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<ADMIN EDIT> I have split this and subsequent messages on prolotherapy off from this thread on Shock Wave Therapy, so we can keep the topics seperate<>

Please help me out here:

1. What is prolotherapy?
2. Why do you start (almost) each word with a capital letter, and how do you decide when not to? :p

Thanks

Quackwatch

Clinical Policy from Aetna

Thank you admin for the links. I note the two links are to the US Health Insurance companies Aetna & Medicare. My impression, acquired over the last 12-months in the US, leaves me to wonder how useful this is to the clinician.

The American Health Insurance industry has been criticized for assuming increasing control, and taking away from the doctors, the freedom to make the best treatment choices for their patients. Although motivated by the need to control the ever spiraling cost of health insurance in the US, those with a critical eye now worry that this development, which seems to be gaining momentum, has gone too far and the patient looses out. There is now a risk that expensive treatments may be denied, over a cheaper alternative. This has left patients very and doctors frustrated.

ECSW is a good example of this whereby insurance companies deny cover for this treatment, on the grounds of insufficient robust research evidence. The alternative i.e. surgical intervention in recalcitrant heel pain patients, has not been required to be validated to the same scientific standards. Yet adverse post-operative effects from such surgery are well documented. At the same time the adverse publicity levelled against ESWT is based, at least in part, on flawed evidence.

It appears the same cannot be said for prolotherapy, a technique which seems devoid of any type of research, with a good or bad outcome.

From a personal perspective, apart from the fact the prolotherapy technique uses some very exotic injectables, would injecting steroids / LA seem to fall within this category also?

Some clinicians in the UK have used a course of LA injections to the "trigger" area of pain, and I have heard of good outcomes.

This: Decompression drilling for heel pain is a thread from Foot Surgery forum, that has some relevance to this thread.

I work with two Physiotherapists who are both advanced traditional Chinese and, also, Western Accupuncturists. They have a technique for heel pain which involves 'peppering' the periosteum of the calcaneus with accupuncture needles. This also elicits an inflammatory response and apparently promotes healing and, therofore, pain-relief, in the same way as 'hitting it with a hammer' (see ECSWT thread on General Forum) and actual osteal drilling.

It is, as you can imagine, extremely painful to 'pepper' in this way and I have recently been carrying-out a tibial nerve block prior to 'needling'. Results are to be awaited, but, obviously, this technique has the advantage of being able to be performed in a clinical room, with little, or no, post-op infection risk.

Phyisos will also use a technique called myofascial release, with some success.

(This reply is also on Surgery Forum)

jeeez.....what a choice! Get hammered or peppered with needles. Are the Chinese pure genius or just sadists? Hope I never have that kind of heel pain to worry about.

One point occurs to me : of these ?new treatments which claim "to promote inflammation" - how do we know the treatment promotes inflammation and neovascularization in the right areas, which , we are led to believe, seems necessary to promote healing of the fascia/aponeurosis?

The people working with ESWT assess changes in the thickness of the fascia to determine the effectiveness of the intervention, using ultrasound scan.

I can feel a new thread coming on .....

dieter,
first let me address the letter issue,i didn't even realize i was doing it.i will have to take it up with my therapist.unfortunately,we have a lot of ground to cover and i don't know when we will get to it.
now about prolotherapy,this form of injection therapy has been around for about 40 years.it consists of injecting coctails of glucose,saline,and local anesthetics into affected joints or connective tissues.the injections are usually with smaller gauge needles,such a #18.the objective is to create lesions in the tissue and promote the elemination of pain through the regeneration of healthy tissue via the healing process(i am simplifying).however,very similar to what is being done with eswt.let me know your thoughts.

Capital letters: please don't stop doing it! That way I don't have to correct my typos!

Prolotherpay - I have been reading up about it but thanks for the explanation also. Do you know what is the exact formula for the cocktail used by the neurologist? I would assume he anaesthetises the heel first? What volume is he injecting? Does he carry out a quantitative assessment to measure outcomes? It's all too easy to think treatments are working when we rely only on patient feedback....

I have had correspondence from a pain managment consultant experienced in prolotherpay who would advise against using this for plantar fasciitis due to the risk of nerve damage, but, he hadded the formulation used in the UK differs to that in the US. He uses it on the ankle to tighten up ligaments when necessary.

Re: cryosurgery - so far the company has studiously ignored my inquiry. I have heard from a colleague who has also been let down.... nice customer service.

dieter,
why don't you try the website in the u.s. or get on dr.fllat's own website,it has a link directly to the company in the states.

Are any podiatrists using prolotherapy in Melbourne? If so, what training did you get? Very interested in learning this technique but don't know where to start. Thanks Folks

dear all..
you can get training for prolotherapy by bedside teaching or join the organization of American Academy of Orthopedic Medicine..
I learn this technique from dr pomeroy which is one of past time president of prolotherapy association.. I've absorb the technique completely so if you want you can buy the DVD for half the price.. Its worth $2200 you can check it on dr pomeroy website but ill sell it for only$1200.. come on its $200/therapy..
if you want contact me panjipriambudi@gmail.com