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Frequently Ask Questions

Now that you have seen the basics about Prolotherapy, PRP and many of our services, you may be interested in more information. This area contains common “Frequently Ask Questions” (FAQ).

Click any question for answers.

Do Your Research! – Educate Yourself – Ask Questions

Dr Croake-Uleman: Prolotherapy on “Fitness Focus” for Hips

Dr Croake-Uleman: Prolotherapy on “Fitness Focus” for Knees

Dr Croake-Uleman: Prolotherapy on “Fitness Focus” for Shoulders

Dr Fields and Prolotherapy on The Doctors TV Show

How long does Prolotherapy last?

Prolotherapy Performed On The Knee: Dr. Marc Darrow

Does the Healing from Prolotherapy last?

Who would be a candidate for Prolotherapy?

Prolotherapy segment on Fox 59 Indianapolis

 

Basic Questions

1 – What are your hours of operation?

We are open Monday 12 Noon-5PM, Wednesday and Thursday from 8AM-5PM

2 – What to expect on my first visit?

In depth analysis from our Doctor pertaining to your issue/s.

3 – Do I need an appointment to ask a question?

We are glad to answer some questions by calling us at 513.229-7333 or you can submit a question directly on the front page of this website.

4 – How do I find driving directions for an appointment?

We are located at:  5700 Gateway Blvd., Suite 100A
Mason, OH 45040
.

You can use our map located in our Contact Us Page.

5 – The common questions we answer

  • Have you been told you need surgery or has surgery failed?
  • Do you take anti-inflammatory medications on a regular basis?
  • Have you had years of pain and been told that there is no treatment?
  • Do manipulations and adjustments only give you temporary or no relief? \
  • Do you hurt worse with doing more activity?
  • Do you frequently need to change positions due to discomfort?
  • Does your pain interfere with your sleep?
  • Do you feel fatigued due to your issues?
  • Do you have a deep achy pain of the spine or joints?
  • Chronic headaches?
  • Pelvic pain?

6 – What can we help treat?

  • Arthritis
  • Back pain
  • Neck pain
  • Headaches
  • Sports injuries
  • Whiplash
  • Carpal Tunnel syndrome
  • Torn Tendons
  • Ligaments and Cartilage Damage
  • Degenerated or Herniated Discs
  • Sciatica
  • Deep Aching Degenerative Disc Disease
  • Disc Herniation
  • Heel Spurs
  • Knee Injuries
  • Migraine Headaches
  • Neuropathy
  • Osteoarthritis
  • Fibromyalgia
  • Vaginal Pain
  • Restal and Testicular Pain
  • Rotator Cuff Tears
  • Tennis Elbow
  • Plantar Fasciitis
  • Neuropathic Pain
  • Shingles Pain
  • Pelvic Pain and more!

7 – Safety Considerations

  • Centrifuge: Arteriocyte
  • Plasma: This is entirely an autologous graft. Only one patient and one graft are prepared at a time. At no time are 2 patients blood to be processed at the same time or in the same time slot.
  • Infectious Disease: PRP is antimicrobial and effective against most bacteria classes except Klebsiella, Enterococcus and Pseudomonas. Standard skin disinfection is used before injection (choloprep x 1 or betadine x3)

8 – What is the lead time to get in?

Within a week

9 – How long does a visit take?

First consultation may take over an hour. Each treatment is only an hour.

10 – Is there an age limit for these types of treatments?

Minimum twelve years of age or of adult stature.

11 – If I have multiple area that need treatment, can I do them all at the same time?

Typically yes, but depends on the areas.

12 – Is Prolotherapy dangerous?

Watch This Video  from Ross A. Hauser, M.D.

 

Preparation Questions

1 – Do I eat before I have a treatment?

Yes, you need to eat a good meal before treatment. Typically a healthy meal consisting of some source of protein. If you are taking any anti-inflammatory or narcotic medications, we will need to discuss the option to stop taking them a few days prior to the treatment.

2 – Do I need to obtain and bring previous medical records or X-rays?

Yes, you need to bring in any medical records including MRI, X-rays or other previous test results and documents.

3 – What do I need to do prior to my treatment?

This will be discussed in the initial consultation

4 – Do I need to make arrangements for someone to drive me home after my treatment?

Not for the initial consultation and not for most treatments based on the area of the body.

5 – Is there any restrictions on food or drinks prior top my treatment?

No

6 – What do I need to do if I need to reschedule a treatment?

Contact the office (513-229-7333) at least 24 hours prior to the appointment to avoid a cancellation fee.

Post Treatment Questions

1 – After Care

  • It is important to re-emphasize that NSAIDs, aspirin, or acetaminophen may not be used for post injection pain control as these medications will inhibit the necessary inflammatory phase.
  • Clearly explained that the patient may have significant pain for up to 3 weeks, although the pain usually improves after 3 days.
  • They may keep the injected part relatively immobilized for comfort for the first 2 days. After 2 days the affected part should be moved through its full range of motion along with gentle negative eccentric exercise. Increase activity as tolerated after 2 weeks.
  • Some ice application sessions of 15 minutes in length may be used, but only absolutely if needed for pain control. Not using ice is preferable for this pro-inflammatory process.

2 – Re-evaluate in 4-6 weeks

Re-evaluate patient’s pain levels, functionality and consider using a written functional assessment tool such as a “quick DASH score.”

  • Be aware that tissue changes on imaging may lag 3 – 6 months behind clinical improvement.
  • If patient was still very sore at 2 weeks, consider re-injecting at 6 weeks.
  • If the patient was over most of the soreness by 2 weeks, consider repeating therapy at 4 to 6 weeks if treatment goals have not been met.
  • These PRP grafts can be repeated as early as 2 weeks, although 4 – 8 weeks is a more usual timeframe.
  • If the patient is >80% improved or has met goal activity level, then the therapy is considered successful and complete
  • .If the patient is <80% improved or goal activity level has not been met, repeat PRP graft placement every 4 – 6 weeks until success met or a maximum of 4 grafts placed.

3 – Articles on Platelet Rich Plasma: Post PRP Instructions

Treatment of Tendon and Muscle Using Platelet-Rich Plasma by  Allan Mishra M.D., James Woodall M.D. and Amy Viera PA-C

4 – Is recovery from Prolotherapy and PRP the same time?

Roughly the same time frame.

5 – Do I need to go to Physical Therapy after the treatment?

Doctor will discuss complementary care consultation and post treatment.

 

Payment Questions

1 – What is the cost for this treatment?

Initial fees are typically covered by insurance for the consultation. Treatment fees will be discussed at the initial visit.

2 – Where can I find financial help?

We typically work with Wright-Patt Credit Union.

Click on the link at the bottom of front page.

 

Definitions

1 – Prolotherapy

Prolotherapy is the injection of a substance (i.e. Dextrose) which promotes growth of normal cells. Pain and dysfunction is often caused by weakened tendons, ligaments and soft tissues. These weakened structures can be healed and strengthened by a series of injections of this substance (i.e. Dextrose) into them. These injections invoke the body’s natural healing response to strengthen the tissues and structures without causing the harmful effects that steroids cause. In effect the pain decreases or completely goes away and the function of the joint/structure improves.

Prolotherapy is an injection technique used to heal injuries that aren’t healing correctly including SPORTS INJURIES and chronic injuries.  Prolotherapy does not cover up the symptoms of the injury for a temporary fix.  It gets to the heart of the issue to permanently fix the injured area.  It is used widely in the athletes and chronic pain patients.  Pain from athletic injuries, motor vehicle accidents, whiplash injuries and headaches, sprains/strains, chronic neck/back/joint pain and overuse injuries, as well as the list below are all treated with Prolotherapy.

Used by many professional and amateur athletes, prolotherapy is also known as non-surgical ligament reconstruction, and is a permanent treatment for chronic pain.  Ligaments are what hold bones together at the joint whether in the knee or the back or other body area. When they are injured, these tight rubber bands that keep the joint together become loose and the joint loses its integrity. This causes pain. The poor blood supply to the ligaments makes it hard for them to heal and they often do not which leads to this chronic pain.

2 – Perineural therapy

Perineural therapy is used for nerve pain or chronic structural pain. It is a series of injections of a natural substance (i.e. mannitol or dextrose) superficially into the skin to target painful nerves. Weekly visits reduce the pain and help you to return to full function.

3 – Traumeel

Traumeel is a safe anti-inflammatory alternative to steroids that’s been used in the United States since 1986 and in Europe since 1937. There is no evidence of the “rebound effect” (inflammation returning to a greater degree than prior treatment), which is often experienced with steroid use.

4 – Prolo

Prolo- means to regenerate and is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak. This causes the ligaments to become strong again and keep the joint properly intact. The pain and dysfunction then goes away as the problem is now fixed. The response to treatment varies from patient to patient, and depends upon one’s healing ability. Some people may only need a few treatments while others may need 6-8. These treatments are done at 4-6 weeks intervals.

5 – PRP

Platelet Rich Plasma (PRP): A new procedure that is gaining popularity across the world in the treatment of tendinopathies and arthropathies is platelet rich plasma administration. This procedure is analogous to autologous blood injections, but involves delivery of the concentrated platelet rich plasma, which is rich in growth factors.

 

Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells. Most importantly to this discussion, blood platelets release growth factors that are directly responsible for tissue regeneration. These substances are called cytokines and include platelet derived growth factor, epithelial growth factor, and other important growth factors.

 

PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. Only in the last few years have doctors and surgeons been experimenting with injecting PRP for the treatment of chronic pain. Tennis elbow, plantar fasciitis, Achilles tendonitis/tendonosis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are all being treated with the injection of PRP with the goal of regenerating degenerated connective tissue with reports of success.

6 – PRP Treatment

PRP treatment: a patient’s blood is drawn and placed into a special collection kit. Using the person’s own blood eliminates the risk of transmission of any blood-borne disease. This kit is placed in a centrifuge for 15 minutes and the platelets and plasma are separated from the red and white blood cells. Two thirds of the plasma is removed and discarded and the remaining plasma is mixed with the platelets. This higher than normal concentration of platelets is what gives us platelet rich plasma. The PRP is drawn into a syringe. The area to be treated is injected with a local anesthetic and after waiting five minutes for the anesthetic to take effect, the PRP is injected.

The injection technique is identical to prolotherapy/regenerative injection therapy, only the solution injected is different. Same instrument, different sheet music. People generally report two days of being sore and then usually pain relief occurs within the first week and continues to improve over a period of months. To date, my experience is that one PRP treatment is the therapeutic equivalent of three or four prolotherapy/regenerative injection therapy treatments using dextrose. One of the attractive aspects of this treatment is the use of a person’s own blood to eliminate the risk of the transmission of disease. The same lab that has developed the preparation kit for production of PRP has also developed a method to collect a person’s own stem cells which eliminates the need for embryonic, umbilical or placental stem cells. This procedure is much more invasive as it requires a bone marrow biopsy and it is quite expensive compared to PRP which is safe, easy and inexpensive.

 

References and Articles

References:

Indications

  • Chronic tendonopathies unresponsive to conservative measures.
  • Partial thickness tendon/muscle tears either not amenable to surgical repair or when the patient does not want a surgical option.
  • Arthropathies unresponsive to conservative measures.

Procedures:

Informed Consent: PRP is an elective procedure for chronic musculoskeletal complaints. It involves drawing up to 60 cc of the patients’ blood into a syringe with ADCA anticoagulant, placing that blood into a specially designed container, conducting a 1 phase centrifuge to concentrate the platelet rich fraction of the blood, and then injecting this platelet rich plasma into the injured tissue. This procedure will make you very sore at the site of injection for at least three days, and for up to two weeks. Pain medicine will be prescribed. In rare cases it may produce a reactive synovitis in the joint injected (a synovitis results in a painful, but not damaged, joint) that may require a corticosteroid injection to relieve the pain. PRP is inherently antimicrobial, and the risk of infection is extremely low. As with any injection, there is a small risk of bleeding and bruising. You will need to follow the post-injection instructions and follow up in 2 weeks. Although many conditions will resolve in 1 or 2 injections spaced 4 to 6 weeks apart, some conditions may require 3 or more injections to achieve a satisfactory result.

Contra-indications to PRP Therapy

Absolute contraindications

  • Platelet dysfunction syndrome
  • Critical thrombocytopenia
  • Hemodynamic instability
  • Septicemia

Relative contraindications

  • Consistent use of NSAIDs within 48 hours of procedure
  • Corticosteroid injection at treatment site or systemic use of corticosteroids
  • Tobacco use
  • Recent fever or illness
  • Cancer- especially hematopoietic or of bone
  • HGB < 10 g/dl
  • Platelet count < 105/ul

Other Articles

How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? by Olena Virchenko and Per Aspenberg
Clinical Updates in Platelet Gel: Sports Medicine by Michael A. Scarpone D.O.
Non-Surgical Repair of Patellar Tendonitis with Autologous Platelet Concentrate Using Ultrasound Guidance:Two Case Reports by Henry Stiene M.D.
Autologous Blood Injection for the Treatment of Chronic Recurrent Temporomandibular Joint Dislocation by Vladimir Machon M.D., D.M.D., Shelly Abramowicz D.M.D., M.P.H., Jan Paska M.D. and M. Franklin Dolwick D.M.D., Ph.D.
Treatment of Chronic Elbos Tendinosis with Buffered Platelet-Rich Plasma by Allan Mishra M.D. and Terri Pavelko P.A.C., P.T.

Help us to educate people with their options

Please submit articles or your experiences about our services to us at: info@swohp.com

Articles on Regenerative Medicine: