Prolotherapy for EDS & Hypermobility

AL, with a history of Ehlers-Danlos Syndrome, had multiple shoulder dislocations despite 4 reconstruction surgeries, including a labral repair. AL’s shoulder was dislocating daily before coming for Prolotherapy. Because of her severe multidirectional instability, she required 12 Prolotherapy visits over the course of 12 months to stabilize her shoulder. 

For 5 years, eighth grader Louise S managed her EDS pain with weekly chiropractic care, until chronic multi-joint dislocations became incapacitating, keeping her from her love of gymnastics, as even bumping into things would cause her joints to dislocate. Louise came to CMRS from Europe along with her mother, looking for an answer to this life altering disease. After 5 treatments of Prolotherapy, Louise was able to become proficient at aerial circus, with improved overall body, core and shoulder strength, without dislocations.

EK first began experiencing the symptoms of Ehlers-Danlos Syndrome, Hypermobility type in the fifth grade, when one of her knees subluxed. Over the next 12 years, the pain and joint subluxations spread to other joints including the other knee, elbows, shoulders, and spine. EK tried many different forms of therapy including physical therapy, massage, ultrasound, taping, and compression braces which managed her pain well enough to perform daily activities as well as gymnastics, track, and cross country. At the age of 19, she tore the meniscus in her right knee and underwent surgical meniscus repair. Following the operation, she experienced intense pain, and subsequently underwent a second operation. While the symptoms in her knee appeared to be resolved, pain in her other joints persisted. During this time, EK also began experiencing other health issues including hypothyroidism, eczema, chest pains, food allergies, irregular menstrual periods, and degenerative disc pain in her neck and back.

In the search for a treatment for her joint pain, EK found Prolotherapy, which she felt was needed for the pain in her neck, thoracic, low back, knees, and shoulders. During this time, she continued physical therapy, and managed her pain with multiple medications. After a year and a half of minimal improvement, her pain doctor referred her to Caring Medical in Oak Park, Illinois for Prolotherapy. As a 21 year-old college student, EK was living with constant joint pain, which disturbed her ability to exercise, study, and sleep. She contemplated dropping out of school. By this time, she also suffered from joint dislocations in her shoulders and elbows causing its own amount of excessive pain and stiffness. Her spine, including the neck, thoracic, and lumbar regions, would also “freeze,” sending shooting pain up and down her back.

EK’s first Prolotherapy treatment at Caring Medical consisted of Prolotherapy injections to her neck, spine, both scapulas, low back, and knee. Within a week of her first visit, EK reported a decrease in her thoracic and scapular pain and improved physical stamina and energy. A month later, she began running again and no longer required treatment to her knee. By her second visit, EK had discontinued all use of pain patches, and only required occasional Tylenol for pain and muscle relaxers to help her sleep. For the next six months, EK continued to receive monthly treatments to her neck, thoracic, and shoulders, showing gradual improvement of pain and well-being. After eight months of treatments, EK no longer required any pain medications, was no longer experiencing any joint dislocations, and was back to running and gymnastics. After her initial eight months of therapy, she was seen an average of once per year throughout her college and Masters program. She has not been seen for treatment for over seven years now, during which time she has received a PhD in her chosen profession. She continues to lead a full life, without daily pain or disability. She has no limitations while exercising most days.

PF is now a 55 year-old retired school teacher and mother of two adult children who lives in Canada. She came to Caring Medical because her Prolotherapy doctor, Fred Cenaiko, MD, retired. She had always known she was “hyperflexible” but had controlled her various joint aches, pains, and subluxations with physiotherapy and chiropractic care. Her pain became unbearable 15 years prior to the first visit at Caring Medical, when she began experiencing pain and instability in her left sacroiliac (SI) joint. After seeing many specialists over the course of several months for her SI pain, including her general practitioner, orthopedists, physiotherapists, and chiropractors, PF was left upset and disappointed by her continued pain and lack of improvement. She was having difficulty working, in addition to raising her two children. If something wasn’t found to help the unrelenting pain, she was destined to soon be completely disabled. Chiropractic adjustments helped for a few hours only to have her lower back go out again. She was told by one orthopedist to get a sacroiliac fusion.

As her low back pain increased, so did the rest of her joint pain. Her popping, clicking, and a feeling of looseness throughout her body increased. No longer were physiotherapy and chiropractic manipulation able to control her pain. Within a year, she had whole body pain and instability that almost completely disabled her for two and a half years. She was unable to take care of her children and she had to rely on strong pain medications in order to function. One day, her European-trained physiotherapist gave her some research articles from medical journals that talked about the tightening of joints with Prolotherapy. PF noted that the main doctor doing Prolotherapy was in Oak Park, Illinois, Dr. Gustav Hemwall. When she called Dr. Hemwall’s office, she was referred to Dr. Fred Cenaiko who worked in Saskatchewan, Canada. It was Dr. Cenaiko who diagnosed PF with Ehlers-Danlos Syndrome, Hypermobility type, and began treating her back and other areas of her body every six weeks with Hackett-Hemwall dextrose Prolotherapy. It took PF, 1.5 years of receiving dextrose Prolotherapy to her lower back to experience complete resolution of her SI pain. She reports that her other joints, including her knees, shoulders and hips healed much more quickly and she only required a couple treatments to each joint to resolve her pain complaints.

After one and a half years of doing Prolotherapy, PF was completely pain free. Because various joints of her body would begin to sublux and become painful over time again, she and Dr. Cenaiko realized that receiving Prolotherapy two to three times a year was what was needed to keep her stable and pain-free. PF has continued to receive Prolotherapy two to three times per year for the past 13 years. She was able to complete the necessary years as a teacher to be eligible for full retirement benefits from teaching. Prolotherapy also helped her get back to being the type of mother, wife, and friend that she wanted to be. PF currently swims laps, jogs, or hikes on a daily basis with no pain. She states that she also enjoys biking but she has to be careful because if she cycles at a high resistance for long distances, her knees start to become unstable. PF also avoids massages because she has noticed that massages tend to loosen her joints. Dr. Cenaiko retired in 2010 and referred PF to Caring Medical to continue her maintenance Prolotherapy treatments.

NP is a 31 year-old registered dietitian who came to Caring Medical in February 2009 from a referral by her osteopathic doctor, because of the diminishing benefits manipulation was having on her pain. She was very interested in the potential benefits Prolotherapy might have on her significant shoulder and thoracic/rib pain. She stated that she “has always had loose joints” and for most of her adult life has needed either chiropractic or osteopathic care to function. Her significant pain started 10 years earlier while on the rowing team at college. Her primary pain was located in the left T1-T4 area and left shoulder. A previous MRI of the thoracic area was read as normal. She had tried acupuncture, electrical stimulation, physical therapy, and various medications and manual therapies without lasting relief.

On physical examination, she had noticeable ligament laxity in multiple thoracic/rib junctions (costovertebral) and her left shoulder easily subluxed anteriorly. Her Beighton Hypermobility Score was 5. At the initial visit, dextrose Prolotherapy was given to her left thoracic facets and costovertebral junctions. When seen one month later, she felt 40% better and another Prolotherapy treatment was given to the same area. She was not seen again until June and felt her thoracic pain didn’t need treatment anymore but she wanted to start treatment for her left shoulder instability. Because of the degree of instability, sodium morrhuate (1cc/10cc syringe) was added to the dextrose Prolotherapy solution and treatment was given primarily to the anterior shoulder.

NP did not return for one year because of resolution of her thoracic and shoulder pain with the previous Prolotherapy treatments. When seen in June 2010, her primarily complaints were clicking, pain and an “unstable feeling” in the left hip. On physical exam, a definite palpable click was felt and a moderate degree of instability was seen. Her anterior and posterior left hip was treated on that date and again one month later. She had complete resolution of these symptoms. She was seen in October 2010 because of low back pain which wasn’t resolving with physical therapy and exercises. Physical examination revealed hypermobility of her left sacroiliac joint. Dextrose Prolotherapy with sodium morrhuate was administered to the left lower back region emphasizing treatment of the left sacroiliac joint.

When NP was seen again in February 2011, the only complaint she had was recurring subluxation of her left shoulder joint during activity. She again had evidence of shoulder joint instability anteriorly. Treatment of dextrose Prolotherapy with sodium morrhuate to this area resolved this issue.

JR, a 22 year-old male college student, came to Caring Medical in April of 2010 for complaints of bilateral knee swelling and shoulder instability. His lateral knee swelling began after he took up running in 2009 in preparation for entering the military upon graduation from college. He stopped running and was evaluated by an orthopedic surgeon who did an MRI and found an oblique tear of his lateral meniscus in both knees. The surgeon recommended arthroscopic surgery but JR looked for an alternative. He received one platelet rich plasma (PRP) injection on three separate visits with only minimal help. He sought a consultation at Caring Medical for Prolotherapy because of the minimal improvement with the PRP injections alone.

His shoulder issues started in 2005 (at age 17) after he tore the labrum in his right shoulder and had surgery to repair the tear. Despite having surgery, he continued to feel instability and pain in his shoulder. Because of his bilateral knee and shoulder pain and instability, even his ability to do non-impact sports like swimming had been affected.

Physical examination revealed joint hypermobility throughout his body, with a Beighton Hypermobility Score of 5. JR admitted that he frequently self adjusts or pops many of the joints in his body. Physical examination of his knees revealed significant bilateral grinding/crepitation with moderate to severe patellar hypermobility. He was instructed not to self manipulate his joints upon starting Prolotherapy, as this could potentially disrupt the connective tissues that are repairing after treatment. Dextrose Prolotherapy with sodium morrhuate was administered around the patella, as well as the various ligaments of both knees. Bilateral intraarticular Human Growth Hormone (2iu/joint) was also given. Because of the improvement in his knee pain with the first treatment, when seen one month later, his shoulders were also treated. He did not return until five months later, because of some continued symptoms, though he was feeling more stability and strength in his knees and shoulders. The knees were no longer swelling and he was back to an active exercise program.

JR returned for three more treatments from October to December 2010. This totaled five treatments to his knees and three treatments to his shoulders. At his last visit, JR reported that he was back to swimming and weight training without limitation, and only had an occasional crepitation in his shoulders but did not have pain. As for his knees, the crepitation was greatly decreased as well as the swelling. He has not yet tested his knees by running.

When SB came to Caring Medical in March 2009, you would not have believed that this was the same woman who had walked into the office in 2001 as an 18 year-old. She was now a graduate of the prestigious Chicago Art Institute, happily married, and able to exercise. She was taking no medications. This was a far cry to the person seen in 2001 who was in constant pain and on Zoloft, Tylenol #3, Prozac, Clonazepam, Effexor and Soma. From the age of six to 12, SB was active in gymnastics. She had to stop gymnastics when her right hip became painful and, despite lots of therapies and doctors, developed into a constant throbbing pain. Her list of previous therapies to resolve this pain included: physical therapy, prescription medications, deep tissue massage, nerve blocks, acupuncture and Feldenkrais. At the time of her initial consult, she was almost suicidal because the pain was so bad. On physical examination, she had joint hypermobility throughout her body, with a Beighton Hypermobility Score of 6. After a thorough discussion that her prognosis was good but would require a lot of Prolotherapy, she and her mother agreed that SB should start Prolotherapy on her right hip, which was diagnosed as hip joint instability with labral tear.

SB came in somewhat regularly for a two year period, during which time she received dextrose Prolotherapy with sodium morrhuate. She was slowly weaned off of all of her medications. By the time was she was 20, her hip was stable and pain free. She was back to regular exercise and attending college. From the years 2002-2007 she was seen once to twice per year because of joint instability in other areas including the shoulder, neck and elbow. The reason she came to the office in March 2009 was for what she called “tune up treatments” of her right hip and shoulder, at which time she wrote she was forever grateful for Dr. Hauser and the Prolotherapy treatments. She was seen once in 2010 for the same “tune-up treatments.” She noted that the Prolotherapy had gotten her 95% better, but could feel the right hip and neck symptoms recurring.

In January 2009, BB, a 61 year-old skier, came to Caring Medical saying she “didn’t want anything to slow her down.” BB always knew she had a tremendous amount of joint flexibility, and thus, excelled at yoga as well.

She had a significant past medical history with five years of suffering with bilateral hip, knee, and elbow pain. She continued to be active, including skiing with a very restrictive knee brace, despite her right knee MRI showing a medial meniscus tear, and her right hip MRI showing a high-grade partial-thickness tear involving the gluteus minimus insertion onto the right greater trochanter as the dominant finding with paritendonitis and trochanteric bursitis; low-grade tenoosseous strain of the iliopsoas insertion the lesser trochanter without tendon tear; more substantive iliopsoas bursitis. BB was a strong natural medicine advocate and exclaimed that “No orthopedic surgeon is doing surgery on me!” She was told by a skiing friend to look into Prolotherapy.

BB was diagnosed with JHS and like SB, had evidence of hypermobility throughout. Her Beighton Hypermobility Score was only 4, but many joints had excessive mobility. She was told that she was an excellent Prolotherapy candidate, but because so many joints were involved it would require some time for all of the instability to resolve.

BB was seen at Caring Medical on 10 occasions over the course of the next two years for treatment. Her elbow responded after four treatments, allowing her to get back to exercise, which included weights and push-ups. Her right knee needed five treatments, and her hips each needed nine treatments. Now BB is back to cycling up and down the hills of Colorado and skiing at a high level without braces and without pain.

JD came to Caring Medical in extreme distress because she was no longer able to work as a physiotherapist, athletic trainer and Pilates instructor. She was a 48 year-old wife and mother from Ontario, Canada and her pelvic pain had completely disabled her. She explained that her previous life as an athlete included Canadian National rhythmic gymnastics team, international level dragon boat and outrigger paddling, recreational triathlons, cross country skiing and water skiing.

JD always had what she called “extreme flexibility.” She had a series of injuries including the following:

• 2004 – plantar fascia pain
• 2006 – severe hip pain on the greater trochanter
• 2007 – inguinal pain, requiring inguinal hernia repair x 2
• 2008 – right groin exploratory surgery and inguinal nerve ablation. Her right groin pain did not resolve. MRIs at this time revealed a torn rectus abdominus, right hip dysplasia, and labrum tear.
• 2009 – right rectus abdominus repair and removal of mesh. Re-injury of right inguinal area. Another right inguinal hernia repair with mesh.

JD’s first appointment at Caring Medical was in August 2009. She had multiple complaints but her primary pain areas were the pelvic floor, pubis, groin, left knee and left ankle. She received some Prolotherapy in Canada previously, but because she did not feel the technique used was aggressive enough, she was not happy with the results. JD said her main goal was get to back to teaching Pilates full time. The pain was completely disabling her from working and driving, and she was becoming very depressed. Her pain was increased with most movements and activities including sitting, standing and walking. She was diagnosed with JHS with her main problem being subluxation of the pubic symphysis. She was felt to have pubic instability and this was causing the majority of her pelvic pain. She had instability of the left knee and left ankle. These areas were treated with dextrose Prolotherapy with sodium morrhuate every four to six weeks. When JD came for her third visit in December 2009 she noted that she was feeling much better. Her groin pain had improved to the point that she was water jogging two to three times per week and doing some core workouts. She started working again, two mornings per week, and was able to drive short distances. On this third visit, she started treatment on her right hip because of popping, clicking and pain from hip joint instability. She was feeling much stronger and less pain overall until she re-injured her right oblique abdominal muscle and this started her right pubic/groin pain again.

At her February 2010 visit, the pubic symphysis was treated again, as well as the right hip. At this visit, JD noted a new pain in her lower right back which was also treated with dextrose Prolotherapy with sodium morrhuate at that time. Over the course of the next year, JD was seen in the office three times (including seven months between two of the visits) necessitating treatment to her left knee, right hip, and new-onset metatarsalgia of her left foot. To date, her disabling groin pain is down to a manageable level, but feels that some of the pain is secondary to the two meshes she has in her. JD is back to work, but not full time like we had hoped.

Kristle Lowell, Double-Mini Trampoline World Champion, diagnosed with EDS was experiencing severe instability from multiple ligament injuries of her left ankle and received massage, physical therapy, cortisone and NSAIDS, from which she saw no long-term relief. Kristle suffered a career threatening injury to her ankle, which made gymnastics training unbearable. She came to Caring Medical and received 2 PRP Prolotherapy treatments. Her ankle was stabilized, enabling her to compete and place second in national championships and qualify for world championships.

Our amazing patient, Olivia, used her Prolotherapy experience to inspire her senior thesis, and was kind enough to share it with you! Check out the video and pdf below. We are so proud of her talents and passion for helping others! She shares her story of a traumatic injury that started her chronic pain journey in her hip, pelvis, and neck. In her thesis, she also makes the argument for FDA-approval of Prolotherapy in hopes of greater coverage by insurance companies to make the treatment more widely available to those who stay strictly within their insurance plan for their medical care. We do want to make a note of clarification that the FDA does not oversee medical procedures, specifically, but that the solution ingredients, supplies, and equipment used for Prolotherapy in our clinics is all FDA-approved.

Olivia’s Senior Thesis