Some problems with ligaments, muscles or joints respond well to time and rest, physiotherapy, etc. but some persist or become worse with time. One option is to consider needle-based treatments. Traditionally people know about cortisone injections which work really well in a lot of circumstances where the main issue is inflammation and pain – here it works as an anti-inflammatory. However, where the underlying problem is instability, the cortisone approach may reduce pain but not treat the underlying problem. In selected situations an alternative approach is sclerosant prolotherapy injections.
Prolotherapy is short for proliferative therapy. Traditionally this involves injecting a form of dextrose into the area. Sclerosants are other chemicals that purposely irritate body tissues. Sclerosants include hypertonic dextrose, sodium Tetradecyl sulfate and Polidocanol. A common use of sclerosants is to treat varicose veins where they have been used for many decades with a high rate of safety and effectiveness.
If you are allergic to sulpha drugs you may be allergic to Tetradecyl - other options include injecting Polidocanol, dextrose (less effective) or just needling (much less effective).
Sclerosant is injected into the damaged tissue – usually a ligament or joint capsule. The idea is that it on purpose irritates the ligament and “tricks” your body into thickening and strengthening - that helps to stabilise the joint. As the whole area becomes more stable, there is less abnormal movement and this can lead to reduced pain. A very mild form of this therapy involves only using a needle with no medication, but this method can be less effective.
Dextrose can be injected into a joint - it seems to work in the same way as cortisone at 5% concentration and is thought to not have any detrimental effects on cartilage and may actually help it to grow back (just a little).
More potent regenerative agents are things like stem cells and platelet rich plasma.
Sclerosants are most useful where the main issue is instability.
This can happen in one area after an injury e.g. in your ankle after a major sprain. In this situation we treat just that area and the involved ligaments. Usually one or two treatments are needed.
In some conditions this may be more widespread due to an underlying abnormality that involves many joints. This is common in hypermobile patients, especially those with Ehlers-Danlos Syndrome and similar conditions. Because of the underlying condition each area may need many treatments.