Are you tired of living with shoulder pain?

Most shoulder problems involve the soft tissues, which include the muscles, ligaments and tendons, rather than the bones.

by Dr. Fred G. Arnold — 

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm — from scratching your back to throwing the perfect pitch. However, mobility has its price, and it can lead to increased problems with instability or impingement of soft tissue, resulting in pain that may be felt all the time or only when the shoulder is moved. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Most shoulder problems involve the soft tissues, which include the muscles, ligaments and tendons, rather than the bones. The majority of these problems fall into three major categories: tendinitis/bursitis, injury/instability and arthritis. Rarer causes of shoulder pain include tumors, infection and nerve-related problems.

The term “rotator cuff injuries” refers to injury to four specific muscles and their associated tendons. Pain secondary to partial tears of the rotator cuff tendons responds well to prolotherapy. While a complete tear of a tendon should be repaired surgically, persistent pain following surgical repair often can be relieved through prolotherapy.

Patients with recurrent shoulder dislocation particularly find prolotherapy beneficial due to the stabilization of the joint capsule, ligaments and tendons. Patients with a frozen shoulder experience capsular tightening or capsular adhesions that may be relieved with a combination of stretching exercises and intra-articular specialized injections to restore normal movement and reduce pain.

Prolotherapy, a proven treatment alternative

Prolotherapy has been used with great success for more than 60 years. Prolotherapy (aka Regenerative Injection Therapy — RIT) is also known as ligament reconstructive therapy or sclerotherapy. It is a recognized orthopedic procedure that stimulates the body’s natural healing processes to strengthen joints weakened by trauma or arthritis. Joints weakened when ligaments and tendons are stretched, torn or fragmented become hypermobile and painful. Traditional approaches with anti-inflammatory drugs and surgery often fail to stabilize the joint and relieve pain permanently.

Steroid injections are commonly given to patients who experience shoulder pain, but they actually weaken the associated ligaments and tendons. Prolotherapy has the unique ability to directly address the cause of instability and repair the weakened sites, resulting in permanent stabilization of the joint.

A unique approach

A doctor evaluates each patient thoroughly with a personal history that includes the neck and upper back as a possible source of referred pain to the shoulder. An orthopedic physical exam, including neurologic assessment and careful palpation of the affected shoulder, is performed. Palpation of a tendon or ligament that produces pain is usually associated with weakened tissues and can, at times, be more beneficial in identifying the problem areas than diagnostic testing.

On an individual basis, further evaluation may include ultrasound, X-rays and/or a MRI before receiving prolotherapy. In cases involving chronic pain, a comprehensive treatment approach is provided that includes rehabilitative exercises, nutrition and specific supplements to maximize health and the ability to heal.

Following the initial injection treatment, the patient is reassessed in two weeks and the injections are repeated at decreasing intervals as the patient’s condition is improved and resolved.

It is not possible to always predict the exact number of sessions required, since each patient’s condition is unique in terms of his or her ability to repair and grow new tissue. Most patients require four to six treatments for a mild or moderate condition, while some require only one to two treatments for resolution of their symptoms. Depending upon each patient’s individual pain level, prescription pain medication may be provided. Most patients do fine with no pain medication or over-the-counter Tylenol.

A common question is, “What are you going to inject me with?” A standard shoulder prolotherapy solution includes a mixture of an anesthetic called lidocaine (which dentists frequently use) and dextrose, a sugar solution. A small amount of Vitamin B12 also may be included to promote healing. When precise injections of dextrose are introduced into the site of pain or injury, this creates a mild, controlled inflammation which stimulates the body to lay down new tendon or ligament fibers, resulting in a strengthening of the weakened structure. As the joint becomes stronger, the pain is relieved.

So what are the benefits of prolotherapy? (1) You are spared invasive surgery. (2) When relief comes, it is sudden, total and seems miraculous. (3) The results are usually long-lasting, unless the injury is caused by repetitive strain.

Prolotherapy is not a cure-all for every type of pain; however, the founders of prolotherapy, Dr. Gustav Hemwall and Dr. George Hackett, who pioneered the treatment in the 1940s, say that it can result in a 30 to 40 percent strengthening of the attachment points in the joints that were weakened by injuries.

Other conditions responsive to prolotherapy include neck, back and hip pain, elbow problems, wrist and hand conditions, knee pain, and ankle and foot problems.

References:

Hackett, George Stuart, M.D., Hemwall, Gustav A., M.D., Montgomery, Gerald A., M.D., Ligament and Tendon Relaxation Treated by Prolotherapy, Beulah Land Press, Oak Park, Il, 2002.

Hauser, Ross A., M.D. and Hauser, Marion A., M.S., R.D., Prolo Your PAIN AWAY, Beulah Land Press, Ill, 2004.

Fred G. Arnold is a chiropractor and naturopathic medical doctor who specializes in prolotherapy/pain rehabilitation services. With more than 20 years of clinical experience, he is a diplomate of the American Academy Health Care Providers. 602-292-2978 or www.phoenixprolotherapy.com.

Reprinted from AzNetNews, Volume 29, Number 6, Dec 2010/Jan 2011.