Prolotherapy is Effective for Sports Injuries

An injured athlete getting better and ditching his crutches
Prolotherapy can get the athelet back on track with good results.

Returning the Athlete Safely to Their Sport

An important goal in sports medicine is returning the athlete safely back to his/her sport.[1] This goal is made more difficult because of the number of both acute and chronic connective tissue injuries in sports, and, as has been discussed earlier, the challenges with connective tissue healing. Even if an injury improves, there is a high risk that healing may be incomplete, leaving the athlete with decreased strength and increased likelihood of repetitive injury.[2] If acute injuries remain unresolved, these can become chronic and more difficult to treat.[3] Athletes also experience a high incidence of muscle injuries, with the potential for scar tissue formation or weakness if not quickly resolved. Treatment of these acute muscle and connective tissue injuries with Platelet-Rich Plasma (PRP) Prolotherapy has been gaining popularity with a growing body of evidence supporting its use.[4]

Standard Treatments for Sports Injuries

Typical treatments for sports injuries include nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, however these have been shown to be detrimental to tissue healing[5] and can promote cartilage loss,[6] which ultimately leads to both chronic pain and deterioration of sports performance—not attractive options. The good news is that patients treated for sports injuries with Prolotherapy Regenerative Medicine have achieved the exact opposite outcomes: decreased pain and increased sports performance and function.[7]

Athlete taking NSAID pain revlievers
Long-term use of anti-inflammatory drugs and corticosteroids can be detrimental to tissue healing.

Prolotherapy Regenerative Therapies for Sports Injuries

Traditional Dextrose Prolotherapy

This effective protocol has been used for decades in the treatment of sports injuries. Ross Hauser’s book Prolo Your Sports Injuries Away! published in 2002, explains at length the many ways Prolotherapy can treat sports injuries. Multiple studies have demonstrated the benefit of Dextrose Prolotherapy treatment for sports injuries. One such study concerned chronic groin pain that had “prevented full sports participation” for an average of 16 months in a group of 24 elite rugby and soccer athletes for whom conservative treatment for groin pain had failed. After an average of less than three monthly Dextrose Prolotherapy treatments, 22 athletes returned to playing at their previous level, and 20 of them were pain free.[8] Other studies have confirmed Prolotherapy’s effectiveness for rotator cuff lesions,[9] Achilles tendinopathy,[10] osteitis pubis,[11] coccydynia,[12] and Golfer’s elbow,[13] as well as other sports injuries.[14]

Patient receiving prolotherapy injection
Traditional Dextrose Prolotherapy has been used for decades in the treatment of sports injuries with effective results.

Platelet-rich Plasma (PRP) Prolotherapy

Many people have heard about platelet-rich plasma (PRP) being used for sports injuries but do not know that Prolotherapy practitioners have been using PRP as a formula long before its use was widely known. Initially when it broke upon the sports medicine scene in the early 2000’s, not much was understood about it, and the World Anti-Doping Agency (WADA) put it on their “prohibited” list. Fortunately, in 2013 it was removed from that list, and WADA declared that despite the presence of some growth factors, “current studies on PRP do not demonstrate any potential for performance enhancement beyond a potential therapeutic effect.”[15] While there is still controversy regarding the best PRP type or method, it is now widely accepted in the sports medicine and orthopedic medicine communities,[16] as well as in professional sports.[17]

Just as with Dextrose Prolotherapy, multiple studies have demonstrated the benefit of PRP treatment for sports injuries, including a study which showed successful repair of ulnar collateral ligament tears (an important ligament in the elbow and commonly injured in throwing athletes such as baseball pitchers). That study concluded, “PRP injections may be particularly beneficial in young athletes who have sustained acute damage to an isolated part of the ligament and in athletes unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.”[18]

Athletes suffering from high ankle sprains have also been shown to benefit from PRP injections, with a shorter “return to play” and less long-term residual pain.[19]

Muscle injuries, also common in athletes, have demonstrated the remarkable ability to recover faster when PRP was used almost immediately after injury. Ultrasound-guided PRP injections were given to athletes suffering with moderately severe muscle tears. All patients had complete healing of the muscular lesion and returned to complete muscular function and sports activity, with complete resolution of pain.[20] Another study showed that even a single ultrasound-guided platelet-rich plasma injection was an effective, long-term treatment for nonresponsive, chronic, distal biceps tendinopathy.[21] Another treatment areas where PRP was found successful are jumper’s knee (patellar tendinopathy).[22] Hines Ward (Pittsburgh Steelers wide receiver who received PRP just before Super bowl XLIII) isn’t the only big name to boost PRP’s reputation; a number of celebrity athletes recovered sooner than expected from injuries treated with platelet-rich plasma injections, including golfer Tiger Woods, tennis player Rafael Nadal, soccer player Cristiano Ronaldo, basketballers Kobe Bryant and Steph Curry, and baseball players Joey Votto and Alex Rodriguez.[23]

Biocellular, Stem Cell-Rich, Prolotherapy

Starting around the year 2000, many professional athletes received Biocellular procedures, both instead of surgery and to accelerate recovery after surgery—among them high-profile US National Football League (NFL) players, many of whom publicly credit these treatments as helping them extend their careers.[24] A 2014 report in Sports Illustrated reported that the NFL considers stem cell–based treatments to be medical—not performance enhancing—and has permitted such treatments as long as they don’t include any banned substance (such as human growth hormone).[25]

An interesting case report describes a baseball athlete who underwent knee reconstruction surgery. After the surgery he continued to have pain and was unable to play, run or jump because of a large tendon tear in his patella tendon. He received Biocellular Prolotherapy using adipose, bone marrow, along with PRP, and was able to return to play, essentially pain free, six weeks later. Ultrasound imaging also showed dramatic improvement in the tendon.[26]

Even when surgery is needed, Biocellular sources used during that surgery may be helpful in speeding recovery and preventing recurrences. A study compared shoulder surgery with and without bone marrow applied during the surgery. The results showed significantly better outcomes, with reduced re-injuries, in the bone marrow group, as long as ten years after the procedure.[27]

Finally, when regenerative injections are done soon after an injury, faster, better healing is possible. There is also evidence that healing may occur without weaker scar tissue, but rather with new, normal, strong tissue, preventing recurrences.

Cells floating mood shot

The Future of Prolotherapy Regenerative Therapies in Sports Medicine

As Albert Einstein said, “The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.” Older thinking about the best ways to treat sports injuries is slowly giving way to newer fundamentals of regenerative medicine. Sports medicine professionals and the athletic community are beginning to embrace regenerative therapies that enhance tissue and joint repair while also avoiding the risks of surgery. Although there are still controversies about protocols, every year, more studies offer information that help to clarify the fine points of these regenerative therapies, and more and more athletes—professional and recreational—are discovering Prolotherapy Regenerative Medicine.

Case Report: Health Educator and Former NCAA Division II Strength and Conditioning Coach

Jessica Balzano, Health Educator and Former NCAA Division II Strength and Conditioning Coach

I have always been very physically active, working almost 20 years in the fitness/coaching industry. I am now in my mid 40’s, and I have learned how important it is to take care of my body. My career requires me to be in top physical shape at all times. My body is my moneymaker; exercise is my stress reliever, and I don’t have time for injuries.

But life happens. When I was in my early 30s, my car was hit by a bus while in San Francisco, and I was left with injuries around the right shoulder and right side of my body that did not resolve and that none of the doctors I had seen knew could diagnose or knew how to treat. I went to numerous specialists to find a way to “fix” my issue. After six months of being in pain and not able to lift weights, I became depressed. To make the situation worse, I put on 40 pounds from my lack of exercise, stress, and depression.

I spoke to Dr. Alderman (one of my training clients) about my “issue,” and her confident response was, “Let’s shoot it.” I, like many, had never heard of Prolotherapy before. I was skeptical that it could help—although, scientifically, the treatment made sense to me. I read the first edition of Dr. Alderman’s book so I could know what I was signing up for. I felt more comfortable about getting the treatment once I understood how it worked. Besides, at that point, I was running out of hope and felt I had nothing to lose.

Dr. Alderman did four treatments of Dextrose Prolotherapy one month apart, and, much to my surprise, I was fixed! I was no longer in pain. I was then on a mission to get back to my workouts and was very motivated to lose the 40 pounds I had gained while injured. I took the weight off, returned to my pull-ups and lifting, and even got my six-pack back! I realized that prior to this injury, I had taken my physical ability for granted. However, now I had my life back and was determined to keep it. I went on to become first Assistant, then Head Strength and Conditioning Coach, at a Division II athletics program.

Five years after that injury, which has never returned, I hurt my hip working out. I had excruciating pain that radiated from my groin down to the top of my thigh. I thought it would go away, so I ignored the pain for a good six months before I couldn’t take it anymore. Finally, I saw Dr. Alderman, who did a diagnostic ultrasound and concluded I had a hip labral tear. Because of the type and location of this injury, this time she recommended PRP Prolotherapy. I noticed a huge difference after just one treatment; after three treatments six weeks apart, I was good to go. It’s been over eight years since the last treatment on my hip and over thirteen years since my last upper back/shoulder treatment, and I am still going strong on both. Because of Prolotherapy, I was able to remain in my profession.

Jessica Balzano,
MS Human Movement Science, NSCA-CSCS