Dr. Ross Hauser is residency trained in physiatry and has gone on to train in prolotherapy. He talks about what it is and why it's the future!
Ross is very passionate about prolotherapy. If you want to learn more about this, visit his website on Caring Medical.
Also, check out all the rest of our episodes on MedEd Media Network, including The Premed Years Podcast, The MCAT Podcast, The OldPreMeds Podcast, Ask Dr. Gray: Premed Q&A, and some more coming in the future!
In the last two months of his residency, Ross had an elective rotation which he did with prolotherapist Dr. Hamwell back in 1992. Then he joined the physician in 1993, so he has been a prolotherapist for over 25 years.
Ross describes himself as always liking old people. Thinking he was going to be a geriatrician initially, it was during his chronic pain rotation in his physiatry residency that he discovered his love of the mystery of pain. He was told by the physician he rotated with that most structural chronic pain is from joint instability or ligament laxity. And the curative treatment in a lot of people was prolotherapy. So he wanted to go for the cure instead of pain management.
The term prolotherapy was originally coined by Dr. Hackett, in short for proliferative therapy. The treatment is designed to cause the proliferation of cells, which make the extracellular matrix made up of ligaments, tendons, cartilages, or whatever you're trying to regenerate.
In the Webster's International New Dictionary, prolotherapy is defined as the rehabilitation of an incompetent structure such as a ligament or tendon by the induced proliferation of cells.
So if a person has a tendon or ligament tear, you want to proliferate the fibroblasts, the actual cells in the body that make the ligaments or tendons. You want to proliferate those cells so they can then regenerate the ligaments or tendons.
Ross goes on to explain that the body's response to an unstable joint is to try itself to limit motion. One of the ways it does is it causes synovitis resulting in a very low level type of inflammation in the joint. Since medical doctors have been trained to very quickly try to get rid of symptoms, that's why treatments have gone more toward a treatment that dissolves the pain quickly.
"Medical doctors have been trained to very quickly try to get rid of symptoms, that's why treatments have gone more toward a treatment that dissolves the pain quickly."
However, 97% of tendon tear, for instance, occur in a degenerated tendon. Under a microscope, a degenerated tendon has way less cells than a normal tendon. So there's fewer cells to regenerate for a degenerated tendon. So the best curative type treatment for this is prolotherapy.
The problem is that beside physiatry, prolotherapy is now becoming one of the standards of care for pain treatment. But in other fields like family practice, a doctor has to get training after residency. But once you get into practice, you get too busy to even get training. Ross hopes medical schools and residency programs recognize that the cause of osteoarthritis or a degenerative disease is ligament laxity or joint instability. Apparently, they have to shift to this paradigm. Otherwise, they won't be able to emphasize prolotherapy.
PRP stands for Platelet Rich Plasma. Ross explains the inflammatory cascade where when tissue injures and there's bleeding, platelets rush to the area and...
