Prolotherapy results inspire practitioner's curiosity

[Guest guest]

September 2005

http://biomech.com/showArticle.jhtml?articleID=170701832

Prolotherapy results inspire practitioner's curiosity

By: Jerry Hesch

Reading the news article on prolotherapy ( " Prolotherapy relieves

groin pain in study of soccer, rugby players, " June, page 11), I felt

compelled to share some comments.

Though limitations of the study cannot be adequately ascertained

given the brevity of the article, the short-term results are very

impressive. Prolotherapy, using lidocaine for analgesia and dextrose

as a proliferant, over the course of 17 months resulted in

significant reduction in pain and return to painfree sports

participation at full capacity in 20 of 24 participants.

Two subjects were not able to return full capacity and two had pain

when participating. The use of lidocaine with a proliferant is

supported by the results, but the lack of a control group means we

cannot separate the different mechanisms of action.

The athletes who did not achieve a successful outcome may experience

some degree of disability, which is likely to spill into other facets

of their lives. I have firsthand knowledge of abdominal neuropathies,

having sustained a pelvic fracture and multiple ANs due to a severe

motorcycle accident. I submit that the possibility of such

neuropathies is worth considering for those who have lasting

disability and unresolved groin pain. Successful ablation of the

genitofemoral and accessory obturator nerves has not resulted in

sensory loss in my personal experience, yet did provide substantial

pain relief, along with improvement in function.

(In researching my own neuropathies I have not had any success

locating studies on the use of fibrinogen/fibrin glue for

prolotherapy, yet the mechanism of action appears to be consistent

with the goals of prolotherapy. I would be grateful to hear if anyone

is performing research with this application.)

Extreme pain, even if a screen for inguinal hernia is negative (no

bulge), can imply an ilioinguinal neuropathy. Pressure above the

inguinal ligament may refer to the medial calf and is easily confused

with a coexisting S1 radiculopathy when in fact the dysesthesia may

be mediated by the terminal saphenous portion of the femoral nerve.

Response to the same pressure can skip the proximal thigh and cause a

diffuse sense of warmth in the foot.

Cautious digital pressure on the scrotal contents can be revealing in

the presence of genitofemoral AN. Other-less common-hernias, such as

at the obturator foramen, should be ruled out. Referral to a

genitourinary or surgical specialist is warranted for recalcitrant

groin pain. The proximity of the hip joint mandates traditional

screening and a standard medical workup to rule out common and occult

pathologies for patients with chronic groin pain.

The concluding quote of the news article: " Treating immature athletes

(for Osgood-Schlatter disease with prolotherapy), who in the past

have been asked to stop playing for two months, for the first time

will emphasize healing the cartilage attachment and patellar tendon

prior to the formation of an ossicle, " seems rather ambitious, given

that the study is presently in search of funding. Although briefly

mentioned in that final paragraph, I would like to request

elaboration on how the goals of prolotherapy are different from other

standards of care for Osgood-Schlatter disease, such as those of the

American Academy of Orthopaedic Surgeons or the American College of

Sports Medicine.

I thank the authors for sharing their impressive study, which

motivates me to express my gratitude to all authors and inquisitive

clinicians, to dialogue, review the literature, and, lastly, to

remain hopeful.

Jerry Hesch, MHS, PT

, NV

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