Neurofascial Prolotherapy (aka Subcutaneous Prolotherapy or Neural Prolotherapy)
Neurofascial Prolotherapy (also called Perineural Injection Treatment, as well as Neural Prolotherapy and Subcutaneous Prolotherapy) involves the injection of dextrose into the subcutaneous tissues to induce healing. This is contrasted to traditional Dextrose or PRP Prolotherapy whereby Prolotherapy solutions are injected into ligament and tendon attachments onto bone (fibro-osseous junction injections). Research into the healing effects of this type of Prolotherapy have primarily been done by a family physician from New Zealand named John Lyftogt, MD. 1,2,3 Dr. Lyftogt is the main proponent and teacher of this type of Prolotherapy.
What types of conditions does Perineural Injection Therapy (Neurofascial Prolotherapy) help?
In regard to published studies it is clear that Neurofascial Prolotherapy helps decrease the pain of Achilles tendinopathy, chronic low back pain, shoulder or rotator cuff injuries, knee pain and elbow pain. For Caring Medical’s Prolotherapists, Neurofascial Prolotherapy can be used alongside any condition that can be helped with Hackett-Hemwall Prolotherapy (HHP). Because these techniques work by different mechanisms they can diminish the pain of similar conditions, so they can be given together or separately.
Conditions treated with Perineural Injection Therapy (Neurofascial/Subcutaneous Prolotherapy):
- Degenerative joint disease
- Ligament Sprain
- Neurogenic pain
- Chronic musculoskeletal pain
- Degenerative disc disease
Perineural Injection Therapy vs Traditional Hackett-Hemwall Prolotherapy?
On a physical examination, most people with chronic pain have tenderness over areas of ligament weakness. This is because most chronic pain is caused by joint instability from ligament laxity. In these situations tender points are areas where ligaments attach to bone. Sometimes tender points or areas of pain are located in muscle bellies or areas where small subcutaneous nerves are located. In these latter situations, Perineural Injection Therapy on these tender points could be indicated. An example of this is when a person has trauma to the medial side of the knee. In such a situation, a sprain of the medial collateral ligament could have occurred and would be tender upon palpation. In this situation, Hackett-Hemwall Prolotherapy would be used to stimulate repair of the medial collateral ligament (and also the medial meniscus if indicated). But just as likely would be a stretching, shearing or tearing of the saphenous nerve, also located on the medial side of the knee. In this latter situation, the person would be tender over the saphenous nerve and would need Perineural treatment to the saphenous nerve to decrease neurogenic inflammation. Once the saphenous nerve regains its own health, it would be able to function properly to stimulate health maintenance and health renewal to then relieve the pain.
In a series of medical lectures in the 1860’s, John Hilton noted in his study of anatomy that often the nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles. For example, the musculocutaneous nerve supplies the elbow joint of humans with pain and position sensation. It also supplies the biceps brachii and brachialis muscles as well as the forearm skin close to the insertion of each of those muscles. What Dr. Lyftogt found is that patients with chronic elbow pain often need subcutaneous Prolotherapy to this nerve and other nerves around the elbow to resolve chronic elbow pain. The nerve supply to the elbow when inflamed not only causes elbow pain, but can also contribute or be the sole cause of degeneration of the elbow and the structures that support (ligaments) and move the elbow (muscles and tendons). Thus to assist regeneration of these degenerated structures, treatment is given to decrease the neurogenic inflammation, so once again the musculocutaneous nerve (and other elbow nerves) can supply “normal” health maintenance and health renewal to the elbow joint and structures around the joint.
- Lyftogt J. Subcutaneous prolotherapy for Achilles tendinopathy. Australia’s Musculoskeletal Medicine Journal. 2007; 12:107-109.
- Lyftogt J. Prolotherapy for recalcitrant lumbago. Australia’s Musculoskeletal Medicine Journal. 2008; 13:18-20.
- Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Australia’s Musculoskeletal Medicine Journal. 2007;12:110-112.