…And what are the Result with Prolotherapy, Ross A. Hauser, M.D.

I have enjoyed seeing many of my brother and sister triathletes for Prolotherapy consultations. I have even treated an Ironman Triathlon champion and several professional triathletes. I have enjoyed injecting each one with Prolotherapy. Here are the top ten injuries I have observed in Triathletes.

1. Chondromalacae Patellae

Chondromalacae patellaE refers to chondro (cartilage), malacae (damage) and patella (knee cap), or cartilage damage underneath the knee cap. This causes a stiff, painful knee. I know about this condition because I have it!!! I was born with an externally rotated tibia on my left leg, so yes my left foot sticks out and looks funny when I run. This has caused me some chondromalacae patellaE (CP). CP can also occur when the quadriceps muscle pulls the knee cap unevently onto the femur during movements. Though exercises help, they do not cure the pain. To cure the pain, I recommend a course of three to six visits with Prolotherapy, along with the quadriceps strengthening exercises. Emphasizing leg lifts with the foot externally rotated to preferentially strengthen the vastus medialis part of the quadriceps. I also prescribe the following supplements:

Pro Cartilage
Prolo Max
Prolo Pack

Another good idea is to take a video of the triathlete running to make sure the running mechanics are normally. For me I have had to alter my running form to make it less hard on my body. I am now trying to run on my midfoot or balls of the feet versus the heels. I am also trying to keep my torso tall. The results have been that besides my knee feeling great, my 5K time is down to 18:44 and my 10K time down to 38:45.

2. Meniscal Tear

Obviously we see a lot of knees in the triathletes we treat. The menisci are important because they cushion the knee. A meniscal tear can happen easily by twisting the knee while running. The treatment is the same as for CP. Again it is typically three to six sessions (2 weeks between sessions) of Prolotherapy. While undergoing Prolotherapy, often the athlete is told not to run except in the pool. Elliptical training, cycling and of course swimming is permissible.

3. Sacroiliac Ligament Sprain

The sacroiliac joint takes a great strain on the bike portion of the triathlon. Triathletes do an awful lot of cycling. When an athlete has low back pain, but it tends to be on one side or the other, it is typically a sacroiliac sprain. This can respond to manipulation, but when manipulation doesn’t cure the problem, the athlete goes to the Prolotherapist. Typically three to six sessions of Prolotherapy are needed to cure the problem. Again I prescribe supplements, but these are for soft tissue healing including:

Enzyme Max
MSCL Enzyme
Prolo Support Pack
Rapid Response 1

Because often cycling is the culprit, the athlete is ok to swim and run if these do not reproduce the pain. Generally they are told not to cycle while the ligament sprain is healing with Prolotherapy. Doing CORE exercises is the main stay rehabilitation that they need to do while getting Prolotherapy. Again, even in cycling, proper form is of utmost importance. It is important for the triathlete not to move the upper body while cycling. Rocking back and forth is a sure set up for a sacroiliac injury.

4. Degenerative Disc Disease

We see triathletes with painful necks and backs. They often come in with x-rays or MRI’s which show degenerated discs. While physical therapy or massage therapy provides temporary relief, Prolotherapy often provides permanent relief. Athletes are seen every two to three weeks (versus every four to six weeks, because they don’t want to wait that long to get relief). Generally three to six visits of Prolotherapy are required. The activity that causes the neck and back pain is generally cycling. The treatment and supplements used is the same as for a sacroiliac sprain. Since dehydration can cause disc shrinkage, making sure the athlete is always well hydrated is also a must.

5. Plantar Fasciitis

The running motion puts hundreds of pounds of pressure on the bottom of the foot. When the pain is located at the bottom of the heal, the condition most often diagnosed is plantar fasciitis. When the condition has occurred over a long period of time, sometimes there is a bone spur on x-ray. The spur forms to help strengthen the area. Another way to strengthen the are where the plantar fascia attaches onto the calcaneus (heel) is Prolotherapy. The athlete is seen every two to three weeks for three to six sessions. They are encouraged to continue running but in the pool. Running on the streets is initially discouraged. When they feel better running on a soft surface or treadmill is done before street running. Ellipitical training, swimming and cycling is encouraged. Strengthening all the muscles of the foot is also encouraged. This is easily done by doing balance work. I like to do my balance work on a bosu ball. Just walking or jogging on the bosu ball will do a great job at strengthening the muscles of the foot.

6. Rotator Cuff Tendinopathy

Swimming is rough on the rotator cuff, especially if the form is not good. Most triathletes do not have good swimming form. I include myself in this, though I work on it basically every time I am in the pool. So the athlete is encouraged to have a coach video tape their swimming stroke and make sure shoulder movements during swimming are showing proper form. Rotator cuff exercises during healing are generally not done until after a few Prolotherapy sessions. If caught early only a few session of Prolotherapy are needed. If the problem has been going on a long time then up to six sessions may be needed. Soft tissue supplements again are ordered (see SI recommendations). The athlete can of course cycle and run during the Prolotherapy healing. Often times, the triathlete can do some swimming drills as these do not cause the pain. If a drill reproduced the pain, this then is not practiced.

7. Pubic Symphysis Pain (Pubaigia)

Triathletes get a lot of groin pains. When the pubis is palpated it is very painful. Often the adductor muscles (which attach to the pubis) are very painful. The triathlete gets groin pain that refers down into the adductor muscles. Sometimes doing abdominal work will increase the pain. Sometimes the pain is so bad that all activities the triathlete does hurt. Yes that means swimming, cycling, and running. This occurs because the abdominal muscles also attach to the pubis. If the pubis ligaments or disc is injured then abdominal and adductor muscle spasms occur. If you can’t contract your abdominal muscles, you ain’t doing any running, swimming, or cycling.

Prolotherapy works great for pubic symphysis injuries. The athlete is seen every two to three weeks for three to six sessions of Prolotherapy. Honestly if it is a real bad case (like I had) I’ll treat someone every week. If the pubis is injured badly even bowel movements are killers, this is why aggressive treatment is sometimes needed. Typically swimming is the first activity to return, then running, and last cycling. I was 90% healed of my pubis injury when I did Ironman Canada last year. So I had to do most of my cycling in the Ironman upright (not in the aero position). Still I was able to knock 52 minutes of my previous best.

8. Iliotibial Band Syndrome

In this condition, the triathlete has pain radiating down the side of the upper leg, often stopping on the outside of the hip. It feels worse while cycling, though running isn’t too good either. Generally swimming is fine. Often the athlete had already seen the orthopedist and physical therapy. They had stretched the iliotibial band to death and it still hurts. Prolotherapy to the attachment of the iliotibial band to the lateral knee and Neural Therapy to the band itself is added to their stretching and exercise regime. Again three to six visits of Prolotherapy and Neural Therapy are required to cure the problem.

Iliotibial Band Syndrome is relatively common in cyclists. A good bike fit is crucial. Often the seat is too low, which causes the cyclist to loose power but also causes the iliotibial band to become tight. The triathlete besides needs a bike fitting, needs to make sure while cycling they get up out of the saddle and stretch. By taking supplements, the triathlete can also help themselves heal better. Myself, especially after long workouts, I’ll make sure I take a lot of supplements to aid in recovery. Some of the supplements that I take on a regular basis are:

Ultimate Pack
Prolo Support Pack
Enzyme Max
MSCL enzyme

This is not all inclusive, but athletes with injuries that aren’t healing, should think to themselves “Is there anything I can do to aid in the healing?” The answer is a resounding yes!!! Take your supplements. Get enough sleep and rest. Eat like a champion!!! Do those three things, and you’ll recover a whole lot better!

9. Exercise-induced Cramps and Headaches

Believe it or not, with these diagnosis often no Prolotherapy is involved!!! We typically check the persons blood pH. Often the blood pH is high and recommend supplements and a diet to bring it down. Once this happens the exercise-induced symptoms go away. Some of the supplements that we would recommend include:

Emergen C
Supervits without iron
MSCL enzyme
Enzyme Max

The diet would be more carbohydrate based. The person would also be checked for mineral deficiencies and dehydration. If these were found then the minerals would be prescribed. If the person had tenderness in their neck, then Prolotherapy to their neck would be recommended (had to get something about Prolotherapy in there!)

10. Aching Body

If a triathlete is having body aches, it means recovery is poor. If sleep is poor then supplements for sleep are prescribed including:

Beulah Relax
Melatonin
5HTP

The training schedule of the triathlete is also checked. Typically the triathlete is not getting enough sleep and recovery. This is because their hormones are deficient for the amount of training they are doing. A comprehensive hormone panel is done. If hormones are deficient, natural hormone replacement is prescribed. Typically the athlete needs to take these from six months to two years. I have had times where I needed some of this, so don’t fear it.

The athlete also undergoes Diet Typing. This is a process where the person gets food allergy testing, blood pH testing and a modified glucose tolerance test. This information will help me determine which diet the athlete needs to get the maximum amount of energy. Once the athlete is getting the maximum amount of energy from their food, this additional energy will go into healing some of their soft tissue injuries. The ones that aren’t healed need what? You guessed it Prolotherapy. Don’t underestimate the role of diet in healing. Since we are talking about healing, the gland that is often weakened in the triathlete with body pains is the adrenal gland. These are the supplements I often prescribe for this:

Ashwaghanda
Panax Ginseng
Adrenal Forte

Of course the athlete needs the herbal supplements I already discussed for soft tissue healing.

In summary, the triathlete doesn’t have to give up the sport(s) they love just because of pain. Triathletes have injuries for a reason. It could be a technique error, too much training/not enough rest, or a healing issue. By seeking out care by someone knowledgeable about triathletes needs and Prolotherapy a definitive answer can be found. Prolotherapy by stimulating the damaged area to repair, has in many triathletes provided permanent relief of their sports injuries. If the triathlete has a healing deficit then changes in training, rest, and eating patterns may be needed. Because triathletes train in three sports, nutritional supplements are recommended to aid in recovery in healing.