“Tendinopathy” is an umbrella term for any tendon problem. A tendon injury may start out as a “Tendinitis” (an inflamed tendon), but if it becomes chronic, inflammation is usually no longer present. Actual biopsies of tendons from patients undergoing surgery for “chronic Tendinitis” showed that there was no inflammation present at all! In fact, what was happening was degeneration of the tendon fibers, with an absence of inflammatory cells. The term “tendonosis” is the more accurate term now used for chronic tendon issues to emphasize that inflammation is absent, and what is happening in those tissues is that collagen breakdown is occurring faster than it is being rebuilt; in other words, degeneration of the tissue is occurring, resulting in connective tissue weakness. These injuries have long been a challenge for classic orthopedic medicine because of their poor response to traditional treatment. With Prolotherapy, what we are really trying to do is turn a nonhealing, degenerative tendon back into a Tendinitis, on purpose, in order to stimulate repair and healing. All three of the Prolotherapy formulas have successfully been used to help with healing tendinopathies. Injecting even a low concentration of the traditional Prolotherapy formula, dextrose, into a tendon will stimulate natural growth-factor elevation within minutes to hours. Multiple studies have also shown the effectiveness of Dextrose Prolotherapy for these problems.
Both Platelet-rich plasma (PRP) and Biocellular (Stem Cell–Rich) Prolotherapy formulas have been found to be safe and effective treatments for tendinopathies. PRP has been shown to improve quality of tendon repair and reduce pain for many tendon areas, including wrist, rotator cuff (shoulder), knee patella tendon, plantar fasciitis, and other tendinopathies. Biocellular formulas have been used for multiple tendon areas as well, including patellar and achilles tendinopathy.
Of note is a case series (more than one patient case report) describing the use of Biocellular Prolotherapy for severe achilles tendonosis and tears. Improvement was seen as soon as three to four weeks after treatment, and at 12 weeks after treatment all patients returned to full activity without pain or dysfunction. Ultrasound images before and after treatment are noteworthy for dramatic healing of this large tendon tear (see Figure 1: Ultrasound of an Achilles tendon tear before and after Biocellular (Stem Cell-Rich) treatment). During follow-up at three to four years after the procedures, all patients were still symptom-free, with no recurrence of any problems or pain.
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