Prolotherapy for Golfing Injuries and Pain (P1)

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Golf is a very popular sport in the U.S. and many other countries. This is, in part, from the non-contact nature of the sport, allowing many different age groups to play, both older and younger participants. Golf is a sport wherehigh performance and skill arenot limited by age. Surveys estimate anywhere from 28.7 million to 37 million golfers in the U.S. alone, with golfers’ reported annual spending estimated at 24 billion dollars per year on equipment and fees. Despite the low impact natureof the sport, several studies over the years have shown that golf has its share of injuries resulting in musculoskeletal pain in the amateur as well as the professional golfer.

Prolotherapy is a non-surgical procedure which stimulates repair of musculoskeletal injuries. This treatment has received increased attention over the last few years, and made its way into the sports world, as well as The New York Times which reports: “Unlike many drugs and surgery, prolotherapy has minimal side effects when performed by an experienced practitioner…” The purpose of this article is to explore common golf injuries, contributing factors, diagnosis, prevention and non-surgical treatment options with prolotherapy.

Prolotherapy for Golfing Injuries and Pain
FIGURE 1. The 5 phases of the golf swing. 1. takeaway: from address until the club is horizontal; 2. backswing: from horizontal to top of backswing; 3. downswing: from top of backswing until the club is horizontal; 4. acceleration: from horizontal club to impact; and 5. followthrough: from ball contact until end of swing.

Prolotherapy Review

Prolotherapy is a method of injection treatment designed to stimulate healing. Many different types of musculoskeletal injuries and pain lend themselves to prolotherapy treatment including low back and neck pain, chronic sprains and/or strains, whiplash injuries, tennis and golfer’s elbow, knee, ankle, shoulder or other joint pain, chronic tendonitis/tendonosis, and musculoskeletal pain related to osteoarthritis. Prolotherapy works by raising growth factor levels or effectiveness in connective tissue ligaments and tendons to promote repair or growth.

Prolotherapy lends itself very well to sports injury and pain because most sports related injuries involve ligaments and tendons. Prolotherapy can be used years after the initial pain or problem began, as long as the patient is generally healthy.

Significant athletic injuries that hinder aperson in playing their sport are almost always ligamentous or tendonous in nature, not muscular. This is because ligament and tendon tissues have a poor blood supply, as opposed to muscles which have a large blood supply and so that they take longer to heal than other tissues—usually four to six weeks. Since the ligaments are the main stabilizing forces in the joints, these are the structures that take the bulk of the forces while the athlete is playing his/her sport. Unfortunately, incomplete healing is common after injury to those structures. In fact, it has been estimated that the usual best result of a completed connective tissue repair process is a return to normal connective tissue length, but only 50% to 60% of pre-injury tensile strength. Over time, and multiple injuries, this can result in laxity and connective tissue insufficiency. In repetitive trauma, common in golf related injuries, each individual trauma may be insufficient to provide enough stimulus to prompt complete healing, so that even minor injury may be enough to accumulate damage to the point of initiating chronic pain.

Prolotherapy works by causing a temporary, low grade inflammation at the site of ligament or tendon weakness (fibro-osseous junction) thus “tricking” the body into initialing a new healing cascade. Inflammation activates fibroblasts to the area, which synthesize precursors to mature collagen, and reinforce connective tissue. This inflammatory stimulus raises the level of growth factors to resume or initiate a new connective tissue repair sequence to complete one which was prematurely aborted or never started. Prolotherapy is also known as “regenerative injection therapy (RIT),” “non-surgical tendon, ligament and joint reconstruction” and “growth factor stimulation injection therapy.” “Sclerotherapy” is an older, inaccurate term for prolotherapy, based on the original theory that scar formation was the treatment mechanism. However biopsy studies have not demonstrated scar formation with prolotherapy agents currently in use. Rather, studies have shown a proliferation of new, normal, thicker and stronger connective tissue after Prolotherapy injections (thus “prolo” for proliferation). A typical course is four to six treatments, spaced from two to six weeks apart.


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