PRP Prolotherapy

What is PRP-ProloTherapy?

PRP stands for Platelet Rich Plasma injection. Human blood has several different cells including red blood cells, white blood cells, serum and platelets. Platelets are very important for clot formation. They stick to each other and form a blood clot. Medical research has found that platelets also contain a number of chemicals and proteins that are involved in wound healing. When platelets are activated, they release these components collectively called “growth-factors”. When blood cells are separated from blood, the resulting fluid is called plasma. Processing the plasma can concentrate the platelets and their corresponding growth factors. This concentrated solution is then mixed with a local anesthetic and anticoagulant, then injected into the injured tissue to promote healing. In essence, the doctor concentrates the patient’s own healing factors and injects them back into the injured area. This approach is very different from using anti-inflammatory medications and steroid injections which decrease inflammation and the healing response. Pure PRP is similar to PRP but there are no red blood cells or certain types of white blood cells. This tends to make less unnecessary swelling and therefore it is less painful and gets you functioning more quickly.

Dr. Rampil is board certified in Neuromusculoskeletal diagnosis and treatment and Osteopathic Manipulative Medicine. She has been performing Regenerative Medicine using Prolotherapy since 2006. She tailor-makes proliferants for the patient. Some of which include Dextrose or Biologics (pure or amber PRP).

She can also create serum scaffolding by concentrating the left-over serum into a rich fibrin, fibrinogen, A2Protein gel. This supercharges the PRP and allows it to stay where it needs to in large spaces like a muscle tear or large joint. When needed, more aggressive injectates can be used. Dr. Rampil has been treating nerve entrapments with her hands using Osteopathic Treatment and by injection using Perineural, NeuroProlo or hydro-dissection if needed. She has over 30 years of palpatory experience feeling anatomy and pathology. Over the last 6 years, she has integrated musculoskeletal ultrasound for diagnosis and injections. Some injuries, like muscle tears may not show up on MRI but can be seen on diagnostic ultrasound when the muscle is moved or stressed.

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What is Prolotherapy?

Prolotherapy also known as regenerative injection therapy, sclerotherapy, (proliferative therapy), ligament reconstruction therapy, and fibro-osseous injection therapy. It is a recognized orthopedic procedure that stimulates the body's natural healing processes to strengthen joints weakened by a traumatic injury or over-use injury. When the joint’s ligaments or tendon attachments are stretched, torn, or fragmented, they become hypermobile and painful. Traditional approaches with surgery and anti-inflammatory drugs often fail to stabilize the joint and relieve this pain permanently. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new fibrous tissues, resulting in permanent stabilization of the joint.
How does Prolotherapy work?

With precise injection of a mild irritant solution directly on the site of the torn or stretched ligament or tendon, Prolotherapy creates a mild, controlled injury that stimulates the body's natural healing mechanisms to lay down new tissue on the weakened area. The mild inflammatory response that is created by the injection encourages growth of new ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area.
What is in the solution that is injected?

The prolotherapy injections contain anesthetic agents (to numb the region) and natural substances which stimulate the healing response. The primary agent is glucose, but each treating physician tailors the selection of substances according to the patients' needs.
Is the Prolotherapy treatment painful?

Any pain involving an injection will vary according to the structure to be treated, the choice of solution, and the skill of the physician administering the injection. The treatment may result in mild swelling and stiffness. The mild discomfort passes fairly rapidly and can be reduced with pain relievers such as Tylenol. Anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the injection.
Can Prolotherapy help everyone?

Each patient must be evaluated thoroughly with patient history; physical exam, imaging study, and full laboratory work up before treatment will be administered. If you already have labs and studies completed, please bring them with you to the visit so they will not have to be repeated. With this information, your physician can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patient's overall health and ability to heal, and any underlying nutritional deficiencies that would impede the healing process.
Who administers Prolotherapy?

Dr. Rampil who is trained specifically in cadaver-based injection techniques.
What areas of the body can be treated?

This form of therapy can be used to treat different joints; such as knee, hip, ankle, wrist, elbow and shoulder. In addition, the cervical, thoracic and lumbar spine including the sacroiliac joints can also be treated. Prolotherapy is also successful in the treatment of carpal tunnel syndrome and temporal mandibular joint dysfunction.
How often do I need these treatments?

The treatments should be administered as determined by your treating physician. Frequency and number of overall treatments will depend on location, severity of injury and your ability to heal. The spine and extremities average 2-6 sessions.
What's the rate of success in treatment?

The anticipated rate of success depends on a number of variables, including the patient's history, ability to heal, and the type of solution used. In patients with low back pain and hypermobility, 85% to 95% of patients treated experience remission of pain with this form of therapy. In comparison, the Journal of Bone and Joint Therapy reports a 52% improvement in patients treated surgically for disc involvement.
Is this form of therapy really new?

Prolotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the shoulder joint. Advances in medicines have greatly improved on this process and led to the modern techniques of strengthening the fibrous tissue rather than producing scarring to fuse tissues. In 1926, a group of physicians met with great success using injection therapy to treat hernias and hemorrhoids. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints with these newer injectable medicines in the 1940s and 1950s. Also, in 1950, George Stuart Hackett, M.D., wrote a book on injection therapy. His work is still used today in training physicians. In the years since this early work, techniques and medications have advanced to move from a scarring or fusing effect to a strengthening effect, which restores the weakened joint to its original level of stability, without loss of flexibility and function. Information compiled from multiple sources including the AAOMED website and The Principles of Prolotherapy by Ravin, Cantieri and Pasquarello.
What to expect prior to Injections?

Dr. Rampil will inform what is the purpose of the injection, exactly what and how the substance is injected. How this may feel to you, the patient. She will review the benefits, side effects, complications. She will also discuss costs, alternatives and traditional options.
What to expect during neural or scar injections?

A very thin needle injects a sterile substance into the scar to help with scar tightness and pulling. This can also help nerves entrapped in the scar. Many times, it can stop pain in other areas that started when a surgery site or injury was sutured. There must be sufficient healing of the scar before this procedure can be performed. Some patients don’t even feel the injection as there are no nerves within the scar, however to others it can feel “pinchy” or mildly uncomfortable.
What to expect with Prolotherapy, PRP with and without serum concentrate?

These tend to be deeper injections that can be more painful. We work with you to make them tolerable. You may be pre-medicated, or a topical freeze spray may be used. There are different types of numbing solutions. We also help guide your breathing and help distract you, as well as give you pressure points to stimulate. There are more details about these injections elsewhere on the website Ultrasound guidance is included in the injection fees.
What to expect during trigger point injections?

These are injections used to treat areas of muscle that are irritated and when touched can shoot or radiate pain to other areas of the body. Dr. Rampil will try to treat the area with her hands first. If the area is persistent, injections can be a way to break the muscle’s irritability. A small needle is used. There are a few different substances that can be injected. Dr. Rampil will discuss with you what is the best solution for your situation. There are usually multiple sites injected during the same treatment. The tender area and radiating pain usually resolve within seconds after the injection. Most people start asking if they can have additional injections in related muscles during the visit. What to expect during perineural injections: Perineural injections are also called NeruoProlo Injections. These injections are most helpful with nerve pain. Very small, short needles are used to inject low dose Dextrose or sugar water into the skin over the pathway of the nerve. There are usually multiple injections in this treatment. Most of these shots do not hurt, while others can feel like a quick sharp pinch. Dr. Rampil will go over details of the injections prior to the procedure.

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