Degenerative disease of the joint is also known as osteoarthritis.  It is characterized by pain in joints that are responsible for weight-bearing and joints that are overused. Often times “wear-and-tear” degrades cartilage faster than the joint repair mechanisms.

 

Osteoarthritis of the hip and knee is now known to no be an inevitable part of aging nor of running. The pathology of osteoarthritis is not confined to the cartilage, but in fact involves loss of cartilage, soft-tissue swelling, and formation of bone spurs.

 

In order to prevent or to treat osteoarthritis, sometimes we need to slow down the breakdown of the cartilage, but the vast majority of cases require speeding of the joint repair mechanisms.

 

Conventional treatments include weight loss to reduce pressure on weight-bearing joints, physical therapy to strengthen the muscles that stabilize a joint, and pain relief medications.

 

Dietary therapy may include antioxidants, vitamin D, and cartilage precursors such as glucosamine sulfate and chondroitin sulfate. Glucosamine and chondroitin sulfate are the “building blocks” of cartilage and increased intake may help with the repair at the joint level. Taking the sulfate form of glucosamine is important. 

 

Hyaluronic acid is a substance secreted by the cartilage cells of the knee, and help to give the joint fluid a slippery quality. Injections of this fluid into the knee may help with pain and decrease the damage in osteoarthritis.

 

Prolozone is an excellent therapy for osteoarthritis, although it is still considered by mainstream medicine to be experimental or alternative. The basic mechanism of prolotherapy is simple. A natural medication is injected into the affected tendons, ligaments, or joint spaces, which leads to local inflammation.  Cartilage growth factors are released in the joint space, such as transforming growth factor, with subsequent strengthening of the joint structure.  Usually ozone is injected into the joint spaces and into affected muscles, although occasionally natural medications such as Traumeel and Zeel are used at the tendons and ligaments.

 

Soft tissue injuries to the joints often start the development of degenerative joint conditions. If the ligaments and tendons that cross a joint are weakened, then the joint itself must sustain more pressure from gravity and joint motion.  Cartilage can then be worn down more quickly than usual, and repair mechanisms may not be able to keep up. Prolotherapy with ozone can reverse this weakening and relieve the pressure and pain on the joint.  Prolotherapy, used in the joint space, can also improve deposition of new cartilage. Since prolotherapy treats the root degenerative causes of joint deterioration, it is extremely useful for a variety of painful conditions.

Orthopedic medicine is one of the most satisfying aspects of a naturopathic practice, as physicians can get excellent permanent results that often save patients from having extensive surgical procedures done.  Traditionally, there have been two ways in which our naturopathic medical skills have contributed to this field: firstly there are natural pharmaceuticals that decrease pain, inflammation, and promote healing, and secondly there are interventional methods that stimulate the body’s own regenerative and healing mechanisms.  Everyone is already well-versed in the familiar uses of bromelain, Wobenzyme, glucosamine sulfate, copper, and such nutrients in the use of injury recovery and slowing of degenerative disease.  There has also recently been an increased interest by both conventional physicians and naturopathic doctors in the use of regenerative therapies such as prolotherapy that, through stimulation of various growth factors, result in permanent improvements in pain through the deposition of collagen and cartilage.  

Traditionally, strong proliferants and sclerosants had been used such as phenol and sodium morrhuate.  Many physicians are leaning towards hypertonic dextrose (>10%) as a proliferant, as this has been shown to be one of the safest.  Recently the use of ozone gas as a proliferant has been used with great ease and success.  This has shown to be an excellent alternative and very versatile tool, as being a gas the rapid diffusion through the tissues somewhat lessens the number of injections per session necessary. It is also usually less painful to the patient.  Ozone used in major autohemotherapy has definite effects on energy production, through the increase of 2,3 DPG and also the stimulation of the citric acid cycle with the increase in delivery of NAD and NADPH to the mitochondria.  2,3 DPG is necessary for the unloading of oxygen at the tissues, and the increased delivery of mitochondrial substrates ensures that sufficient ATP is formed. It is possible that this effect is partly to explain the excellent results of the use of ozone in orthopedic medicine.  With increased stimulation of ATP production, the healing process initiated by prolotherapy with ozone is more likely to be successful in relief of pain.  

The use of ozone in prolotherapy (or Prolozone for short) is extremely versatile. It has been most useful in osteoarthritic knees, chronic low back pain, rotator cuff tears, ankle sprains (especially chronic cases that have progressively become weakened), SI joint dysfunction, and myofascial trigger points.  The general dosage of ozone used is 20-30 ug/ml, at a total volume dependent on the joint or tissue size.  Usually the area is pretreated with a solution consisting of procaine 2%, Traumeel or Zeel, and B12.  The homeopathics and the procaine are usually in a 1:1 ratio, and B12 1-2 mls total is added. Once the solution is injected, the needle is stabilized with a hemostat, the syringe filled with the ozone is loaded, and subsequently the injection is completed. A few cases below illustrate typical cases.

In general, osteoarthritic knees can be treated very successfully.  It is a very simple injection technique that involves a medial approach into the knee capsule. Generally, 5 cc of the pre-treatment solution is injected, and then 10 cc’s of the ozone gas is injected.  There is usually a sensation of “full-ness” to the patient, and later in the day there may be some significant pain.  However, there is usually also significant relief after the first few treatments, and even patients who have had no relief with NSAIDS and were candidates for surgery respond remarkable well, early. This has made OA of the knees one of the most rewarding conditions to treat.  Dr Shallenberger notes that sometimes he adds growth hormone after the ozone, but I have never found this to be necessary.

A case example involves a 65 year old lady who was being treated by myself with chelation therapy. In casual conversation she had mentioned that she can no longer sit on the floor at the mosque, and this had been causing her some distress as previously she was able to partake in religious celebrations fully.  X-rays had indicated that a knee replacement would be needed in the next few years.  After the first injection, she complained of fullness that changed into radicular pain that persisted for 2-3 hours. 3 days after the injection, she noted that her knees did not have as much crepitus on movement.  After 2 more injections, spaced 2 weeks apart, she was able to sit on the floor in the mosque for at least 45 minutes at a time.

The shoulder joint also responds remarkably well.  Even patients who have had chronic pain for years do well with just a few injections.  Sometimes the pain post-treatment is quite severe for one or two days, and then mild to moderate improvement occurs, only with the pain to recur after a few days of relief.  If the second injection can be done before the pain has reached baseline, results can be remarkable.  Usually a posterior approach to the shoulder capsule, below the acromion and towards the coracoid process is used. Again, 3-5 cc of the pretreatment solution is added, and then 5 cc of ozone is added.  While the injection is painful, compared to traditional prolotherapy with liquid proliferants, the number of injections per session is drastically reduced and usually well-tolerated.  

A 35 year old lady had complained of shoulder pain, knee pain, symmetrical wrist and finger pain and was seronegative for RF. She fit the criteria for RA based on symptoms and history. Another physician had placed her on an elimination diet.  She was extremely hesitant to do systemic treatments for RA, and after 2 weeks of elimination, all pain was gone except a very persistent shoulder pain that radiated into her neck and temple.  After the first treatment, there was pain for two days that culminated in a migraine attack.  Following these two days, the pain was roughly 60% better for the rest of the week.  She was treated again that week, with minimal aggravation.  After the third treatment, she stated her pain had disappeared.

Chronic low back pain can often be reproduced by deep pressure over the iliolumbar ligament.  If pressure in this area reproduces pain, a trial injection of the pre-treatment solution may indicate whether or not ozone as a proliferant should be used.  Usually 5 cc of the solution is injected into both the right and left ligament, followed by 5-8 cc’s of the ozone gas.  This is another area of pain that responds dramatically well and early.  Traditional prolotherapy injections into the low back are numerous and painful, and thus a trial of the prolozone treatment may be warranted first. 

A 43 year old female under treatment for fibromyalgia and mercury toxicity was consistently wearing a heavy plastic lumbar brace that was laced up over the abdomen.  She stated that without the brace, her lower back would feel weak and hurt if she sat in the chelation chair for longer than 30 minutes.  She experienced similar pain if standing for extended periods of time.  Treatments were given to both iliolumbar ligaments with no perceived pain nor aggravation.  After 5 treatments, she noted that she definitely felt “stronger” in the low-back, and was able to use the brace much less.  Treatments had to be discontinued as the patient was convinced that the ozone was causing her insomnia.

Questions and Answers About Prolozone

 

1. What is Prolozone?

 

Prolozone is a method of treatment in which weakened joint structures are strengthened by treating the ligaments and tendons that cross it. Most chronic pain can be very effectively treated this way.

 

2. I’ve heard of cortisone injections; is this the same thing?

 

Cortisone injections actually weaken structures. Dr Chan and Dr Ward use ozone, Traumeel, Zeel, and other natural medications  to strengthen and heal structures. Of these, the properties of ozone are remarkable in relieving pain, usually permanently.

 

3. Will this treatment work for migraines?

 

Migraines with a significant tension component that precedes the attack can be effectively treated.  Usually, treatment in conjunction with an oxidative modality such as UV irradiation will be most effective.

 

4. What about "sciatica" pain?

 

This is effectively treated.  Usually the piriformis muscle belly, its insertions and origins, and the iliolumbar ligaments are treated to have excellent results.

 

5. How many treatments will I need?

 

This varies based on the patient but tends to range from between 2 to 6 treatments.  These are usually given at 1 week intervals.

 

6. Is Prolotherapy safe?

 

This is an extremely safe treatment. The common effects are a soreness that occurs for 1-3 days after the treatment, and of course relief.  

 

7. Will my insurance cover this?

 

MSP does not cover this treatment, or visits to a naturopathic physician. Extended coverage may cover part of the cost, but varies according to the plan.  Cost of the treatment varies from 80 to 150 dollars depending on the areas treated.