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
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
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
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
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
When is this type of injection
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
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
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
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
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
What are Dr. Resk’s
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