Korean J Sports Med.  2016 Jun;34(1):1-9. 10.5763/kjsm.2016.34.1.1.

Regenerative Medicine in the Treatment of Sports Injuries: Prolotherapy and Extracorporeal Shock Wave Therapy

• Kwon DR

• KMID: 2361663
• DOI: http://doi.org/10.5763/kjsm.2016.34.1.1

Abstract

The treatment of sports injuries traditionally has included the use of the PRICE principle (protection, rest, ice/cold, compression, and elevation), analgesics/nonsteroidal anti-inflammatory drugs (NSAIDs), and, commonly, corticosteroids. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to even worse long-term outcomes by potentially interfering with tissue healing. Regenerative interventions, including prolotherapy and extracorporeal shock wave therapy, recently have been used to treat refractory painful conditions such as chronic tendinopathies because of the potential of these interventions to facilitate tissue healing. The true utility of prolotherapy and regenerative medicine for sports injuries will become clearer as more high-quality research is published.

Keyword

Prolotherapy; Extracorporeal shockwave; Sports; Injuries; Wound healing

MeSH Terms

Adrenal Cortex Hormones
Anti-Inflammatory Agents, Non-Steroidal
Athletic Injuries*
Pain, Intractable
Recovery of Function
Regenerative Medicine*
Shock*
Sports*
Tendinopathy
Wound Healing
Adrenal Cortex Hormones
Anti-Inflammatory Agents, Non-Steroidal

Figure

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  Fig. 1. Wound healing stages.

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  Fig. 2. Rationale of prolotherapy.

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  Fig. 3. Posterior photo of right lower leg showing injection points for management of Achilles tendinopathy. The ‘X’ markings represent the anteromedial, posterior midline and anterolateral margins of the tendon, with orange lines demarking the Achilles tendon17).

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  Fig. 4. Anteroposterior photograph of knee illustrating injection points marked ‘X’ starting over the most distal area of pain on the tibial tuberosity and moving proximally in 1-cm increments to the most proximal painful point with pressure. The orange lines represent the attachment of the patellar tendon from the patella to the tuberosity or its fragments17).

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  Fig. 5. A case of successful treatment with prolotherapy in patient with lateral common extensor tendon tear (A). Ultrasound findings before prolotherapy: complete rupture of right common extensor tendon (red arrows), cortical erosive change with periosteitis involving right lateral epicondyle. (B) Normal findings of left epicondyle. (C, D) Color Doppler shows increased vascularity in Rt. common extensor. (E, F) Three months after prolotherapy with 25% dextrose injection, when compared with previous study, previously suspected tendon defect of common extensor tendon is filled with soft tissue echo (red arrow). No increased vascularity is detected. Erosive bony cortex is not changed. Rt.: right, Lt.: left.

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  Fig. 6. Plantar photograph of left foot illustrating the injection site for management of plantar faciopathy. The ‘X’ marking represents the medial heel site used for the ultrasound-guided platelet-rich-plasma and prolotherapy injections, with the orange lines demarking the medial band of the plantar fascia17).

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  Fig. 7. Conversion of energy flux density from radial to focus type.

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  Fig. 8. Calcific lateral epicondylitis. (A) Pre-treatment. (B) Longitudinal view. (C) Transverse view post-treatment. (D) Longitudinal view. Transverse view, 2,000 shocks, 3 times weekly, 0.1 mJ/mm2, 3 Hz, focus type, calcification (white arrows).

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