And did you know that this diagnosis is often overlooked because
X-ray and MRI is not sensitive enough to pick up sprained ligament
and tendon insertions (what we call stretched insertions), which is
often the root cause of the pain?

Did you know that there is a safe and highly effective treatment to
stimulate the body to repair these structures and heal the
root-cause of the problem, without resorting to surgery?

What is the root cause of your pain?

If you or someone you know has some type of musculoskeletal pain,
the most important question you can ask is- what is the root cause
of the pain? Half of solving a problem is diagnosing where it comes
from i.e. understanding it!. Does the pain come from bone, nerve or
is it connective tissue? It may surprise you to know that the vast
majority of this type of pain actually comes from the connective
tissues i.e. ligaments and tendons. The insertions at the bone of
these structures are highly innervated and give the body joint
feedback known as proprioception. The flip side of all this nervous
system information is if these structures are damaged they become
very big pain generators. Unfortunately, these stretched insertions
are not picked up on MRI or x-ray and are therefore often
overlooked. What does show on x-ray and MRI are bone, meniscal and
disc abnormalities, hence pain syndromes are often assumed to be
caused by these things.

The problem is that these latter diagnoses often dictate surgical
and invasive procedures to fix them and unfortunately there are
attendant risks with these procedures. If the diagnosis is wrong
these procedures are unlikely to help the pain and solve the
problem.

Two examples:

Patient no. 1 , 60 year old gentleman, comes in with backpain that
he has had for many years. His MRI shows a disc protrusion. Pain
level is 5 to 7 aggravated by walking or sitting for long periods.
I examine him and he has the “jump sign” when I push on his left
pelvis. Further inquiry reveals that he fell out of a tree when he
was 12 and took some time to recover.

His diagnosis his left pelvis sprain/strain. Recommended treatment
is nonsurgical regenerative injections to the affected region. My
opinion is the disc abnormality is incidental and is not the cause
of his pain. Patient decides to give it a shot and requests
Prolotherapy/Regenerative medicine. patient is somewhat improved
after 3 sessions (at weekly intervals) so we spread out the
treatments. after eight treatments patient has no more pain and
returns to golf.

Patient no 2. is a 35 year old lady runner with knee pain. MRI
shows meniscal tear. When I see the patient and examine her knee
there is no clicking or locking but there is pain on palpation of
the medial collateral ligaments. Diagnosis is sprained knee,
specifically medial collateral ligaments. Recommend Prolotherapy
for 6 to 10 visits. Patient improves with 5 treatments and goes
back to running with no further problems. I do incidentally
recommend good orthotics to reduce wear and tear on the knees.

Please visit ProloMD.com or call (941) 955-4325 for more information or to book a consultation.

What can Prolo/Regenerative Medicine do and what can it not do?

To start with, no single approach can solve all problems. Prolo cannot address bone fractures, total tears of connective tissue structures and true nerve impingement (accompanied by weakness). However if the primary symptom is pain, I would suggest that your first visit should be a connective tissue specialist as ligaments and tendon insertions are by far the biggest pain generators in the musculoskeletal system.

Yes, the injections can be sore and the symptoms may be aggravated for a few days after the shots. Most people will accept this short-term discomfort once they understand that this may very well be the only way to solve the long-term problem.

If your primary complaint is weakness, your first visit should be to get an MRI and see a good Neurosurgeon.

It does take time. Prolo is not magic. In all likeliness it will take 6 to 10 sessions to solve the problem. To be sure, many patients experience improvement in 3 or 4 sessions but this is not to be expected. I cannot predict how a given person is going to respond. Rather, I ask my patients to rate their pain at each visit and simply observe what transpires. Regenerative Medicine is about healing and healing takes time. The good news is once the affected structure is repaired, it is likely that the healing will be permanent, and the pain will be gone.
It is true that in some cases the healing may not be complete and/or the patient may re-injure an area or still have some pain. As in life, Nothing in medicine is 100%. If I can get a patient 80% relief of a condition and return them to active living, I consider that a success.

How to find a doctor who does regenerative medicine.

Unfortunately there is currently only about two or three hundred connective tissue specialist in the U.S. It is of prime importance that you find an experienced Doctor. Key questions are how long the doctor has been doing it and who they trained with. You want somebody who does these injections all the time, someone who can correctly diagnose the structure(s) involved and can inject them safely and properly.

I personally got my training through a group called the Hackett-Hemwall foundation, associated with the University of Wisconsin. I was part of the medical team that went down to Honduras to help the local people with various musculoskeletal conditions. As far as I’m concerned I had some of the best teachers in the world and having them show me in a hands-on fashion how to do the various shots was invaluable. In the end, doing these injections requires an in-depth knowledge of anatomy and a feel. This cannot be acquired without proper supervised training.
For more information:

Watch out for updates and new articles. If you have registered your email with us, you are on our email list and will receive new material as it rolls out. If you have friends who may be interested, tell them to visit ProloMD.com and sign up for the free service.

Sign up for free seminars: If you are in the Sarasota/Tampa area attend one of Dr. Walter’s free seminars, which are held monthly. Call (941) 955-4325 to sign up.

Consultation with Dr. Walter: If you would like to consult Dr. Walter, either in person, by phone or online by SKYPE please call (941) 955-4325 (HEAL) to arrange.

A Short Intro to some special types of injuries:

Golf Injuries

As an avid golfer I hate to see fellow golfers suffer unnecessarily. Golfing injuries are most often repetitive strain type injuries. Common sites are shoulder, elbow, knee and low back. The tissues involved are almost always ligaments and tendons and Prolo/Biosurgery are the treatments of choice. I recommend a good quality arnica either by gel or by mouth. Avoid anti-inflammatories as this might perpetuate the problem. and avoid any steroid injections until you make a thorough evaluation as steroids can often weaken the structure involved. Heat and massage are often helpful. If the pain persists more than a couple of weeks find a connective tissue specialist for evaluation. Also, don’t forget to try and understand where the injury came from. We often develop less than optimal swing patterns that might put undue strain on certain structures. Review your swing with a good teaching professional to see if you can fix any faults.

Tennis Injuries

Tennis, like Golf, tends to lend itself to repetitive strain type injuries. Common sites are wrist, elbow, shoulder, knee, ankle and low back. All of these are readily addressed with Regenerative Injection therapies, whether Prolo or Biosurgery. Sometimes braces can be helpful to prevent further injury. Avoid pharmaceutical anti-inflammatories like Alleve as this interferes with the body healing itself. Instead use Arnica, Tylenol or tylenol with codeine to help with pain control. Try and start your Prolo as soon as possible as it may take six or eight weeks before the tissues can heal. Heat and massage are helpful. TRy and massage the affected region yourself before activity and several times per day. If you can find a painful trigger point, that’s the area you need to address with your massage (and that’s the area that needs injection!)

Auto whiplash

Common areas involved are neck (whiplash), shoulder, wrist, low back, knee. If x-ray fail to reveal any fracture, the majority of the injuries are likely connective tissue and muscular structures. Because muscle has good blood flow this will tend to heal readily with a little massage and time. If the pain persists more that 2 or 3 weeks we ae likely dealing with sprains and strains of ligaments and tendons and these may never heal by themselves. Again, avoid pharmaceutical anti-inflammatories but use tylenol and tylenol with codeine (prescription required for the latter). Find a connective tissue specialist who can properly diagnose the affected structures. Massage, heat (hot showers and baths) and arnica can be helpful. If the pain persists proceed with Prolo/Biosurgery treatments to get the healing rolling.

But how does it work? How can injections stimulate healing?

Here, the most important thing is to realize that healing of connective tissues is totally dependent on blood flow. The body can only heal what it can get blood flow to. This is why the connective tissues are so problematic. Their blood supply is tenuous. If you look at ligaments and tendons in the body, they are white. This means that there is little blood flow, versus something like muscle that is red and hence has a lot of blood flow. You tear a muscle, it usually heals with not too much trouble. If you tear or sprain a tendon or ligament it very well might take weeks to heal if at all. These damaged structures may cause pain and debility for weeks, months and years, if not attended to. The general rule is if your body can heal it it will do so in a about4 weeks. If the pain persists more than this it may be permanent, unless you intervene with Prolotherapy or Regenerative medicine to stimulate the blood flow.
What do we inject?

I use two formulas. the first is a very concentrated sugar (i.e. dextrose) solution. Why sugar you ask? Because it’s safe. It works as an osmotic shock that dries the area out and actually causes localized inflammation, This will bring new blood flow and over the ensuing 6 or 8 weeks will cause a healing cascade where specialized cells such as macrophages clean up the debris and fibroblast move in to help the body regenerate the damaged tissues.

The second formula which is really a type of “super” Prolo is to use a patients own blood to isolate growth factors and use that as the proliferant. Many well known athletes have used this technique, with or without surgery, to heal sports injuries.

I usually start with regular (“classic” Prolo and only progress to PRP (Platelet rich plasma) if the regular solution fails.) However in cases where people want optimal results as fast as possible, I might offer PRP as an option to start with.

Our overall success rate is about 85% but it may take 5 or 6 before you notice an appreciable difference and 6 to 10 before the problem is solved. I urge my patients to be patient (no pun intended). The good news is once it works it should be a permanent improvement.
Using PRP (i.e. your own growth factors) to stimulate healing.

More on Platelet rich plasma, since I have many inquiries about it. In essence, the technique is exactly the same, the only difference being the proliferant (what you inject to stimulate proliferation and regrowth of connective tissue). We now refer to PRP sessions as Biosurgery, since the results can be extraordinary and perhaps one day more and more surgery will be replaced by this minimally invasive technique.

The key for successful Biosurgery remains that you must inject the correct spot, and enough times to stimulate healing correctly. As such the success of the program is totally dependent on the experience and expertise of the connective tissue specialist you see. I personally have been doing regenerative medicine almost exclusively for a decade, but many doctors only dabble. Ask them how long they have been doing it and where they got their training. There are a few exceptional teachers around and I was lucky enough to train with some of the best in the world.

The PRP is taken as a regular blood draw and spun down to isolate the platelet rich component. this fraction is the richest in growth factors. THe PRP then should be injected promptly into the affected areas. A word of notice, the pRP may be more irritating than the regular dextrose, so you might be extra sore after it. Most people accept this aggravation of their condition I have a little saying- “No pain. no gain”. Some people dislike this saying but it remains true that if you have a prolotherapy /regenerative med session and you feel absolutely nothing, it is unlikely that the doctor hit the right spots. Conversely, I frequently have patients who observe that the sessions where they were most sore, were also the ones where they achieved the most improvement.
What you can do to help the healing and relieve pain.

First of all, I ask all my patients to discontinue anti-inflammatory medication prior to Prolo/Biosurgery this interferes with the healing cascade that I am trying to set up.

Second of all I encourage movement of the affected region. If it is a shoulder, I suggest swimming. If it’s a knee or hip I suggest swimming or light cycling. The goal is movement without stress. walking can be harder and weights are out for a couple of months.

Third, I might suggest a homeopathic medicine like arnica gel for superficial joints like the shoulder, wrist, knee and arnica pellets for deeper structures like the pelvis or hip.

I also suggest a good vitamin C like Emergen-C and fish oil (the brand I prefer is called eskimo3 as I have found the purity/ efficacy is superb.

Aside from this I usually do weekly sessions (every 2 weeks for PRP) until I get the patient over the hump, meaning where they notice some improvement. Then I can afford to spread session to every 2 or 3 weeks.

Since heat help promote circulation I often suggest hydrotherapy in a hot tub or spa, or at least an extended shower to heat the affected areas.

As an MD who specializes in musculoskeletal pain and Regenerative Medicine, one of the most common presenting complaints I encounter is backpain. Unfortunately the true cause of backpain is often misdiagnosed and naturally, conventional orthopedic and neurosurgical treatments often yield poor results.

Approximately 80 to 90% of backpain actually come from the connective tissues i.e. the ligaments, tendons and joint capsules that hold the body together. The bony attachments of these tissues are highly innervated structures that give us our joint feedback (so-called proprioception). If these structures are stretched they become huge pain generators. These are in fact, sprains and strains and account for the vast majority of pain syndromes in the musculoskeletal system. They are far more commonly the problem than any bone, cartilage or nerve.

The problem arises that xray and MRI are not sensitive enough to pick up these stretched tendon or ligament insertions. The only reliable way to pick them up is via a physical exam by an experienced prolotherapist. If I palpate a damaged structure directly and the patient feels the same pain that they routinely experience, I feel with a large degree of certainty that I have diagnosed the problem.

Prolotherapy is a precise microinjection technique to stimulate the healing of the damaged insertion. The problem with connective tissue healing is a question of blood flow. These tissues are white, fibroelastic tissue that lack blood flow and may therefore never heal (the body can only heal by getting the right cells in the area to repair the damaged area). In Prolo we use concentrated dextrose or PRP (the patients own spun down blood) as proliferants to stimulate the blood flow and healing of damaged tissues. The process usually takes 4 to 10 sessions depending on the degree of damage, the accuracy of the microinjections and the healing rate of the person.

Prolo and Regenerative Injection techniques have been around for over 60 or 70 years and if done properly, are very safe. The shots are often a little uncomfortable but we do numb the skin to attenuate the discomfort. Most patients don’t mind a little extra pain once I explain that the regenerative injections are indeed the only way to fix the problem once and for all. The mantra “No Pain, no gain” is most applicable to this field.

My success rate once I have identified a candidate is about 85%. Patients are often amazed that the pain that they have suffered with for so long, can actually be cured with such a simple and safe technique.

That’s all for now. Stay tuned for more on this exciting field. For those in the tampa bay region, call the office to check when the next free seminar is being held.

As an M.D. who specializes in musculoskeletal medicine and non-surgical orthopedics, I often see patients who have persistent joint, neck or back pain due to injury or degeneration. What is exciting is we now have the technology to regenerate damaged joints with precisely directed injections. This new field is known as Regenerative Medicine. For many people suffering with joint, neck and back pain there is finally hope for a simple and elegant solution – without the attendant risks and downtime of surgery.

The concept and technique of regenerative joint injections has actually been around for a long time (with a similar technique known as Prolotherapy). The only difference is in what we inject. We can use simple solutions containing a very concentrated dextrose or we can actually use growth factors and stem cells isolated from a patients’ own blood (known as PRP or platelet rich plasma) as the ultimate healing stimulant or proliferant. Many top Sports Medicine and Orthopedic specialists are coining the term “Biosurgery” for these precisely directed injections. Tiger Woods had this procedure as an adjunct to his recent knee surgery and other elite athletes have used Regenerative Injection Biosurgery to return to full functioning without the risks and downtime of conventional surgery. This truly is the medicine of the future.

We can use regenerative injection therapies (RIT) therapies for many types of orthopedic conditions (including degenerative disc disease, some meniscal tears, osteoarthritis, sports injuries, tendonitis) affecting just about any joint, including plantar faciitis, ankle, knee, hip sciatica, back, elbow, wrist, whiplash and rotator cuff. What is important is the skill and experience with which the physician diagnoses and is able to inject with precision the exact structure(s) that is damaged, be it articular joint, ligament or tendon. It generally takes 4 to 10 sessions of injections (and about 6 to 8 weeks of healing time) to fully regenerate the damaged structure. In the hands of an MD proficient in Regenerative Injection techniques there is about an 85% success rate.

How do we determine who is a candidate for RIT? To be sure MRI’s are helpful  but they actually tell only part of the story. Very commonly, the underlying problem with joint, neck or backpain lies in the surrounding capsular ligaments and tendons which are sprained or stretched. These highly innervated stretched insertions are exquisitely sensitive and are by far the most common underlying cause of musculoskeletal pain. The best and indeed only way to properly diagnose the root cause of the problem is by physical exam with an MD properly trained in Regenerative injection therapies. If the physician can elicit the “jump sign” and reproduce the pain symptoms by palpation and pressure on a specific structure (trigger point), this correctly identifies the damaged structure and the proper location for regenerative injections.

If done properly, the only real downside of regenerative joint injections is there can be soreness with the injections and there may be transient soreness for a day or two after the injections. Most patients readily accept these inconveniences once they understand that these Biosurgical approaches may, in many cases, be the treatment of choice and the best chance they have of a safe and complete recovery from their condition.

With these Biosurgical techniques we now have a high success rate in regenerating damaged peripheral (i.e. knee, shoulder, etc.) and vertebral joints(neck and back) effectively and without resorting to surgery. For many people suffering with persistent joint, back and neck pain there is now hope for a simple and elegant solution. Best of all, in the hands of an experienced injector, the technique is very safe and has little risk and downtime. Regenerate your pain away!

Mark Vincent Walter, M.D. is a McGill-trained physician who originally specialized in Family Practice and Sports Medicine. Dr. Walter is a pioneer in the field of Regenerative Medicine and has sub-specialized in the field of Connective Tissue and Non-surgical joint reconstruction for over a decade. For five years Dr. Walter was part of a medical mission team to Honduras (sponsored by the University of Wisconsin) where he had the privilege to train and teach with some of the top experts of Regenerative Injection Therapies (and Prolotherapy) in the world. In Regenerative Medicine circles he is recognized as a gifted injector and known for his gentle yet precise technique. Dr. Walter also has a passion for educating people about the benefits of this therapy and  offers seminars and workshops monthly. Dr Walter also has an interest in medical weight loss and Nonsurgical Bodysculpting. He is founder and medical director of ProloMD and BodysculptingMD located at 2365 S. Tamiami Trail (corner of Hibiscus) in Sarasota.