& Rehabilitation Services
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Oak Park, Illinois 60301
Top 10 Reasons why you need Hackett-Hemwall Prolotherapy in conjunction with PRP Prolotherapy, not just “PRP”
Ross A. Hauser, M.D., Prolotherapy Doctor; Physical Medicine and Rehabilitation, Medical Director, Caring Medical and Rehabilitation Services, Oak Park, Illinois
Editor-in-Chief, Journal of Prolotherapy
It is extremely common for me to see patients who still have pain after receiving PRP (platelet-rich plasma) injections from another practitioner. Here are my top reasons why the PRP may not have worked for them. I will give examples from cases I have seen.
REASON #1: YOU ARE NOT GOING TO A HACKETT-HEMWALL PROLOTHERAPIST
Most doctors who are doing PRP (platelet rich plasma) injections are not Prolotherapists. In a recent case, this young lady had seen an orthopedic surgeon who apparently had gone to a weekend course and now was doing PRP injections. The orthopedic surgeon as far as I could tell had absolutely no training in Prolotherapy. All he was doing was injecting PRP into an area that he normally would inject steroids. Would you get surgery by a person who is not a surgeon? An experienced Prolotherapy doctor is someone who performs Prolotherapy full time in their practice. Is the doctor giving you the treatment a Prolotherapist? How long has he/she been doing Prolotherapy? Is PRP the only Prolotherapy solution he/she uses? If so, this person is not an experienced Hackett-Hemwall Prolotherapy doctor. They are either orthopedic surgeons or doctors who typically give steroid shots and decided for marketing reasons to offer PRP. Again, if someone took a weekend course to learn “surgery,” would you go to them for surgery? I didn’t think so.
REASON #2: YOU DO NOT HAVE AN ISOLATED LESION CAUSING YOUR PAIN
What are the odds that there is just one structure in your body causing your pain? In other words, if you have had pain for one year, two years, or any length of time, what is the likelihood that all of your current pain is from one isolated structure that the one shot of PRP is going to help? The likelihood is not very high, right? Common sense tells you and I that you have more than one structure that needs repair. If that is the case, I can tell you definitively that one shot of PRP Prolotherapy is not going to do the trick. I recently saw a patient who had received three PRP treatments for an arthritic knee without much resultant improvement. On physical examination, it was clear the patient possessed knee instability from various ligament laxities, including the ACL and MCL. She definitely needed to strengthen and tighten these structures to provide more stability to the knee. Once the patient was treated with Hackett-Hemwall Prolotherapy, her pain and instability was gone. You need to ask yourself this question, “What caused the joint, meniscal, labral, or disc degeneration in the first place?” The answer is ligament laxity and/or joint instability! If this is not treated, along with the other structures associated with your pain, you are not going to get better. This is another reason why you need Hackett-Hemwall Prolotherapy along with PRP Prolotherapy
REASON #3: YOU HAVE JOINT INSTABILITY
Here is my bottom line related to joint instability and PRP. If you have joint instability, you can receive PRP Prolotherapy to the joint a hundred times and you will continue to have instability if ligament laxity (weakness) is involved. One shot of PRP into a joint is not going to regenerate an injured, lax ligament that is responsible for providing joint stability. The following case is a perfect example. A patient came to see me because PRP Prolotherapy from another physician was not helping his hamstring tendinosis. The patient thought he had spent over $5000.00 for the PRP Prolotherapy. On physical examination, the patient exhibited obvious hypermobility in his entire body, especially his right knee on the side of the hamstring pain. What he needed was Hackett-Hemwall Prolotherapy to his knee, as well as to the hamstring attachment on the ischial tuberosity. It was the stabilization of his knee with Hackett-Hemwall Prolotherapy, however, that made all the difference. He was able to get back to full activities after two treatments.
REASON #4: PRP PROLOTHERAPY IS NOT STRONG ENOUGH
There are many different Prolotherapy solutions that Prolotherapy physicians use. Only an experienced Prolotherapy doctor would have enough knowledge to know which solution is best for a certain condition. A doctor who just does PRP Prolotherapy has only PRP to offer. So guess what? No matter what condition you have that requires regeneration, you will receive PRP. In the whole scheme of Prolotherapy solutions, there are mightier solutions than PRP. Surely PRP will have its place in the gamut of conditions that need Prolotherapy, but I suspect when it is all said and done, it will have a very minor role. One very experienced Prolotherapy doctor and I discussed this (one who runs some of the best Prolotherapy conferences) felt in the scheme of all Prolotherapy cases, only about 2% require PRP. It means if physicians just offer PRP Prolotherapy, 98% of the time they are not using the best solution for the particular problem. And there is more! PRP Prolotherapy is just about the most expensive type of Prolotherapy you could receive. Here is my main point: PRP being more expensive and more "high tech," does not necessarily make it better.
An older gentleman came to the office because he had PRP Prolotherapy for an arthritic joint. This produced only minimal results (he was receiving only one shot). We switched him to Hackett-Hemwall Prolotherapy using a variety of other solutions and after several visits, he too was back to full activities.
REASON #5: THE PRP DOCTOR INJECTED STEROIDS BEFORE THE PRP
A physician who is experienced with Prolotherapy almost never uses steroid injections and does not quite remember what an NSAID is (okay, I am joking, but you get the point). We recently saw a patient whose orthopedic surgeon was injecting steroids into the area before administering the PRP. Yes, at an expense of about $2000.00 per injection! The basic premise is that PRP Prolotherapy and any other Prolotherapy stimulates healing via stimulating the inflammatory cascade in the area. Using a steroid shot before the PRP or any other type of Prolotherapy just stops the healing mechanisms or the ability of the Prolotherapy to work. This makes no sense. We used Hackett-Hemwall Prolotherapy on the patient, helping stabilize his joint and quickly the condition and, of course, the pain resolved.
REASON #6: THE PRP DOCTOR HAD THE PATIENT USE AN ANTI-INFLAMMATORY MEDICATION AFTER THE PRP PROCEDURE
We frequently see patients who come to the office stating that their physician prescribed an anti-inflammatory medication after the PRP. This makes no sense. PRP and other Prolotherapy treatments work by stimulating the normal inflammatory healing mechanisms. Only on very, very rare situations (like giving Prolotherapy to someone with inflammatory or rheumatoid arthritis) would an experienced Hackett-Hemwall Prolotherapist use any type of anti-inflammatory medication after Prolotherapy. A doctor who routinely uses them after Prolotherapy is just inhibiting the response of the Prolotherapy. Since you, the patient, are paying for the Prolotherapy, I would advise you not to inhibit the Prolotherapy response because that is what is going to get you better quicker!
REASON #7: YOU ARE DOING THE WRONG KIND OF EXERCISES
Specific exercise guidelines must typically be followed after Prolotherapy. Because I am a PM&R doctor, as well as an avid athlete myself, I realize the effect that proper exercise post treatment can have on a patient’s overall outcome and address this with each of my Prolotherapy patients. Joanne came to see us because her PRP done at another office was not working. When she explained her exercise regime, it was clear to see why she was not healing. She was doing daily yoga stretches on an already unstable joint. When Hackett-Hemwall Prolotherapy along with PRP was performed to the unstable joint and her exercise regime was changed to more strengthening, her results were fantastic and she was back to working out 100%.
REASON #8: NON-STRUCTURAL CAUSES OF PAIN
At Caring Medical, we look at the overall health of each patient who comes into our office. Many factors can effect healing and if left unaddressed, you may be fighting a losing battle. While it was true that this patient, Sarah, needed Prolotherapy for her right shoulder which was being treated by another practitioner without success, her shoulder pain was only one of several problems she suffered from. Some of her problems included the following:
- She consumed a terrible, fake-food diet.
- She was taking the birth control pill (which inhibits healing).
- She hated her job.
- She honestly felt her current relationship was going nowhere.
- She had lost her faith.
- …too many more things to mention…
The bottom line here is that by the doctor just performing PRP Prolotherapy and not addressing her myriad of other complaints, it was really telling Sarah that what she thought, what she ate, what she did, and what she felt didn’t have any effect on her health and really just didn’t matter. The body is all connected and thus, it all matters. Once Sarah was here, the team at Caring Medical began to truly care for her and helped her turn her life in the direction she truly wanted. While it took most of the year, by the end of it, she was healthier, had a more optimistic outlook, was cooking her own food, had a normal menstrual cycle (on her own, I might add) and was dating someone who truly respected her. Yes, she did receive Hackett-Hemwall and PRP Prolotherapy, but the combination is what really helped cure her.
REASON #9: YOUR HEALING ABILITY IS NUTRITIONALLY COMPROMISED
Many people heal well after Prolotherapy without changing their diets all that much (or not at all). However, some people really do need to eat better in order to heal. John had received just one PRP treatment from a doctor in another state, but came to Caring Medical after not getting any real “reaction” from it. After taking his medical history, it was clear that John was not too sophisticated in the nutritional department. He was a coffee and donut man. He was overweight and very fatigued. We performed Hauser Diet Typing and found him to be a Type II diabetic (new onset). We also tested his hormones which revealed very low hormones levels. When he was placed on the Hauser Otter Diet and prescribed testosterone and DHEA, along with a comprehensive nutritional supplement program (www.benuts.com), not only did he get stronger, and have more energy, but his Hackett-Hemwall Prolotherapy for his knee arthritis worked wonderfully. His pain is 80% gone and I suspect the rest will be gone soon! His diabetes is gone as well – by following the above program. No need for medications.
REASON #10: THE PERSON IS OUT OF MONEY
It is a relatively common occurrence for us to receive emails and phone calls from people who are simply out of money because of all the expensive Prolotherapy they have received elsewhere. It is common for us to hear about cases where people spent $2000 to $3000 for one PRP treatment or other Prolotherapy injections where the doctor performed the procedure under fluoroscopy (x-ray) or ultrasound guidance, injecting PRP or some other solution into the injured area.
The main problem with this type of Prolotherapy from my standpoint is the fact that it often involves injecting a relatively small amount of solution, but carries an enormous price. Hackett-Hemwall Prolotherapy is performed by using a large amount of solutions and injections to ensure that the injured structures are truly stimulated to repair. By definition a procedure under x-ray guidance, means the doctor believes that the injured area is very, very small and I just don’t find that to be the case.
Genevieve came to us after spending something like $12,000 getting PRP Prolotherapy from someone on the other side of the country and was about 20% better. We received an email from her in response to our post-new patient visit email from our operations manager. She could not express how much better she was after her first visit! She was thrilled. Admittedly, Genevieve’s treatment was rather costly, with the new patient consult fee and me injecting her whole cervical and lumbar spine. The visit cost her around $1300 (not inexpensive by any standard) but she received around 200 injections with very strong proliferants (versus the $4000 she was spending for six injections under fluoroscopy). She said in her email that this was the first time her neck had stopped clicking and popping every time she moved it. The tingling down her arm was gone and her back felt very stable. I/we do not know if she will be completely cured of her pain with Hackett-Hemwall Prolotherapy at this point in the game. I can tell you this, however. She could have had another 20 PRP treatments under fluoroscopy and she would never achieve stability in her neck.
What should you do? If you are dissatisfied with your response to PRP Prolotherapy, before giving up please get an evaluation by a doctor who truly is a Hackett-Hemwall Prolotherapist with a lot of experience. These are a few examples and reasons why you may not have healed with PRP Prolotherapy. If you would like for me to review your case, I am happy to do so. Send me some details at email@example.com. If you desire to see me for a consultation and treatment, please email us at firstname.lastname@example.org or phone us at 708-848-7789 for an appointment.