Reconstructive Therapy

With a series of injections into the joints, reconstructive therapy endeavors to speed healing of torn, damaged, injured, pulled, or weak joints, ligaments, tendons, and cartilage. It is typically given to treat degenerative arthritis, low back pain, bursitis, tennis elbow, or carpal tunnel syndrome.

Treatment programs typically begin with a thorough diagnosis of the problem, including an orthopedic, neurological, and--in some instances--osteopathic musculoskeletal exam. The doctor will also order x-rays or an MRI (magnetic resonance image), as well as laboratory tests.

The injections are made directly into the damaged area. They are typically supplemented with amino acid mixtures, B-complex vitamins, and minerals to further stimulate growth of healthy connective tissue. Patients are advised to avoid caffeine, alcohol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil and Motrin.

Treatment Time: After the initial diagnostic work-up, sessions are usually brief.

Treatment Frequency: Once per week. About 12 to 30 injections are usually needed to bring a joint back to full strength and function; and some severe conditions may require multiple injections during the same visit. You should begin to notice marked improvement after the first six weeks, when new tissue has begun to develop. The ultimate length of treatment depends upon the severity of the problem and how well the body responds. Treatments can continue for a few months to as much as a year.

Reconstructive therapy relies on natural irritants to mobilize the healing process in a damaged joint. The injections typically contain the local anesthetic lidocaine and an irritant such as sodium morrhuate (a purified derivative of cod liver oil), dextrose, phenol, minerals, or other natural substances.

According to the therapy's proponents, the injected solution prompts blood vessels in the area to dilate and triggers a migration of healing cells known as fibroblasts into the damaged tissue. Once there, the fibroblasts produce collagen, a structural protein needed for the formation of such connective tissues as ligaments, tendons, and cartilage. These regenerated tissues serve to stabilize and cushion the joint, thus enhancing its strength and endurance and alleviating pain.

Although it is the pain of a damaged joint that sparks most patients to seek therapy, practitioners of reconstructive therapy are careful to point out that the treatments are not merely pain-killers. Instead, they ease pain by remedying its cause--in this case worn-down cartilage or torn ligaments and tendons. As healthy new tissue grows, the pain diminishes, until finally it disappears altogether.

Although not yet widely used in the United States, reconstructive therapy has been validated in several clinical trials. For example, in a series of studies conducted in the 1980s at the University of Iowa the researchers found that reconstructive treatments increased tendon and ligament size by 35% to 40%; increased strength in those areas by as much as 40%; and more firmly attached the tendons to the bone. A later study at a clinic in California documented moderate to marked improvement in 88 percent of the chronic low back pain patients who received treatment.

Also known as sclerotherapy, prolotherapy, and proliferative therapy, reconstructive therapy appeals to many people as an alternative to surgery and drug treatments. Advocates boast that it's not only more effective than surgery in many instances, but provides relief at a fraction of the cost. And unlike drugs, they add, the treatment is permanent. Once the injections are finished, no further treatments of any type should be required.

Before beginning treatment, check with both your own physician and the doctor giving the injections to make sure that you're not susceptible to an allergic reaction. Also make certain that any medications you must take won't conflict with the treatments.

When performed correctly, reconstructive therapy carries a low risk of side effects. However, some patients experience an allergic reaction to the injections, often resulting in stiffness, pain, swelling, and redness at the injection site.

Some pain can also be expected after the first two or three injections, due to the development of a controlled micro-inflammatory condition. Pain is particularly likely if several injections are given in a single session. To provide relief, the doctor will probably recommend Tylenol, Tylenol with Codeine, or ice packs, since nonsteroidal anti-inflammatory drugs (NSAIDS) can interfere with the formation of new tissue. The pain typically subsides within a few hours.

Other reactions include nausea and headache, usually ending within a few days after treatment. There is also a minor risk of infection and hemorrhage.

Due to the risk of side effects, you should make certain that the physician offering the injections has undergone specialized training in the necessary techniques. Reconstructive therapy is not taught in medical school; but postgraduate education and certification is offered by both the American Association of Orthopedic Medicine and the American Osteopathic Academy of Sclerotherapy.

Keep in mind, however, that although reconstructive therapy has been practiced for more than 40 years, it is still relatively new to the United States. There are less than 100 physicians who offer it in the U.S. and even fewer who practice it in Canada.

These resources can provide you with basic information about the available practitioners. However, you may also want to check with potential therapists regarding their backgrounds, training, qualifications, and success rates. Because there is usually some pain associated with the injections, you should ask about the doctor's protocols for pain management.

Although many patients begin to notice improvement within the first week of treatment, it may take two or three injections to produce noticeable results if swelling is present.

By the sixth injection, you should experience improvement no matter what the situation. If you don't, treatment should be suspended while the doctor attempts to find out what's interfering with therapy. In otherwise healthy individuals, an irritant such as the injections should almost immediately jolt the body's healing mechanisms into action. Failure to respond implies a hidden medical problem capable of defeating the healing mechanism.

Most people turn to reconstructive therapy only after traditional drug treatments and surgery have failed. If the reconstructive approach also meets with failure, you'll need to explore other options--perhaps bodywork or osteopathy--or return to conventional treatment. Certainly, if treatment failure leads to detection of another, unsuspected medical problem, conventional measures may well be required.