Regenerative Injection Therapy(RIT), also known as Prolotherapy, is a minimally invasive injection procedure that stimulates the body’s natural healing mechanisms to repair chronically damaged ligaments, tendons and fibrocartilage. In Prolotherapy, the damaged ligament or tendon is injected with a substance that either directly or indirectly causes a small amount of local tissue irritation or inflammation. The resulting inflammation triggers the body’s natural repair processes to strengthen the existing tissue and to enhance the growth of new tissue. Other substances may also be injected, including Substrates (building blocks for collagen synthesis) and Growth Factors (chemical messengers that promote the healing response).

Ligaments and tendons are cable-like structures that allow you to walk and move without falling apart. Ligaments connect bone to bone and tendons connect muscles to bone. These structures are flexible, but they do not stretch very far. Injuries, such as when you sprain a ligament, twist a knee, take a bad fall, suffer whiplash, lift an object which is too heavy, or perform repetitive movements (whether as part of your job or as a sports activity), can tear or fray these cable-like structures.

The injury typically causes some local inflammation, and the repair process is initiated. You know this process is happening when you feel the pain, heat, swelling, and have difficulty moving the injured joint. If the healing process is completely successful, the ligaments or tendons will be restored to their normal strength and length, and you can return to your normal activities. If this healing process does not completely work, the ligaments or tendons may remain in a stretched or weakened state. This “stretched out” condition may cause pain and discomfort with movement or result in joint instability. Chronic ligament or tendon damage also can cause the surrounding muscles to tighten up and cause additional pain.

Ligaments and tendons are made up of many fibers arranged in parallel bundles, like rope or cable. The fibers are made of long-chain molecules called “collagen” (Glucosamine and chondroitin are some of the molecules that make up collagen). The collagen fibers are held together by smaller chains or links. In chronic damage, there is a disruption of the normal parallel arrangement of the collagen fibers. Persistently injured ligaments and tendons may have 30-40% fewer collagen fibers, and the fibers are in disarray or unorganized. When a tendon is freshly injured, it is called “tendinitis”. The “-itis” implies inflammation. But if the injury doesn’t heal properly, the resulting condition is known as “tendinosis” or “tendinopathy”.

Electron microscopic studies have clearly demonstrated that degenerative ligaments and tendons do not contain cells of inflammation. Studies have shown that sometime between 4-10 weeks after a tendon or ligament injury, there is no longer inflammation present. The resulting ligament or tendon is degenerated, weakened, and overstretched.

While response to treatment varies, most people will require between 2 and 6 sets of injections. Each set of treatments is spaced between 4 and 6 weeks apart. We never give treatments more frequently than every 4 weeks.

In our office we typically plan on doing 3 sets of treatments initially. If there is no indication that the treatments are helping after 3 treatments, we usually stop treatment as it is unlikely they will help. If improvement starts to be noted, then treatments continue.

Are there special instructions after I get the injection?

You need to restrict the use of anti-inflammatory medications (NSAIDS) during the course of treatment. At a minimum, NSAIDS should not be used 3 days prior to injection and for the first 7 days after injection. The use of NSAIDS does not preclude treatment however, since clinical benefit occurs in patients who are on regular prednisone treatment for other medical conditions.

You should rest the treated joint for a week after treatment, followed by progressive resistance exercise. This will help “line up” the newly laid-down collagen fibers in the proper direction for maximum strength.

You may have increased pain for the first 2 to 5 days during the “inflammatory phase” of the healing process. Your doctor will prescribe for you a pain killer to take for this time that will not interfere with the inflammation. It’s important to understand that this is a “pro-inflammatory” treatment, and this should not be suppressed.

Regenerative Injection Therapy is not covered by insurances. Though this form of preventative medicine has been around for over 50 years, most insurances still consider it to be “experimental”, along with more current Regenerative Medicine treatments such as Platelet Rich Plasma injections, and Adult Mesenchymal Stem Cell Injections. RIT however is more affordable that the others, and with a longer track record, and similar results. Our fee is $250 per joint treated per session, $400 if two joints are treated at the same session.