SCLEROTHERAPY
PROLOTHERAPY
Sclerotherapy a.k.a. prolotherapy is the introduction via injection of solutions that promote tissue re-growth. Reconstructive therapy is a term coined by William Faber D.O. in his book Pain Pain Go Away. It is not the proper term for the treatment procedure. Sclerotherapy is generally the term used in the osteopathic profession while the allopathic profession uses the term prolotherapy. In my experience there is no significant difference.
These irritating injections are introduced into the weakened areas of the body. The primary areas of injection are the ligaments but tendons may also be injected.
What are ligaments?
Ligaments are the supporting structures of the body. They are really fibrous bands(like rubber bands) that connect the joint surfaces and hold the joints together properly. They are the initial support mechanisms to hold the joint together. Sprains are joint injuries in which some of the fibers of the supporting ligament(s) are ruptured but the continuity of the ligaments usually remains intact.
Strains are injuries to the musculature. There is a difference between sprains and strains. However, modern medicine generally tends to lump them together for insurance purposes. However, for the patient the difference is tremendous along with the treatment. Ligaments do not respond to exercise.
The tendons and muscles move joints. Ligaments run one layer of tissue below muscles and tendons generally and create the joint itself..
How do ligaments work?
The function of the ligaments is simply to hold the joints together. If the ligaments are too loose from repeated or single injury, the joint will not function properly. What happens is that the joint tends to not track properly and then wears down the joint structure itself.
Tendons, however, are attached to one and are one layer above the bone and ligament. The tendons and muscles move the joints, but the ligaments hold the joints actually together as the first line of defense. Without proper ligamentous support the joint will be painful.
What is the goal of sclerotherapy?
The goal of sclerotherapy or prolotherapy is to produce an irritation in the ligaments being treated to cause the body to create more ligament. As a result we create a stronger " rubber band". How does this work? Simply stated, the body responds to an irritation by laying down more ligament. This is a controlled chemical reaction to a known irritating solution.
How long has sclerotherapy been available?
Actually, sclerotherapy has been present in medicine for a thousand or so years in various forms. In the Fifth Century BC, Hippocrates treated separated shoulders of wounded soldiers with cauterizing irons. This technique was very successful for that period of medical history since it caused the body to lay down fibrous tissue( a form of " ligament") in response to this crude therapy.
Approximately one hundred years ago a French physician named Valpeau used sclerotherapy in treatment of abdominal ruptures. Dr. Valpeau injected an iodine solution or carbolic acid to produce scar tissue that strengthened the abdominal muscles of the patients.
About sixty years ago, after the invention of the syringe, the entire procedure has become more refined. In the 1930's Dr. Lippman successfully used the injection of sclerosing solutions for the treatment of inguinal hernias. In 1936, Dr. Gedney extended the uses of sclerosing solutions to weakened knees and low back joints with excellent results. Currently, we use sclerotherapy for virtually all accessible joint structures.
Later, Dr. Hackett reported in The Journal of the American Medical Association successful results in 82 percent of 253 patients with sacroiliac joint weakness. He later extended his success to patients with spondylolisthesis. Dr. Hackett is considered the father of modern sclerotherapy.
Today, sclerotherapy is used with better results than back surgery, though it get less publicity. Surgical intervention for disc involvement results in approximately 50-60 percent satisfactory results according to The Journal of Bone and Joint Therapy. In comparison, approximately 90 percent of patients obtain satisfactory results from treatment with sclerotherapy of unstable lower back and other musculoskeletal syndromes. The past Surgeon General of the United States,
C. Everett Koop, M.D. has been treated with and has practiced sclerotherapy.
SOME COMMON QUESTIONS AND ANSWERS REGARDING SCLEROTHERAPY
When is this type of injection needed?
If any joint (neck, back, hip, shoulder, ankle, knee, wrist, etc.) has become hypermobile or unstable (too loose) the joint becomes painful. Use of a sclerosing solution by injection reduces the hypermobility or looseness in the joint and surrounding structures The joint then stops the self-destruction effect that it once had when it was hypermobile. When a joint is stable the pain is diminished or eliminated and the joint functions return to "normal". This includes the production of synovial fluid to acta as the joint’s lubrication.
How long does the procedure take to work?
Individual patients and their problems vary so the length of therapy and the results will also vary. Generally, injections are done no more than once per week. The average patient needs a minimum of two to six to eight injections to achieve a satisfactory result. The amount of injections is dependent upon the size of the joint. Some patient may require many more injections as each problem is slightly different. Results are felt by the patient usually after the second week, if not sooner.
Is cortisone being used?
Absolutely not! Cortisone works just the opposite of the sclerosing solution and breaks down the ligaments with repeated use.
Is this procedure covered by my insurance?
Most insurance companies cover this procedure. Since it is considered a surgical procedure, payment is usually at the 80% level. If you have any questions, please contact your individual insurance company for verification. Medicare does cover sclerotherapy but only for esophageal varices usually resulting from chronic alcoholism.
Does the procedure keep me from working?
In our experience, there is no need to take time off from work. The pain level is minimal and is usually controlled by aspirin. You will experience some swelling about the area injected and occasionally some itching. However, this should not stop normal activities.
Are there other uses for this therapy?
Yes, this particular treatment is used for in-office correction of small varicose veins generally referred to as spider veins or telangiectasias and certain inguinal hernias.
What are Dr. Resk’s qualifications?
Dr. Resk has been performing sclerotherapy for almost thirty years. Dr. Resk has been a board member of the American College of Osteopathic Pain Management and Sclerotherapy, Inc - the specialty board of the American Osteopathic Association which promulgates the use of sclerotherapy as a reconstructive and pain control modality.
Dr. Resk is also a former assistant professor of medicine at the College of Osteopathic Medicine of the Pacific at Pomona, California. Dr. Resk is board certified in family practice and osteopathic manipulative medicine by the certifying boards of the American Osteopathic Association as well as holistic medicine by The American Board of Holistic Medicine.
I am a contributing author to the book Pain, Pain Go Away by William Faber, DO. which explains the sclerotherapy to the public in lay terms.
We have had patients from all over the world come to her office for this treatment with remarkable success. While we cannot help every patient, the aim is to obtain the best possible results for everyone. We always looks for the solution to the problem and not merely temporary relief. At To Life ! We feel that this is the best way to practice medicine.
Each case has its own unique problems and requires individual attention. At your scheduled appointment time any additional questions that you may have will be answered.