It’s common to have an ankle rolled or knee injuries in sports. What should we do?

What we should do is elevate the ankle and start early range of motion exercises. We can give either a mild narcotic or Tylenol, and certainly physical therapy in which controlled motion of the joint is started. This will not only help in aiding the healing process; it will make the tissues heal in the right direction and in the right way.

You mention prolotherapy limitations and side effects – what, if any, side effects are there with prolotherapy?

Actually there are virtually no side effects. The only recorded side effect that I’ve ever recorded giving injections was a transient rash which lasted for a few days and then went away.

Being an athlete, or being athletic, obviously being active is an important part of their daily routine. Is there any limitation to activity when experiencing prolotherapy treatment?

Actually there’s very little limitation. If you get a prolotherapy injection, you should avoid any traumatic sports or heavy weightlifting. You are encouraged, in fact, to continue moving the joint, exercising the joint in a safe and proper manner. This actually aids in the healing. The less we use our joints, the less we use our muscles… the old statement “If you don’t use it, you lose it!” is true.

What are the prolotherapy success rates?

I tell my patients that if they go through prolotherapy, there’s an 80 to 85% chance that they’ll get at least a 50% reduction in pain – and some people get complete pain relief.

What are some examples of injuries athletes have endured that are treated with prolotherapy?

I had a professional hockey player who had a groin injury and couldn’t play hockey for six months. Today he is fine and skating for a professional hockey team. We have tennis players with tennis elbow – chronic elbow pain which is successfully treated with prolotherapy. People with partial rotator cuff tears, football players, other athletes, they’re all been successfully treated with prolotherapy. I’ve had a strong man who had plantar fasciitis who was successfully treated with prolotherapy.

There are many different ligaments in your body that have aches and pains. One of the most common ones is a sacroiliac instability. People think that they have a disc problem, but it’s not. They have pain on the sides of the back, difficulty getting up in the morning. I treat them with prolotherapy. Pain is reduced and sometimes completely resolved.

When is prolotherapy not the best treatment?

Some people are not cured with prolotherapy – these usually are people that are smokers, have autoimmune disease or are not in general good health. But if you’re healthy and live a healthy lifestyle, prolotherapy is very successful.

I have to ask, do the injections hurt and how many are required?

Yes I’m sorry to say that injections do hurt, but only for short period of time. I use a solution of 50% dextrose with some lidocaine, so approximately 3 to 4 minutes after the injection the pain goes away. A couple of hours later when this wears off, you will have increased pain and it may last for a day or two, but then that will subside.

Depending on the patient, usually I give one injection each week for 3 to 5 weeks. Then I wait 6 to 8 weeks to see if we’ve caused the tissue to repair – and the pain should go away, if not completely, at least by 80 or 90%.

Treatment depends on the area that I have to inject. If you have a large area site, say like in the sacroiliac area, I may have to do three or four injections that day to cover the whole area. But usually injections are spread out one each week for 3 to 5 weeks. If you miss a week because you happen to be out of town, it’s not a problem. As long as we keep the inflammatory reaction going, eventually the tissue is going to heal and your pain will go away.

Dr. Franchi talks about treatment of certain joints in which implants and joint replacements are not successful; specifically, ankles, wrists, elbows and the great toe of your foot. In these cases, the implants do not work very well; therefore, you are left with a choice of the fusion of the joint. The downside of this, is that you will have a stiff joint after. A fusion causes the transference of the stress, that was normally taken up by that joint, to the joints above and below the fusion. As a result, a patient will eventually develop arthritis in those joints. Additionally, a patient will have limited range of motion. Prolotherapy can successfully treat these conditions, successfully, and a patient can avoid this.

Cortisone Boston

Cortisone shots are used to treat a range of orthopedic issues, including tendonitis and arthritis. Cortisone mimics the actions of cortisol in your body, which is released by the adrenal glands. Unfortunately the effects of cortisone are short-lived.

While cortisone shots are powerful anti-inflammatory medications, they have many limitations. At Boston Prolotherapy & Orthopedics, we encourage treatments that provide long-term relief to issues such as back pain, arthritis, and tendonitis. We recommend Prolotherapy for patients who want to lead more active lives.

Uses of Cortisone

Cortisone shots typically contain a corticosteroid medication, and the doctor may include a local anesthetic for pain relief. The shot can be painful, especially if the physician removes fluid before the injection. You will feel more pain when receiving the injection to a small joint compared to a larger one. However, the pain will be tolerable if experienced hands give the shot.

Cortisone injections will relieve inflammation around the targeted area and reduce pain. The shots typically work within several days, with the effects lasting for a few months. Various conditions for Cortisone treatments would include:

• Bursitis
• Osteoarthritis
• Gout
• Arthritis
• Back pain

What to Expect

1. Before the Treatment

You may benefit from cortisone if you have pain because of an inflamed joint. Your medical history will affect the medication’s suitability for you. You will also need to disclose all medications you are using, including blood thinners and dietary supplements with blood-thinning effects.One of the side effects is that cortisone may increase blood sugar in brittle diabetics.

Your physician may recommend X-rays and other tests, depending on your age and diagnosis. You can also ask your physician about other options for treating your condition since cortisone injections only provide short-term relief.

2. During the Treatment

Cortisone shots are typically administered in an outpatient setting and take just a few minutes. To start, you will lay down at an angle that gives the health professional access to the inflamed joint. It is advisable to take deep breaths to be as relaxed as possible.

You will experience a pinching sensation as the cortisone is being injected, although a local anesthetic will be included to make you more comfortable. The physician will then clean and bandage the injection site. You may be required to flex the joint to encourage the spread of the cortisone.

3. After you are treated with cortisone.

Most people will walk around immediately and effortlessly after the shot. You can drive yourself home after being observed for a short time. Resting the joint is vital for reducing inflammation, and you should avoid formal exercise for several days.You can use a mild analgesic or ice to relieve soreness around the area.

It is essential to monitor pain levels after the cortisone injection for your doctor to review during follow-up consultations. You will likely experience reduced pain two to seven days after the shot.

How Many Cortisone Injections Can You Get?

Most physicians limit the number of cortisone shots to a joint to avoid damaging the cartilage. Typically, you can only receive cortisone injections three to four times a year, with at least six weeks between successive injections. The risk of side effects of cortisone also increases with the number of injections. If you are looking for a safer and more long-term treatment for joint pain, you should consider Prolotherapy.

Risks of Cortisone Injections

Like any other treatment, cortisone injections carry side effects and risks. Potential complications include:

• Pain and swelling
• Fat atrophy
• Increased blood sugar
• Cartilage damage
• Menstrual changes
• Sleep problems
• Weakened ligaments and tendons
• Infection (although rare)
• Allergic reactions

Due to the potential risks, cortisone shots are not recommended for people with an existing infection or broken bones. You can reduce the risk of some side effects by strictly following your physician’s lifestyle restrictions. In addition, notify your physician immediately should you experience unusual swelling and major joint instability.

What if a Cortisone Injection Does Not Work?

If the benefits of a cortisone shot wears off quickly, you might want to explore other treatments that can provide effective results. The side effects of cortisone can also be serious, and it is better to seek safer remedies.

At Boston Prolotherapy & Orthopedics, we use Prolotherapy to treat the root cause of joint inflammation. While cortisone will temporarily ease the pain, prolotherapy will stimulate the healing of an injured tendon or ligament as well as create a fibrous cushion in the joint of arthritic patients. This should provide long term relief.