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Neural prolotherapy

This information relates to prolotherapy for irritated nerves. You can find information related to prolotherapy for ligaments, tendons and joints here.

neural prolotherapy

Premise:  An injury of some sort damages a tissue and following this, the nerves that supplies the damaged tissue becomes irritated.  This irritation can continue long after the original injury has settled and can affect the nerve higher or lower than the injury.  Results of an irritated nerve can include pain, swelling, altered reflexes and muscle spasm.

 

Nerve fibres contain a large amount of connective tissue and are subject to strains and injury like any other tissue.  A sharp ‘yank’ on a nerve, for example at the outside of an ankle during a sprain, can affect its function for a long time.  This may be due to the organisation of nerve bundles.  If you think about a tube of plastic electrical conduit. The fibres of the nerve run inside, with the connective tissue packing out the volume.  The ‘tube’ is the epi-neural sheath.  Around the outside of the sheath run the blood vessels and the tiny nerves that supply the nerve itself called the nervi nervorum.

 

The mechanism of nerve injury it currently thought to involve a Chronic Constriction Injury (CCI).  The theory being that, in areas where a nerve passes from one area to another through a hole of some sort (which happens in many, many places) swelling will enlarge the nerve inside these passage ways which have a fixed diameter, causing a ‘strangulation’ of the nerve.  As the blood supply and nerves run around the outside of the nerve bundle, they are most prone to this compression and strangulation.   This results in malnourishment of the nerve and limits healing of the tissues that the impaired nerve services.

 

What is injected:

 

Peripheral cutaneous nerves  5 % weak solution.

 

Effects of Neural Prolotherapy:

Decreased pain

Improved function

Anabolic effect (repair) on connective tissue

Reduction in number of neovessels

Reduced cross section of tendon in tendinosis ie tighter bundles of muscle fibres

Reduced tendon oedema / swelling

Improved architecture of collagen in tendons ie more orderly bunches of connective tissue

 

Which nerves are injected during neural prolotherapy?

 

This depends entirely on the location of the pain.  A knowledge of nerve anatomy is required to determine which nerve is likely to be supplying the painful area, and carrying the pain impulses back to the brain.  The nerves will be palpated along their course and painful trigger points are marked.  A normal nerve does not have the painful spots to touch that we find in affected nerves.

 

The weak glucose solution is introduced via a fine needle just below the skin.  Because the injections are this superficial, they are not particularly painful, although there may be a series of five to ten spots done to follow the nerve until it reaches the constriction point.  While stronger glucose solutions can be irritating, at this strength, they are not and so local anaesthetic is usually not used. Often, the injections will relieve the pain immediately and patients leave without the original discomfort.  This improvement fades initially and a  series of three to six treatments is usually envisaged.

 

  • CECS (compartment syndrome)
  • Recurrent calf muscle ‘strain’
  • Medial Tibial Border Syndrome and Stress#
  • Medial/lateral ankle pain
  • Achillodynia
  • ‘cuboid syndrome’
  • Morton’s neuroma
  • ‘Bunion pain’
  • Plantar fascia syndrome
  • Peripatellar pain
  • Bakers Cyst
  • ITB syndrome
  • Pes Anserinus syndrome
  • Jumpers knee
  • Runners knee
  • Infra/supra patellar tendinopathy
  • OA pain
  • ‘Shin splints’ medial and lateral
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