Shoulder Pain and Prolotherapy

A patient of mine has a blog and posted some content related to treatments that we have been doing together.  I thought that I would post it up here for anyone else who might be interested.

I have been told that the rotator cuff is a very strong subset of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that are in place to stabilize and initiate movement of the upper arm at the shoulder. However, after years of competitive volleyball the rotator cuff muscles in my right arm no longer feel strong or stable. Also, there is quite a bit of dull, achy pain that varies in intensity depending on my daily activities.

The pain in my shoulder began gradually and has been getting progressively worse. For years now I have moderate to severe shoulder pain with overhead motion and also while I am sleeping. In other words, my shoulder pain has really been affecting my day-to-day life.

What are the options?

I see a Naturopathic Physician as my primary health care provider, so a while back I decided to begin a dialog around the possible options for my shoulder pain. Unfortunately, there has been a long-standing debate in the medical community with regard to the optimal treatment for rotator cuff pain and dysfunction. I was given an array of options from acupuncture to physical therapy to nutrition and lifestyle counselling. However, the modality I was most interested in was an injection therapy called ‘prolotherapy’.

What is prolotherapy and how does it relate to shoulder pain?

This is where things got interesting. Prolotherapy (or ‘prolo’ as the injection is affectionately known) is a complementary therapy for chronic musculoskeletal (MSK) conditions including the tendinopathy in my right shoulder. It includes injecting a mild irritant dextrose solution into tender connective tissue attachments, as well as surrounding joint spaces. The idea is that chronic MSK pain and dysfunction often result from degeneration of the structures. With prolotherapy, however, this degeneration is addressed at the tissue level. Prolotherapy injections are associated with localized inflammation, which likely leads to an induction of tissue growth factors that help the body heal more efficiently.

What does the science say?

In several studies, overuse injuries have responded well to prolotherapy; but I was most interested in those relating to shoulder pain. In 2016 prolotherapy was put up against control injections (normal saline) in painful rotator cuff tendinopathies. The idea was to ascertain the therapeutic efficacy of dextrose prolotherapy on pain levels and degenerative changes in rotator cuff tendinopathies. In this randomized double blind control trial, those that suffered from moderate to severe shoulder pain and received the prolotherapy injections (in combination with physical therapy) reported significant long term pain improvement and satisfaction when compared to those that received the saline injections (also in combination with physical therapy). Another study relating to rotator cuff pathologies published in early 2017 painted a similar picture.

An added bonus to this complementary injection therapy is that it is a very safe option, with no adverse events reported in the literature.

At this point, after years of pain, I have a viable treatment plan that will leave me with less pain and more stability in my right shoulder.

To recap, at its core, prolotherapy involves injecting a small amount of dextrose solution into tender ligamentous and tendinous attachments in a peppering fashion. As well, a practitioner will likely choose to inject into adjacent joint spaces. Typically treatment with prolotherapy encompasses at least three injection sessions with the time between injections ranging from two to six weeks.

Bertrand et al. Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Archives of Physical Medicine and Rehabilitation. 97(1):17-25. 2016.

Jensen KT et al. Response of knee ligaments to prolotherapy in a rat injury model. American Journal of Sports Medicine. 36(7):1347-1357. 2008.

Seven MM et al. Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthopaedics & Traumatology: Surgery & Research. 103(3):427-433. 2017.

I do appreciate when others are commenting about my work and how it can benefit everyone.  If this write up intrigues you, then come by for a free 15 minute consult.