also increases the stress exponentially on the anterior column (the front edge of the disk) and forces pressure posteriorly along the weakest area of the disk. This allows the disk herniation.

If I am right, we can help this problem with prolotherapy on the spinal facets which will tighten up these joints, restore proper spinal function, and provide an environment for the disk to heal itself.

We have helped many patients with herniated disks with prolotherapy!

Here is an example.

A 53 year old active duty Marine Corps Master Gunnery Sergeant with a history of repetitive low back pain after a sports injury 10 years prior. He was told that he had disk rupture with stenosis and surgery was recommended. He underwent 1 year of physical therapy and other conservative therapies and had no improvement and his left leg started hurting. He stated that his pain was getting worse and it hurt to sit and lay down.

An MRI was obtained and is shown below:

low back disk herniation before prolotherapy

low back herniated disk before prolotherapy transverse

 

 

 

 

 

 

 

 

 

 

 

June 14, 2010 – the patient received his 1st prolotherapy procedure with standard proliferant solution.

July 30, 2010 – the patients states that he has no back pain but does have some left buttock and radiating pain to the top side of his foot from 1 week prior. He received his 2nd round of prolotherapy with dextrose and added PRP at this time.

August 27 & October 2, 2010 – prolotherapy & PRP (#3 & #4). He has no back pain with only mild pain on the dorsum of his foot. He states that he is more than 90% improved at this point.

November 13, 2010 – he states he has almost no pain and he received his 5th prolotherapy procedure.

April 8, 2010 – he returned to the Army Hospital and saw his orthopedic surgeon who told him “you can’t cure ruptured disks and spinal stenosis with an injection” and that this was “nonsense!” The surgeon wanted to “prove this nonsense” with a follow up MRI.

The comparison of the before and after MRIs are below. The herniation is depicted by the arrows.

low back herniated disk before and after prolotherapy cure

low back herniated disk transverse before and after prolotherapy cure

 

 

 

 

 

 

 

 

The surgeon was surprised by this MRI finding and had to admit the success. The patient stated that he had no problems with tough military training.

This case underscores the potential benefit of prolotherapy with a specific injury. We have tremendous success with treating low back pain with prolotherapy in our clinic and would love to help you with your pain.

Consider the cost of surgery: time off from work, family, and exercise; physical therapy; medications; and potential risks.

Now consider the cost of prolotherapy: no time off of work; limited recovery needed; no medications (generally); and very low risks.

The choice is clear. Contact us to schedule your prolotherapy evaluation today!

 

 

Prolotherapy Is A CrossFit Athlete’s Best Friend!

CrossFit Prolotherapy Revolution Health Tulsa Jimmy PullupI have been doing CrossFit for several years (since 2008). When I was a physician for US Army Special Operations I saw countless injuries and musculoskeletal pains. Many of these soldiers were doing CrossFit. I have been injured during CrossFit workouts and I have seen a ton of CrossFit injuries in my patients. Not because CrossFit is bad but simply because it challenges us. Of course there is always the problem of doing too much or with bad technique but that isn’t specific to CrossFit!

Injury goes hand-in-hand with sports and athletics and the more intense the sports or athletics the more common and intense the injury potential. The injuries vary from overuse & overtraining to torn muscles, ligaments, meniscus, herniated disks, labrums, etc.

Every CrossFit athlete’s goal (that we’ve seen anyway) is to increase their health, fitness, strength, endurance, power, etc as much as possible. Therefore, they push the limits on what their body can handle. This makes injury a more common entity.

 

Revolution Health & Wellness Clinic CrossFit Prolotherapy Tulsa Oklahoma Becky

The goal of every CrossFit box, trainers, etc is to keep these athletes in the gym and to increase the performance of their athletes. The goal of Revolution Health & Wellness Clinic is to keep our patients as healthy and fit as possible. Thus, we share the same goal of these athletes, trainers, owners, etc. We want to prevent injury as much as possible but when injury does occur we want to fix it as quickly as possible so that these athletes can resume optimal fitness and performance.

I was an Athletic Trainer in college and worked with athletes and their injuries. My training, at that time, was the standard dogma of “R.I.C.E.” or Rest, Ice, Compression, and Elevation as initial therapy for most injuries. In fact, we literally had T-shirts that simply said “Just Ice It.” This was generally followed by motrin, naprosyn, etc for the pain and swelling. Motrin is often called “Ranger Candy” in the Army due to its frequency of use for “all that ails you.”

R.I.C.E. therapy and NSAIDs (Anti-Inflammatory medications) serve to decrease the symptoms (pain & swelling) after an injury but they DO NOT help to heal the injured areas sooner. In fact, they can be very detrimental and actually slow or even stop the healing process. It is a faustian bargain!

Since our goal is to get these athletes back as quickly as possible, we want to find an intervention that heals the damaged tissues faster and produces better, stronger, and thicker ligaments and tendons. In short, we want the CrossFit approach of healing.

Prolotherapy is the CrossFit of healing!

Prolotherapy stimulates more rapid and complete healing. In fact, studies performed in the 1950’s showed that prolotherapy increases the diameter of the injected ligaments by up to 40%, increases the attachment area to the bone by 30%, and increases the strength of the ligament by 50%.

Better, thicker, stronger

If you have been reading our information on Prolotherapy then you know that most causes of musculoskeletal pain can find its roots in ligament and/or tendon relaxation or damage. Relaxed ligaments and tendons will not show up on an MRI and are a common cause of “unexplained pain” with normal radiologic studies. Additionally, an abnormal finding on MRI doesn’t mean that the abnormality is the cause of the pain or problem.

I have seen numerous soldiers and other patients with extremely painful conditions but nobody could identify why. They are generally referred to surgical procedures (without improvement by the way), physical therapy, pain management, etc. Who wants that?

The optimal treatment is to RESTORE NORMAL ANATOMY AND FUNCTION!

When ligament and tendon relaxation is the cause of pain then the only therapy is prolotherapy! Unfortunately, the art of physical exam for ligament and tendon damage as been lost with the advent of more expensive testing such as CT & MRI which cannot accurately evaluate these structures as the source of pain anyway!

We treat CrossFit athletes every day with minor and significant injuries. We have had the honor of treating several nationally competitive CrossFit athletes and had excellent results. We have been able to reduce pain, improve performance, and return them to full function sooner than any other therapy we’ve seen.

If you are a CrossFit athlete (or if you know one) then you should have a prolotherapy physician’s information stored in your phone. You should have their phone number in your rolodex. You should have their information posted in your gym.

We all have the same goal. Let us help you achieve it!

Platelet Rich Plasma (PRP) Therapy Explained

Revolution Health PRP Platelet Rich Plasma ProlotherapyDr Edwards has been performing Prolotherapy for several years and has had excellent results. However, there are some patients that don’t respond as well as we would like and need a little more stimulation of their immune system in order to provide the desired results.

That is where Platelet Rich Plasma (PRP) Therapy comes in.

PRP has been around for several years and has more support in the medical literature. The rational for this is quite simple. The machines & systems used in order to obtain the platelet rich plasma portion of the blood are proprietary and there is money in selling the machines and kits for PRP. Thus, these medical device companies have a vested interest in equipment sales. Therefore, the greater the demand for PRP the more devices they will sell. Any time there is money there can be research studies to back it up!

The procedure for PRP is essentially the same as for prolotherapy. We are stimulating the immune system to heal itself. The primary difference is in the type of proliferant solution. PRP uses the platelet rich portion of plasma once the blood has been ‘spun’ to separate the components.Tulsa Platelet Rich Plasma PRP Prolotherapy Device

Platelets are very small cell components that critically contribute to the healing process. As the body’s primary source of bioactive tissue growth factors, platelets include:

  • CTGF (Connective Tissue Growth Factor)
  • PGDF (Platelet Derived Growth Factor)
  • TGF-β (Transforming Growth Factor-beta)
  • EGF (Epidermal Growth Factor)
  • IGF (Insulin Growth Factor)
  • bFGF (basic Fibroblast Growth Factor)
  • VEGF (Vascular Endothelial Growth Factor)

By concentrating these growth factors and injecting them at the site of injury, the body’s own stem cells are drawn to the injured area and differentiate to form new healthy and robust regeneration of damaged ligaments and tendons.

PRP does seem to be a bit more potent in stimulating the inflammatory response. The pain after the procedure also seems to be a bit more intense as well.

For those that want to see the process of PRP, here you go…

PRP concentrates Mesenchymal stem cells (MSCs).

MSC’s are multi-potent stem cells that can transform into several of types of cell during the tissue repairing process. The different types of cells that MSC’s have been known to transform into include collagen secreting cells, bone forming osteoblasts and cartilage forming chondrocytes. Collectively, all of these cells can potentially rejuvenate tissues that have been damaged due to injury, osteoarthritis and degenerative changes.

What does it do?

The platelet rich plasma process concentrates fibrin, mesenchymal stem cells and platelets so that each cubic millimeter of the solution consists of 1.5 to 2 million platelets. This results in up to a five-fold increase in the platelets and bioactive growth factors. Platelet Rich Plasma acts as a tissue growth accelerator which amplifies the natural process of the tissue reparation and healing, due to its potency. Studies have revealed that PRP stimulates not only the production of new collagen at the fibroblasts, but bone and cartilage cells at the site of the injection. This strengthens injured ligaments and tendons by rebuilding the joint cartilage. This new, strong, collagen is naturally incorporated into the existing cartilage and ligaments making them thicker and more elastic.

How Does PRP Prolotherapy Compare With Cortisone Shots?

Cortisone injections actually weakens tissue. Although cortisone injections have been known to provide temporary relief and to stop inflammation, they do not provide long-term healing. The process of Platelet Rich Plasma therapy heals and strengthens the tendons and ligaments, in some cases thickening the tissue up to 40%.

How Does PRP Regenerative Injection Therapy compare with regular Dextrose Prolotherapy?

When regular dextrose prolotherapy has provided positive results but recovery has not been ideal, PRP Regenerative Injection Therapy is especially useful. In these types of situations PRP is often the treatment option that will resolve the less responsive or more injured areas. In fact, clinical and anecdotal experience has demonstrated that using PRP as the prolotherapy injection solution creates a deeper healing effect and results in an accelerated healing process in fewer treatments than the regular dextrose prolotherapy..

Frequency Of Treatments

Usually patients feel the benefits of PRP injection therapy after only two treatments. Sometimes satisfactory results may occur even sooner, however this is not absolutely certain. Although individual responses to the treatment do vary, most people require 3-6 sets of injections. Each treatment is spaced four to six weeks apart.

So what conditions are successfully treated with PRP?

Because of the high success of normal Dextrose Prolotherapy, PRP is not something we normally think of as a first line solution. For really, really, bad tears or injuries, especially if someone has had some Prolotherapy elsewhere, it may be used as a first-line therapy. Because of the greater cost of PRP due to the cost of filters and PRP technology as well as preparation it is preferable to begin with regular prolotherapy as it provides excellent results 80% of the time. For those who do get PRP solution as their Prolotherapy solution, we typically see them for follow-up in four to six weeks. Generally, people know by the second PRP Prolotherapy whether it will work or not. Overall the results have been extremely positive. It is very safe. There have been no reactions related to the solution.

When to consider PRP solution as your Prolotherapy Option:

  • regular prolotherapy has resulted in some success, you are confident the treatment has been done properly into the appropriate areas, but the results are not optimal.
  • Your injury is very severe or complex
  • labral or meniscal tears
  • high performance athletes who put more demand on joints
  • out of town patients who cannot return for visits frequently
  • persons who wish to maximize their results with a minimum number of injection visits

MRI For Musculoskeletal Pain Is Often Not Helpful

As an Army Doc I saw countless patients with musculoskeletal complaints.MRI low back pain Tulsa Prolotherapy PRP

It wasn’t uncommon that someone would come up to be asking for an MRI in order to “find out what is going on“. I often asked them if they were considering Surgey to correct the problem and the most frequent response is “no way, I just want to know what is going on!”

My residency training taught me that an MRI was a great tool to help evaluate the need for surgery and identify a surgically correctable cause for the problem. MRIs can cost over $2000 so they aren’t cheap. Somebody has to pay for it and there should be a good reason to ask for one!

A lot of tests (labs, xrays, CT, and MRI) are like picking your nose in public… what are you going to do with the results?

If an MRI is going to change my management then it is something to consider and may be worth the cost.

However, MRIs are not perfect tests!

I read an article the other day on incidental findings of meniscal damage during knee MRIs. This study evaluated the incidence of meniscal damage in patients who had no knee complaints. They evaluated 991 patients in Framingham, MA without regard to whether or not they had knee complaints and then evaluated whether or not they had any symptoms. They noted that 61% of patients with meniscal tears on MRI didn’t have any knee pain, aching, or stiffness within the previous month.

I like this study because it relays what I’ve been thinking for years…

Just because they find a problem on an MRI it doesn’t mean that it is the cause for the symptoms!

I’ve had numerous patients tell me that they have a herniated disk and they think that is the cause of their back pain. However, on physical examination, I can reproduce their pain by palpation (by pushing on their back). I can also, almost always, dramatically reduce their pain (and in some cases make them pain free) with a prolotherapy injection that doesn’t go anywhere near their intervertebral disk!

Multiple studies have shown that there is no relationship between presence of disk herniation and symptoms.

One study (Boos et al.)  evaluated patients with jobs that had high-risk of causing disk herniation (frequent bending, twisting, lifting, vibration, etc). All 96 of these patients were asymptomatic. However, the following ‘abnormalities’ were found:

  • 76% had disk herniation
  • 17% had minor nerve root compression
  • 4% had major nerve root compression
  • 85% had Degenerative Disk Disease (DDD)
  • 13% had disk extrusion (the jelly in the disk is leaking out)

And none of these patients had ANY symptoms!

If you are middle-aged (average age of 45) and you have an MRI on your lower back, here are the chances you’d have something “abnormal” on your MRI – regardless of symptoms:

  • Disk bulge – 38%
  • Disk protrusion – 29%
  • Disk extrusion – 10%
  • Nerve root compression due to herniation – 4%
  • Findings of disk bulge, protrusion, or extrusion – 60%

So, MRIs are a valuable and useful tool. BUT we need to exercise discretion when ordering them. It is a rare instance that I need to get an MRI before prolotherapy treatments. I just haven’t found them that helpful.

References:

  1. Englund M, et al. “Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons.” N Engl J Med 2008;359:1108-15
  2. Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373
  3. Boden SD et al. “Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” J Bone Joint Surg Am 1990; 72A:403-408
  4. Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666
  5. Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625
  6. Powell MC, et al. “Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women.” Lancet – 1986; 2:1366-7
  7. Boos N, et al. “Natural history of individuals with asymptomatic disc abnormalities in MRI: Predictors of low back pain-related medical consultation and work incapacity.” Spine 2000; 25:1484
  8. Borenstein G, Boden SD, Wiesel SW, et al. “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic individuals: A 7-year follow-up study. J Bone Joint [am] 2001; 83:320-34
  9. Wiesel SW, et al. “A study of computer-associated tomography: I. The incidence of positive CAT scans in asymptomatic group of patients.” Spine 1984;9:549-51
  10. Wood KB, et al. ‘Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individual s.’ J Bone Joint Surg Am. 1995 Nov;77(11):1631-8
  11. Jarvik JJ, et al. “The longitudinal assessment of imaging and disability of the back (LAIDBack) Study.” Spine 2001;26: 1158-66.
  12. Boden SD, et al. “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatci Subjects.” J Bone Joint Surg [AM] 1990; 72:403-408
  13. Fraser RD, Sandhu A, Gogan WJ. ‘Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation.’ Spine 1995 Mar 15;20(6):710-4. “The findings of this study indicate that long-term improvement of a patient’s symptoms after treatment of disc herniation may occur with or without resolution of the hernia. This and the similar morphologic findings in the different groups is consistent with the 10-year clinical results after the treatment of disc herniation reported by Weber.”
  14. Masui T, et al. ‘Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years.’ J Spinal Disord Tech. 2005 Apr;18(2):121-126. “Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.”
  15. Giuliano V, et al. ‘The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.’ Emerg Radiol. 2002 Nov;9(5):249-53.

Prolotherapy (or PRP) for Plantar Fasciitis

Plantar fasciitis can be very debilitating and extremely difficult to eliminate. I’ve had it twice myself and struggled for quite some time with fixing it! The first time I had it I was able to get rid of it with constant stretching and activity modification (rest). The 2nd time stretching didn’t fix it but a night splint over several months did the trick.

Prolotherapy Tulsa Plantar FasciitisI have many patients who have been struggling with plantar fasciitis for months or years and nothing has helped. Many patients try the stretching, orthotics, night splints, ice massage, physical therapy and eventually progress to steroid injections which do help some patient.

Unfortunately, it is all to frequent that nothing else helps and these patients are seeking surgery as an option to finally eliminate their pain!

We have found that nearly all of our patients respond to Prolotherapy (or PRP depending on the patient) for plantar fasciitis. The procedure we use works extremely well.

While we certainly treat the source of the pain (the junction of the plantar fascia with the calcaneous), we also want to help restore the normal arch of the foot which reduces the strain on the plantar fascia. When we do that we dramatically reduce the likelihood of recurrence of plantar fasciitis.

Check out this video on Prolotherapy for plantar fasciitis and see how simple it really is! Most patients require 3-6 procedures. The healing is a process over time but it works for most patients.

Contact us to learn how we can help you with PRP or Prolotherapy!

Prolotherapy for Sports Injuries

Prolotherapy is an excellent therapy that stimulates that body to heal the painful, damaged areas.

Prolotherapy stimulates the repair of injured, damaged structures. It involves the injection of a proliferant solution, which is all natural, (along with anesthetics to decrease the pain associated with the injections) at the exact site of an injury (ligaments, tendons, menisci, muscles, growth plates, joint capsule, and cartilage) so that the immune system is stimulated to repair the damaged area. Inflammation is the process by which the body heals itself

Specifically, Prolotherapy causes proliferation of fibroblasts (where the term Prolotherapy comes from). Fibroblasts are the cells that produce the collagen which grows the ligaments and tendons. Fibroblast proliferation stimulates new, strong, collagen tissue which is what is needed to repair ligament/tendon sprains and other sports injuries.

ISN’T THE PAIN AN INDICATION OF TOO MUCH INFLAMMATION?
The body heals through an inflammatory reaction.  The inflammation is what heals the damage to the ligaments & tendons which is caused by sports injury or trauma.  Persistent pain in the athlete indicates that these tissues are still damaged.  Persistent pain is not normal and should let the athlete know that there is persistent damage to these structures. The appropriate response for the athlete should be to obtain prolotherapy as opposed to the common response of taking anti-inflammatory medications. These medications have been shown to reduce the healing and cause further weakening of the damaged structures.

IF ANTI-INFLAMMATORIES AND CORTISONE WEAKEN TISSUE THEN WHY DOES THE PAIN GO AWAY?

The best way to explain this is to compare it to the check engine light in your car. When the light comes on it indicates a problem. You have 3 options when the light comes on:

  1. deal with the light being on and ignore the underlying problem
  2. fix the underlying problem and make the light turn off
  3. clip the wires going to the light making the light turn off but ignoring the underlying problem
Taking anti-inflammatory medications (including steroids) is similar to simply clipping the wires. The indicator goes away but the problem remains. These medications reduce the inflammation which does reduce the pain but it also reduces the chances of any healing! Remember, optimal performance requires tight ligaments & tendons. We can eliminate the pain but that does not mean that the structure is completely healed. This explains why athletes commonly damage the same structures over and over again. Taking these medications halts the healing process leaving a weakened structure making them more susceptible to repetitive injury. The best thing to do would be have these areas treated with Prolotherapy. Every athlete should have the goal of complete healing!

WHY DO DOCTORS RECOMMEND THESE MEDICATIONS IF I NEED THIS INFLAMMATION?

The principle of optimal healing is not ‘standard medicine.’ When I was an Athletic Trainer in collage, we had shirts that said “Just Ice It.” RICE is the treatment for nearly all musculoskeletal problems.

This is similar to the mercury toxicity issue.  It is clear from the government standpoint that mercury is toxic to the human body as there are strict guidelines for mercuries use in industry and industry exposure. The Environmental Protection Agency has clear guidelines to how much exposure of mercury is ‘safe’ in the workplace and the environment, yet the government allowed and still allows dentists to put mercury directly into the mouths of Americans via amalgam fillings. For the American Dental Association and other ‘authoritative’ agencies to now ‘admit’ that mercury is a poison (which it clearly is) could cause anarchy and tremendous legal action.

You can imagine that there would be a huge backlash if the medical community suddenly reversed their position. What if they admitted that NSAIDs and steroids actually inhibited the healing process and were the primary cause of arthritis. Can you see the commercials from the lawyers?

Athletes should not tolerate the medical therapy! Please help us let every athlete know how to restore their ligaments/tendons and keep them in the game longer! Tell everyone you know about the benefits of Prolotherapy & PRP!

Prolotherapy & Risks & Benefits

 Prolotherapy & PRP performed at Revolution Health & Wellness Clinic in Tulsa, OK is extremely safe and beneficial.

There are some potential complications that can be encountered with the procedure and it is very important that every patient understands these potential risks. We recommend that each patient watch the video below to gain a greater understanding of the potential risks. Each patient will be given an opportunity to ask questions about these risks in relation to their specific procedure.

Prolotherapy & PRP Risks

The majority of the risks associated with Prolotherapy & PRP are inherent with the needle injection. These risks include:

  • Bleeding; It is not uncommon that we will hit a smaller blood vessel with the needle and this can cause some minor bleeding and bruising. We have not seen this to be problematic and simply want you to be aware.
  • Infection: conceptually, this is a possibility. However, Dr Edwards has been doing prolotherapy for several years and has performed hundreds of procedures. He has never witnessed a single infection from prolotherapy. Additionally, we are associated with the Hackett-Hemwall Foundation where there are numerous prolotherapists and we have not heard of a single case of infection since 1956.
  • Pneumothorax: a pneumothorax is a collapsed lung due to air entering the space between the chest wall and the lung itself. This is a potentially serious complication and we would need to know about this immediately. The potential for this complication centers around the chest wall and ribs as that is where the lungs reside. Symptoms of a pneumothorax include chest pain, shortness of breath, difficulty breathing, voice changes, increased heart rate. The treatment for a pneumothorax depends on its severity and generally needs to be evaluated by a physician or an emergency room.
  • Hitting something we don’t intend: we do everything we can to minimize these risks but it is impossible to completely prevent these types of complications. If we are injecting around the spinal column, it is possible to hit the spinal cord. This sounds like a big problem but, more often than not, the problem lasts for a second or two and then goes back to normal. We could hit nerves, arteries, or veins. Physicians put needles into arteries and veins every day intentionally. We don’t want to do this with prolotherapy but it is occasionally inevitable.
  • Spinal Headache: anytime the spinal canal is punctured there is the possibility of a spinal headache. This is similar to having a lumbar puncture or an epidural injection.
  • Migraine Headache: this has been reported but we haven’t seen it in our clinic.
  • Allergic Reaction: our solutions are very safe and allergy to any of the components in our solution is very unlikely. However, if you are concerned about this then please make us aware of your concerns and we will make sure that everything is as safe as possible.
  • Lidocaine Toxicity: we use a very small amount, generally 0.1%, of lidocaine making toxicity extremely unlikely except in the most extreme amounts of proliferant injected.
  • Increased pain: Most patients have some discomfort after the procedure that can last several days. Some patients experience extreme discomfort that is generally described as aching for up to a week. This varies dramatically from patient to patient. If you are experiencing a significant amount of pain please call our office so that we can manage your pain appropriately. PRP generally invokes a greater pain response during this period. It is important to remember that this is part of the healing process and is not an indicator of a problem.

Does It Hurt?

As stated in the video, this is an injection technique where we are injecting an irritating solution into already painful areas. So, yes, it can be painful. Most of our patients tolerate the procedure very well but some do have extreme pain during the procedure.

We are committed to keeping you as comfortable as possible during the procedure as well as afterwards. There are several things we can do to help reduce the discomfort of the procedure.

Medications: there are several medications that can be prescribed and taken prior to the procedure to help you stay as comfortable as possible. Here is a short list of medications that we can use. If any of these medications are prescribed for you then you will need to take them exactly as they are prescribed.

  1. Valium 5-15mg (1 to 3 pils) 1 hour prior to the procedure
  2. Norco 5-15mg 1 hour prior to the procedure
  3. Flexeril 10mg 1 hour prior to the procedure

You may be prescribed all, some, or none of these medications. If you take any of these medications prior to your procedure then you will need to have a driver to bring you to the clinic and back home.

Topical anesthetic: we can apply a topical anesthetic that will numb the skin so that the pinch of the needles is reduced. This does not help with the deeper pain or discomfort. This anesthetic takes between 45-60 minutes for full effect so you will need to let us know that you want this and arrive 1 hour prior to your procedure.

Tennant Biomodulator: this is a specific device similar to a TENS unit (but different in effect) that can help distract from the procedure. Some patients get significant benefit from this device. This is easy to do in the clinic. We simply attach the electrodes to certain areas, turn on the device, and increase the intensity as high as you can tolerate. The more you can tolerate the more benefit you will receive.

Sooting music, Squeeze balls: The more relaxed you are the more comfortable you will be. The squeeze balls seem to help a little as well.

IV Medications: we can do some light sedation by giving you pain medications and anxiety medications through an IV. These medications kick-in within minutes and can make you extremely comfortable. We do not completely sedate you. We want you awake and able to interact with us during the procedure. However, these medications may induce amnesia so you may not remember have the procedure performed once the medications wear off.

It will take several hours to return to ‘normal’ after having these medications and the procedure only takes minutes so we have to decide if it is worth it. There is an additional fee associated with IV medications due to the level of supervision required, IV supplies, medications, etc. It takes a significant amount of resources to make sure that this can be done safely!

Our goal is to resolve your pain as quickly, cost-effectively, and comfortably as possible.

Contact us today to schedule your appointment so that you can get started resolving your pain as quickly as possible!

Prolotherapy Endorsed By Surgeon General (C. Everett Koop)

Revolution Health & Wellness Clinic in Tulsa, Oklahoma is Tulsa’s premiere holistic, natural, and comprehensive medical clinic and is the only clinic in Oklahoma to offer both Prolotherapy and Platelet Rich Plasma (PRP) Therapy.

Many people with pain, who are looking for a surgical alternative to their problems, ask us why prolotherapy and PRP aren’t more common. Many people, including Physicians, are extremely skeptical about the effectiveness of the procedure.

One of the most striking testimonies by a physician is from C. Everett Koop, MD, the former Surgeon General of the United States. He was the Surgeon General under President Ronald Reagan.

This is his story…

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Tulsa Prolotherapy Holistic Natural Medicine C Everett Koop

Dr. C. Everett Koop

Prolotherapy is the name some people use for a type of medical intervention in musculoskeletal pain thatcauses a proliferation of collagen fibers such as those found in ligaments and tendons, as well as a shortening of those fibers. The “prolo” in Prolotherapy, therefore, comes from proliferative.

Other therapists have referred to this type of treatment as Sclerotherapy. “Sclera” comes from the Greek word “sklera”, which means hard. Sclerotherapy, therefore, refers to the same type of medical intervention which produces a hardening of the tissues treated – just as described above in the proliferation of collagen fibers.

Not many physicians are aware of Prolotherapy, and even fewer are adept at this form of treatment. One wonders why that is so. In my opinion, it is because medical folks are skeptical and Prolotherapy, unless you have tried it and proven its worth, seems to be too easy a solution to a series of complicated problems that afflict the human body and have been notoriously difficult to treat by any other method. Another reason is the simplicity of the therapy: Injecting an irritant solution, which may be something as simple as glucose, at the junction of a ligament with a bone to produce the rather dramatic therapeutic benefits that follow.

Another very practical reason is that many insurance companies do not pay for Prolotherapy, largely because their medical advisors do not understand it, have not practiced it, and therefore do not recommend it. Finally, Prolotherapy seems too simple a procedure for a very complicated series of musculoskeletal problems which affect huge numbers of patients. The reason why I consented to write the preface to this book is because I have been a patient who has benefitted from Prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients – but more on that later.

When I was 40 years old, I was diagnosed in two separate neurological clinics as having intractable (incurable) pain. My comment was that I was too young to have intractable pain. It was by chance that I learned that Gustav A. Hemwall, M.D., a practitioner in the suburbs of Chicago, was an expert in Prolotherapy. When I asked him if he could cure my pain, he asked me to describe it. When I had done the best that I could, he replied., “There is no such pain. Do you mean a pain?” And then he continued to describe my pain much better than I could. When I said, “That’s it exactly,” he said, “I can fix you.” To make a long story short, my intractable pain was not intractable and I was remarkably improved to the point where my pain ceased to be a problem. Much milder recurrences of that pain over the next 20 years were retreated the same way with equally beneficial results.

I was so impressed with what Dr. Hemwall had done for me that on several occasions, just to satisfy my curiosity, I watched him work in his clinic and witnessed the unbelievable variety of musculoskeletal problems he was able to treat successfully. Many of his patients were people who had been treated for years by all sorts of methods, including major surgery, some of which had left them worse off than they were before. Many of his patients had the lack of confidence in further treatment and the low expectations that folks inflicted with chronic pain frequently exhibit. Yet I saw so many of them cured that I could not help but become a “believer” in Prolotherapy.

I was a pediatric surgeon, and there are not many times when Prolotherapy is needed in children because they just don’t suffer from the same relaxation of musculoskeletal connections that are so amenable to treatment by Prolotherapy. But I noticed frequently that the parents of my patients were having difficulty getting into their coats, or they walked with a limp, or they favored an arm. I would ask what the problem was and then, if it seemed suitable, offer my services in Prolotherapy at no expense, feeling that I was a pediatric surgeon and this was really not my line of work. The results I saw in those many patients were just as remarkable as was the relief I had received in the hands of Dr. Hemwall. I was so impressed with what Prolotherapy could do for musculoskeletal disease that I, at one time, thought that might be the way I would spend my years after formal retirement from the University of Pennsylvania. But the call of President Reagan to be Surgeon General of the United States interrupted any such plans.

The reader may wonder why, in spite of what I have said and what this book contains, there are still so many skeptics about Prolotherapy. I think it has to be admitted that those in the medical profession, once they have departed from their formal training and have established themselves in practice, are not the most open to innovative and new ideas.

Prolotherapy is not a cure-all for all pain. Therefore, the diagnosis must be made accurately and the therapy must be done by someone who knows what he or she is doing. The nice thing about prolotherapy, if properly done, is that it cannot do any harm. How could placing a little sugar-water at the junction of a ligament with a bone be harmful to a patient?

C. Everett Koop, M.D., ScD
Former United States Surgeon General

Reprinted Excerpts from Prolo Your Pain Away
by Dr. Ross Hauser

Prolotherapy & Platelet Rich Plasma In Tulsa

This article was written by Dr Chad Edwards, Medical Director & CEO of Tulsa’s premiere holistic medical clinic – Revolution Health & Wellness Clinic.

We are the only clinic in Tulsa to perform Prolotherapy and Platelet Rich Plasma (PRP).

I have been performing prolotherapy since 2009 and have had amazing results. It seems that the vast majority of people get significant results from this procedure. We have had hundreds of satisfied patients because of the success of this procedure in restoring them to normal function without pain.

However, although rare, we have not been able to help some people with prolotherapy. This is where Platelet Rich Plasma (PRP) comes in. I started doing prolotherapy in the military because I could do it with the standard equipment that I had available to me. When I started working at Warren Clinic, I was able to continue doing prolotherapy for the same reason.

I continued doing only prolotherapy because the vast majority of people get better with it and it is cheaper than prolotherapy. At Revolution Health & Wellness Clinic our goal is to help as many people as possible and we don’t like to tell patients that there is nothing else we can do for them.

Fortunately, we have been able to add PRP to our repertoire. We have had great results with this procedure as well.

I discussed how prolotherapy works previously. PRP works by a similar mechanism but platelets contain growth factors that are potent stimulators of growth of collagen and repairing tissues.

The risks and benefits are the same as prolotherapy.

Now for the down side… Platelet Rich Plasma (PRP) Therapy is more expensive than prolotherapy and is not generally covered by insurance. You can read more about Prolotherapy & PRP costs and prices as well as insurance information.

Notable athletes to have received PRP Therapy include Tiger Woods, Alex Rodriguez (A-Rod), Hines Ward, and Kobe Bryant to name just a few.

We generally recommend getting the injections at 6 week intervals whereas we generally perform prolotherapy every 3-4 weeks.

The pain after PRP does seem to be a little more robust than after Prolotherapy so we often prescribe pain medications for use after your procedure. You will still want to avoid anti-inflammatory medications as stated on the Prolotherapy & PRP Procedure Instructions page.

This procedure is effective for the same conditions as Prolotherapy:

  • back pain
  • neck pain
  • knee pain, partially torn or damaged ligaments
  • Osteoarthritis
  • Headaches (depending on the source)
  • Elbow Pain (lateral & medial epicondylitis)
  • Carpal Tunnel Syndrome
  • Thumb Arthritis
  • Ankle pain, ankle sprains, ankle laxity
  • Chronic muscle pains (these are usually due to ligament/tendon damage)
  • Sciatica
  • Rib pain
  • Shoulder pain, rotator cuff injuries
  • Many more

Contact our office today to see if PRP can help you!