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What is prolotherapy?

What is prolotherapy?Prolotherapy is a complementary medical treatment used for muscle-joint pain and injuries.

With prolotherapy, a liquid mixture is injected into the joints, cartilage, ligaments and tendons that have been damaged or lost their function, which will put these tissues in the stage of restructuring and self-repair. Prolotherapy is applied by injecting a natural irritant into the soft tissue of an injured joint. The injection of the irritant initiates the body's healing response. Supporters of the practice believe that prolotherapy can provide significant relief for joint or back pain.

What preparations are made before prolotherapy?

Before the appointment, your doctor evaluates the area to be treated with imaging methods such as direct X-ray, magnetic resonance imaging, and computed tomography scanning. Then the points where the injections will be made are determined.
Before the procedure, the skin in the relevant areas is cleaned with alcohol. Next, they apply lidocaine cream to the injection site to reduce pain. Patients who feel severe pain can be put to sleep with sedation if necessary.
Before prolotherapy, it is recommended to eat a meal containing plenty of protein to strengthen immunity. In addition, your doctor may recommend that you stop taking anti-inflammatory drugs at least three days before the appointment so that the body can create a strong immune response and respond well to the treatment. Blood thinners, which can cause bleeding tendency, can also be stopped under the control of a doctor for a certain period of time before the procedure.

How is prolotherapy applied?
Prolotherapy is completed in a total of 30 minutes or less, including pre-procedure preparation. After the application of local anesthesia, the injection is carefully made into the affected areas. Immediately after the treatment, the patient rests for 10-15 minutes by applying heat packs to the injection sites. After heat application, the patient can return home.

How does prolotherapy work?
Prolotherapy involves injections of aqueous solutions to relieve pain in the affected joints. These injections typically contain natural ingredients such as dextrose, saline, in addition to a narcotic such as lidocaine. This treatment differs from injections of platelet-rich plasma (PRP) and steroids, which require stem cells from the person receiving the treatment. However, some experts consider PRP injections a subtype of prolotherapy.
Dextrose solution is generally preferred in prolotherapy. Dextrose is a potentially irritating solution and triggers the body's healing response. Thus, reparative factors are activated in the body. This activity begins to strengthen and repair damaged ligaments in the joint. Strengthening the ligaments helps stabilize the joint over time. When the joint is better supported, the pain may disappear.
Your doctor injects into one or more specific and targeted sites at the injury site that triggers the healing response in your body. Because this treatment promotes tissue growth, it may not be effective in patients with long-term conditions such as Crohn's disease or chronic fatigue.
Prolotherapy usually requires several sessions of treatment at the injury site or weakened area to be effective. A person can be applied 4 to 15 applications per session. These sessions are completed in a period of 3 to 6 months. It is important that the irritant is applied correctly to the area or areas requiring repair.

What is the recovery process like after prolotherapy?
Mild swelling and stiffness are common immediately after the procedure. But these resolve quickly, and most people can resume normal activities the same day or the day after. Some patients may experience bruising, discomfort, swelling and stiffness for up to a week.
Prolotherapy should never cause severe pain. It is essential to seek immediate medical attention, as severe pain, especially accompanied by fever, may be a sign of infection. Multiple prolotherapy treatments may be recommended to continue to encourage new tissue growth. Some experts recommend about 3 to 6 treatment sessions administered every four weeks.

What are the types of prolotherapy?
Prolotherapy is the injection of various substances into the body to stimulate the growth of normal cells, tissues or organs. Different prolotherapy solutions are used for injection and these are selected according to the problem being treated. Types of prolotherapy include proinflammatory dextrose, prolozone, PRP (platelet-rich plasma), and stem cell (from bone marrow or fat) solutions.
Depending on what is being treated, the doctor may recommend various types of prolotherapy treatment. Each treatment is effective in treating pain and promoting soft tissue repair.

Dextrose solution
Dextrose is a solution that triggers the release of growth factors. Therefore, intense dextrose is injected into and around the injury site. Stimulated growth factors stimulate the growth and repair of tendons, ligaments and other soft tissues.

Platelet-rich plasma (PRP)
PRP consists of the initials of the English words platelet rich plasma and means platelet rich plasma. It is a form of prolotherapy that involves the injection of platelet-rich plasma taken from the person's own body to the injury site. Platelets are tissue repair components that secrete various growth factors. For this purpose, blood is first taken from the patient and then centrifuged. This process separates the blood plasma and concentrates the platelet content. When PRP is injected into the face, it gives a younger look and repairs scars.

An ozone solution is used in Prolozone injections. Ozone injection is often used to treat soft tissue injuries, arthritic joint pain, back pain, and sciatica.

Stem cells
Stem cells for prolotherapy are obtained from the patient's own bone marrow or adipose tissue. The aggregated cells are specialized cells that have the potential to replace other cells in various tissue structures and stimulate healing. Bone marrow stem cells can also be used for bone repair where needed.

Which diseases are treated with prolotherapy?
Prolotherapy mostly uses it to treat injured joints and ligaments. It is most commonly applied to the back. It can also use prolotherapy in the following body areas;
• Knees
• Other joints and ligaments

Some of the ailments in which prolotherapy is used;
• Sports injuries
•Back pain
•Neck pain
• Carpal tunnel syndrome
• Partially torn tendons, ligaments and cartilage
However, the treatment areas are not limited to these and can be used for different musculoskeletal pain. In some cases, it may be preferred to relieve pain in patients with chronic conditions such as degenerative disc disease or arthritis.

Are there risks to prolotherapy?
The risks of prolotherapy are significantly less than those seen with surgical treatment. Prolotherapy does not require general anesthesia and hospitalization. Recovery time is much shorter than surgery and the possibility of infection is significantly less.
Prolotherapy is generally considered safe. Although positive effects are seen, the fact that it is a new treatment means that there may be risks that are not yet known. For example, some experts have expressed concern that the dextrose solution injected in prolotherapy may cause tissue-damaging sugar molecules to accumulate in joint tissues in the long term. But so far there is no data to prove this. Existing research has shown extremely positive results.
In rare cases, infection may occur after treatment. Signs of infection include pain and fever. In this case, the patient is given antibiotics for treatment. Receiving prolotherapy treatments only from a trained and certified professional will minimize the risks that may occur. The greatest risk in prolotherapy treatment is nerve damage from injection too close to a nerve.


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