Introduction To Prolopuncture
Prolopuncture is a new form of Acupuncture that focuses on proliferating cells at the junction of ligaments, tendons and bones. This area is called the fibro-osseous junction, and can only be repaired by fibroblast cells. The needle is placed against bone in Prolopuncture, which causes a local inflammatory reaction. The inflammation releases growth factors, which brings fibroblasts to the area. The fibroblasts are the adult stem cells for connective tissues.
Whereas anti-inflammatory injections of steroids would be depriving the injured area of an immune response, Prolopuncture would be causing an immune response. This could be considered the anti-life versus pro-life approach.
Prolotherapy is an injection technique named and developed by Dr. George Hackett, M.D. in the 1950’s. Prolopuncture is basically the same as Prolotherapy, except the needle is solid and no irritant solution is injected. The solid needle is safer to use compared to an injection needle, because it does less damage to any tissue it passes through. The beveled tip of an injection needle cuts like a knife, whereas the solid acupuncture needle has a single, very sharp point that will not cut while being inserted. Also, since no fluid is being injected with Prolopuncture, the procedure is safe to use on any age, any condition, and with any medication.
How Prolopuncture Came To Be
I would like to share a short autobiographical account of how Prolopuncture came to be.
At Loyola College of Baltimore, my pre-med studies were very challenging. Biology, chemistry and physics classes were intriguing and difficult. My little internal voice kept asking, “When are we going to learn how to heal people?”
During my senior year in 1993, my first semester was spent at Assumption University in Bangkok, Thailand as a study abroad. Camillian Hospital in Bangkok allowed me to volunteer and observe different procedures going on all around the hospital. It was a great experience. Watching births, an eardrum operation, bone setting and casting, EKG’s, and going on rounds with Medical Doctors.
One Doctor, during rounds, complained of his patients all using herbal medicine. He said it was very difficult to keep track of how well his medications were working because all of his patients also went to Chinese Herbalists. This sent my mind spinning. After growing up in Connecticut with no hints of Chinese medicines’ existence, I realized there was a whole field of medicine I needed to check into.
Wandering around Bangkok, and especially around Chinatown, I noticed Chinese herbal stores on every block. I walked into these stores every chance I got, and was amazed to see the hundreds of different plant and animal specimens. They were all precisely prepared and labeled, and were so beautiful. The natural colors reminded me of the fall foliage in Connecticut. The Herbalists were always busy putting together formulas from little drawers of a huge cabinet that would hold all the different medicines. It seemed as though they had memorized what each drawer held even though there were hundreds of drawers.
The Chinese herbal pharmacies were always bustling and full of eager patients wanting cures for every possible ailment.
This discovery of a totally different form of medicine excited me, and also confused me. I had wanted to be a doctor since I was ten years old. Now it was my senior year and time to start applying to schools and studying for the MCAT test. My inner voice kept asking, “When are we going to learn about healing?”
At the end of the semester in Bangkok, we spent ten days in Hong Kong and Guangzhou, China. At the street markets along with storefronts I saw lots more herbal medicine. The herb shops were more numerous than America’s gas stations and coffee shops combined, herbal medicine became a true reality for me.
When I arrived back in the United States, I went to a bookstore to see if there was anything about Chinese Medicine. I found a book called The Complete Book of Chinese Health and Healing, Guarding the Three Treasures, by Daniel Reid, Shambala Publications, 1994. This book blew me away. I read it constantly, and had read through the entire book several times over the next few months. It started a non-stop train that has continued to this present day. Daniel Reid has done a great service to humanity by writing this book. The Chinese masters over the last 10,000 years are the true heroes though.
After finding this book, my simple question as to ‘when will I learn about healing’ was finally answered. I learned so much about true healing from Reid’s, The Complete Book of Health and Healing.
At the end of this book, there was a list of different schools where Chinese Medicine is taught. Now the light truly came on. To the horror of my parents and friends, I announced that I wanted to learn Traditional Chinese Medicine.
First I had to save money to start my medical education, so I became an Emergency Medical Technician and started working for three different professional ambulance services over the next two years. I bought every book about Chinese Acupuncture and Herbal Medicine I could find.
Anyone at the ambulance companies that asked me my interests, never wanted to know about Chinese Medicine. In fact, they seemed totally freaked out when I would talk about it. Clearly, this was something I had to keep to myself. So all the books were wrapped in plain brown paper covers. One of these books was always with me at work, but I never discussed it with others. Sometimes I would try to strike up a conversation about Acupuncture, and would be met with silence and eyes wide open as if I were speaking about satan worship. It was hopeless to talk about it with anyone. So I just kept working and saving money.
After visiting several Oriental Medical Schools around the country, I decided to attend Emperor’s College of Oriental Medicine in Santa Monica, California. The school had a very nice feel, offered internships in hospitals, and also had a very busy clinic on campus.
So with $10,000 I had saved over the last couple years and two suitcases, I flew to Los Angeles. There were no family members or friends for thousands of miles, but Oriental Medicine was quite accepted in Los Angeles at that time, and I could talk of it freely. It was such a relief to not have to hide my real passion in life. Within a few weeks I was all set. I had bought a used car for $2,000 and found a place to live. Glendale Adventist Hospital had offered me a Cardiac Monitor Technician/ Unit Clerk/Nurse’s Aide job, and I started classes at Emperor’s College.
The classes were all fantastic. Each one continued to answer my initial question, “When will I learn about healing?” Each class was full of useful information and I loved it all. We learned about Western Medicine along with Eastern Medicine simultaneously. There were internal medicine classes from both East and West, along with the Acupuncture, Herbal and Massage training.
I bought a bright red Yamaha 500cc racing motorcycle, which was perfect for weaving through Los Angeles traffic. My studying was done at Venice Beach where I also did lots of T’ai Chi and rollerblading.
During my first year of school, a classmate was going to study in Shanghai at the Traditional Oriental Medical School there. I went along and spent two weeks studying in Shanghai and Hangzhou. It was a great experience, and gave me a real view of Chinese Medicine.
By the third year my school internships began. These were done at the Daniel Freeman Hospital, The UCLA Student Health Center, The Los Angeles Free Clinic, and the clinic at Emperor’s College. I was performing very safe treatments, all according to Traditional Chinese Medicine.
During my senior year I won an essay contest that allowed me to study in Taiwan for two weeks. The trip was sponsored by Qualiherb, a world class supplier of Chinese herbs. We went to several hospitals, clinics, herbal factories and research facilities. I learned so much, and was very impressed with the health care system in Taiwan. All citizens are given a health card, which allows them to receive free treatment and herbs at any facility in the country. When the people arrive at the hospital, they are asked if they would like Western Medicine, Eastern Medicine, or both? This impressed me the most.
By the end of four years in Los Angeles, my training was complete. I received all A’s except for two B’s giving me a 3.98 average. Now it was time to enter the real world.
My parents had retired in Marco Island, Florida, which was fairly quiet in 2000. Los Angeles has seven schools of Oriental Medicine and thousands of practitioners, so it did not seem like a good place to start out. The logical thing to do was to move to Florida.
So, in the year 2000 I moved to Florida and became licensed to practice in Florida and California. My first patients were my parents’ friends. I started working as a Cardiac Monitor Technician at Naples Community Hospital on weekends, which brought me lots of nurses as patients. I found an office to work out of, and started teaching Tai Chi classes at the hospital’s Wellness Center. Whenever possible, I would give talks about Oriental Medicine at health food stores, yoga studios, and various organizations who needed a group speaker.
By sticking with it, I eventually built up a practice and was able to quit my hospital job. My treatments were similar to the ones I did in Medical School. Very safe, and included lots of Tui-Na Massage.
In 2002 I had an opportunity to spend three weeks at the Guangxi Province Hospital in Nanning, China. The Herbal, Acupuncture and Tui-Na Massage departments were very busy. Patients were especially lined up at the Herbal department. The Tui-Na Massage department was second with lots of people filling a large room. There were no walls or even curtains separating patients. The Doctors wore no shirts and only a lab coat, and all were covered in sweat. They worked very hard. The Acupuncture department was quiet, but steady. They dealt with the more serious pain or internal medicine patients. Most patients received injections along with the Acupuncture. One man walked in with the hiccups, which he had had for three days. The Doctor laid him down and put one needle deep into his wrist area. The man immediately fell asleep and started snoring. His hiccups were gone. The Doctors were all so nice to me, along with the patients. I observed lots of treatments and was able to treat many patients. Acupoint Injection Therapy was what interested me most, since Florida had just passed a law allowing us to do injections.
A few months after returning from China, I was able to take the 60 hour class required in Florida for Doctors of Oriental Medicine to do injection therapy.
Initially, I only injected vitamin B12 with an insulin syringe at Acupuncture points. This treatment was actually very beneficial, and patients loved it. As a way to get my feet wet, this worked out perfectly.
In 2004, I found out about something called Mesotherapy. It was very popular in France. So off to Paris for research. I expected there to be an easy way to find Mesotherapy practitioners, but I was wrong. The only way to find them was to simply walk the streets and look at placards on the buildings. I actually had a fantastic time doing this, and really got a feel for what it’s like to live in Paris. First, I went to the medical school’s bookstore and bought the two books they had about Mesotherapy. Interestingly, the books were in the same section as the Acupuncture books. Then I hit the streets for a week hunting for Mesotherapists. I stumbled upon three different Medical Doctors who practiced Mesotherapy. I went into these offices to get some information. The Doctors were very kind to me, and gave excellent advice. One Doctor brought out an orange book that said ‘Heel’. He said, “This is what you need to learn about.” Another Doctor specialized in pain management and showed me her needles and how she does the injections. The third Doctor specialized in cellulite reduction and face rejuvenation. She did not give me much information but told me about the main Mesotherapy organizations and how to contact them.
When I returned home from Paris, I found out more about the company called Heel. It is a homeopathic company in Germany. They just happened to be holding a seminar a few weeks later in Florida on Mesotherapy. It was like a miracle.
The teacher, Juan Mendez, M.D., was such a great guy who has a practice in Caracas, Venezuela. My mind was completely blown by his Mesotherapy lecture and I have never been the same since then. He taught me how to use homeopathic injectables, which I had not used at all at that point. This was a whole new world that was deep and mysterious. Mesotherapy using homeopathic medicine could really treat everything. There were formulas for every different symptom under the sun. I was already very knowledgeable with Chinese herbal medicine, but now a new frontier was on the horizon.
Along with Mesotherapy, Dr. Mendez also taught us a great deal about something called Neural Therapy. This type of medicine began in 1905 in Germany, with the invention of procaine made by a Doctor named Einhorn. Dr. Mendez showed us many different nerve ganglion injection techniques. Nerve ganglions are like small brains located throughout the body’s face, neck and trunk. The nerve cell bodies are in the ganglion, their axons spread out to the local tissues. These ganglion injections were so far over my head at that time. I really did not understand much of what was said during the whole lecture. It would take many months to really absorb the information. Actually, many years.
So I began buying different injectable homeopathic formulas and mixing them with vitamin B12. There were treatments for cellulite reduction, face rejuvenation, pain management, digestive problems, nerve disorders, emotional problems, and just about everything else. These were the main issues that I focused upon, however. To this day, I use the same things that Dr. Mendez taught me at the first lecture.
A few months later I attended a three day seminar in San Diego, California about Mesotherapy. There were Doctors from all around the world lecturing each day. Dr. Mendez was there, and it gave me a chance to learn his material better. Another person who impressed me was Dr. Alta Smit, M.D. who practices in South Africa. She really helped me to understand the idea of the matrix, the mesoderm, and how homeopathic medicine treats this region.
The mesoderm is a layer of a growing fetus that creates all the connective tissues. Science has shown that later in life, the mesoderm still exists. The adult mesoderm is a subcutaneous layer that is 4-6 mm under the skin. The mesoderm is interconnected by nerve endings, blood vessels, and fibroblast cells. This area is also known as the matrix. The nerve endings connect with the underlying structures of the skin. The fibroblast cells are like the adult stem cells for connective tissue. The skin, ligament, tendon, and fascia are all created by fibroblasts. The fibroblast cells create the matrix of connective tissue, which consists of collagen fibers, elastin, hyaluronic acid, and supporting filaments.
Injecting fluid 4-6 mm under the skin is considered Mesotherapy, no matter what the fluid may be. The first Doctor I visited in Paris said to me, “Mesotherapy is simple, it’s what you inject that is most important and difficult to learn.”
It was becoming clear to me that the mesoderm area just under the skin would always be sore if there was an injury to the underlying tissue. For example, if someone had a deep hip injury, just touching the skin fairly lightly in that area would be quite painful. So the amazing discovery was that the mesoderm is sensitive and has an inflammatory reaction when the underlying tissue had an inflammatory reaction. There was communication going between the mesoderm and the tissues underneath it. Later, I would find out that this is called the ‘Cutaneo-Visceral Reflex.’
So at this point in my career, Mesotherapy was my big thing. Most Acupuncture patients were including Mesotherapy injections with the treatment, and lots of patients were starting to prefer the Mesotherapy alone. It was producing great results in lots of different sorts of cases, and I was very happy with my practice. I also attended many more seminars regarding Mesotherapy and homeopathic medicine.
I had taken up dirt biking on weekends. Motorcycles are a real passion of mine. I also had a Honda Gold Wing for longer trips, but my Honda Dual Sport motorcycle let me go on and off road as I pleased. The freedom and versatility is so much fun. One day in December of 2006, after enjoying some fun trails, I was driving on US 41. A few miles up the road I had to stop at a red light. In broad daylight, with no warning, a car struck me from behind. The car slammed my bike into the truck in front of me and continued to roll over the bike. I was thrown to the left and was not run over by the car luckily.
It happened so fast, I just could not believe someone could be so stupid. Rage filled my body, but I was so hurt and lying on the ground, that I could not act upon it. My low back, left hip, knee and ankle took the most damage. I did not have any health insurance, so when the ambulance showed up, I refused service.
After getting a ride to my office, I immediately set to work on myself. First, I set up several syringes full of Traumeel, which is a homeopathic medicine for injuries, mixed with vitamin B12. My entire left low back, hip, knee, ankle, and leg in general were in a terrible spasm and it was very painful. Mesotherapy injections were done in all the main painful areas. After performing the injections on myself, it was time to do Acupuncture.
Little did I know it, but this was the dawn of a new era for my medical practice. For the first time, I was doing Prolopuncture. Up until that point, I never touched the bone with my Acupuncture needles. If a needle did touch the bone, it freaked me out and I immediately withdrew it. In my training, the teachers and clinic supervisors had never told me to reach the bone with needles. But my leg was so swollen and painful, I knew drastic measures were in order. As I started doing the Acupuncture, the relief came when the needle reached the bone.
Before long, I had 300 needles in my knee area alone which, were all touching the bone or were inside the knee joint. I went through box after box of needles. After hours of doing the Acupuncture on myself, I put herbal plasters all over my back, hip and leg. By that time it was evening and I got a ride back home. I took an Epsom salt bath, which felt great.
This routine of doing Mesotherapy, hundreds of Acupuncture needles down to the bone, patches, and Epsom salt baths became a daily ritual for me. This is because the leg would go back into spasm every day. It is natural to have such tightness when a traumatic injury is sustained. Our nervous system is just trying to protect the joints. I did all the treatments myself, and never missed a day of work. For the first two weeks I had to use crutches all the time, because it was too painful to put any weight on the leg. T’ai Chi was my main form of physical therapy, and every day the leg was performing better and better.
What I was realizing through my treatments, was that all fear should be left aside. The needles needed to be placed at the MOST painful spots and also had to reach the bone in order to reach the spasms. The muscles would twitch when the root of the pain was reached, and then the nervous signal would be released. Afterwards came the muscle lengthening and pain relief. This is the essence of Trigger Point therapy. Later I would find out that the famous Doctor Janet Travell, M.D. who wrote, The Trigger Point Manual, was actually trained in Neural Therapy in Germany. So the whole idea of trigger points and releasing the autonomic nervous signals is actually Neural Therapy. The Mesotherapy from France was named by Dr. Pistor, M.D., who was also trained in Neural Therapy in Germany. In Neural Therapy, the same Mesotherapy technique is called, ‘Segmental Therapy’. In the 1950’s, because of World War II, Doctors who were trained in Germany would find political resentment regarding German techniques, so these techniques were renamed to “Trigger Point Therapy”, and “Mesotherapy”.
Everything I was doing could all be traced back to Neural Therapy from Germany. The main difference is that Neural Therapy also included the injection of procaine, a mild anesthetic also known as Novacaine. Back at that time, though, all I knew was that the deep Acupuncture to the bone was what I needed and was what worked.
By the late Spring I was
feeling much better and returned to playing in table tennis tournaments and
riding my street motorcycle. A few
months later I bought another dirt bike and was back on the trails. There was still a great deal of pain in
my low back, hip, knees and ankles, but I struggled through it. The pain was very tiring, however, and
my limitations were always apparent.
At a seminar, sitting with my Teacher at lunch, we discussed our pains and injuries. He told me how much Prolotherapy had helped him and I was very curious.
I had heard of Prolotherapy from a Massage therapist who said it helped her back and knee pain. When she told me it involved causing inflammation with an irritant injection, I immediately rejected the idea and thought it was nuts. Everything that had been taught to me in school and through the media pointed to inflammation as the ‘Bad Guy’. My whole goal in practice at that point was to stop inflammation. But now my Teacher was telling me how great Prolotherapy is. So I asked him if he could treat my pain and explain more about Prolotherapy in the process.
He said many people were asking him to hold a Prolotherapy class and that he would let me know about it. By March of 2007, my Teacher had put together a class that was certified by the state of Florida and gave us continuing education hours. I was thrilled.
The first class was a bit scary for me, I drove up to toward Tampa the night before so as not to be late. Unfortunately, all the hotels and motels were full in the whole area. I had to sleep in my truck. I arrived looking a bit rough, but it all turned out great.
We started learning about the mechanism of Prolotherapy. The area where ligament and tendon tissue melds into bone is called the ‘fibro-osseous junction’. This area is filled with sensitive nerve endings, but is too dense for a good blood supply. The fibro-osseous junction is often injured during traumatic injuries or through overuse, but the lack of blood vessels does not allow the area to heal. This leads to chronic pain. The nerve endings tell the brain about the problem, but without blood, the body can never reach the area with a good immune response. Therefore, the number one rule in Prolotherapy is that the needle tip MUST be touching bone in order to perform an injection. After treating my motorcycle accident injuries, this made perfect sense to me. It also gave me lots of confidence in Prolotherapy because I knew the only way to get rid of deep pain was to touch the bone.
With Prolotherapy, not only do we touch the bone with the needle tip, but then we inject an irritant solution to cause inflammation. The main irritant used is Dextrose, which is corn sugar. The dextrose is considered an osmotic irritant, because it causes dehydration. When the local cells become dehydrated, they eventually become injured and some contents spill out from the cell membrane. When the inner contents from the cell contact the nerve endings in the fibro-osseous junction, the immune systems is tricked into thinking that a major injury has occurred. This causes inflammation.
Inflammation is the only tool our body has to repair itself. Without inflammation, we would all die. Any little cut or wound would never heal if it did not first have an immune response with inflammation.
The inflammation generally lasts a few days, never more than seven. During this time lots of lymphatic fluid and blood floods the area. A fibrin clot is produced which acts as a patch along with being the framework for the new tissue to build upon. Macrophage cells and lymphocyte cells clear away toxins and damaged tissue while releasing growth factors. The growth factors are the chemical signal that brings adult stem cells to the area. An immature cell capable of reproduction and repair is called a “- blast” cell, and is an adult stem cell. For connective tissue, the Fibroblast does the repair work. For bone it is the Osteoblast. For cartilage, it’s the Chondroblast. During the next four to eight weeks, these cells create their respective tissue at the area of inflammation. After that, the tissue remodels for several months and becomes strong.
With Prolotherapy, the main cells that are proliferated include the Fibroblasts for ligaments and tendons, and Chondroblasts for cartilage repair. The cartilage lies inside of joints, so this requires that the dextrose solution be injected directly inside the joint. Prolo is short for Proliferate. Prolotherapy is a pro-life treatment that actually rejuvenates the joints.
For this first class, we focused on the hip, knee, ankle and foot. These are the safest areas to treat, and were perfect to start with. I observed Dr. Swihart doing Prolotherapy to many hips, knees, ankles and feet during the clinical portion that day. We also watched videos of these treatments being done. I was able to treat someone’s hip, and had my own hip injected. The treatment was surprisingly easy to receive. A month later, there was a tremendous improvement as far as strength and flexibility in my treated hip. I had truly become a Prolotherapy convert, and was sold hook, line and sinker.
After the training, I started using Prolotherapy right away. It seemed too good to be true, but torn ligaments and tendons were mending. Long term chronic pain was disappearing. Prolotherapy turned out to be no joke, it became clear that it is a miracle cure for pain.
Every couple of months, my Teacher would hold another Prolotherapy class. The next class focused on the shoulder, elbow, wrist and hand. This was followed by the lumbar spine, then the cervical spine and jaw, and concluded with the thoracic spine, sternum and ribs. So a year after my Prolotherapy adventure had begun, I was fully trained to treat the whole body. At this point my whole body had been treated with Prolotherapy also. During the training seminars, we all would treat each other. This worked out so great, the chronic pains in my spine, occiput, elbow, wrist, sacroiliac joints, hips, knees, and ankles all were cured. I was rejuventated and felt like a teenager again.
As I was learning how to do Prolotherapy, my Acupuncture sessions for patients ended up being my main training ground for Prolotherapy. After my motorcycle accident, needling to the bone became a everyday treatment style for me. With the Prolotherapy training, it gave me permission to do this all over the body.
It became very apparent that my Acupuncture treatments were much more successful after learning Prolotherapy. I certainly did not abandon any knowledge from Traditional Chinese Medicine. Everything I learned in medical school was still being earnestly employed, but now there was so much more depth. The Prolotherapy style in Acupuncture fits perfectly into the entire model of Traditional Chinese Medicine (TCM).
In TCM, the main cause of pain is blood stagnation. This fits perfectly into the Prolotherapy cause of pain, which is a weakness of ligaments, tendons and cartilage. These areas already have a weak supply of nutrients and oxygen, mainly supplied by the lymphatic system and whatever blood that can reach the area. When there are tears or worn out and stretched ligaments, tendons or cartilage, the nerves become very sensitized. This sensitization sends a pain message to the brain, and also sends a message to the local muscles to guard the area. This muscle guarding causes lots of pain, fatigue, immobility and depression. It also does not allow a normal supply of blood into these muscles. Over time, the muscle cells start to die and muscle atrophy occurs. All of this can be considered blood stagnation. The ancient Acupuncturists understood this whole mechanism and knew that blood was essential for the healing process to occur.
The Acupuncture points are indispensible knowledge when it comes to Prolotherapy or Prolopuncture. It gives me a framework to work by, and pain often travels along a meridian line. This helps to trace a referral pain back to its source. The dermatome charts are also great to know when dealing with pain that comes from the spine, as in radiculitis. Oftentimes, treating the ligaments and tendons around the spine will relieve pain along the entire dermatome coming from that the particular vertebrae.
An interesting thing that I came to understand by doing and studying Prolotherapy, is that ligaments and tendons themselves refer pain and neuropathy. When looking at charts that show the referral from L5 for example, my original concept was that the L5 nerve root was always involved. Prolotherapy has shown me that it could be the facet ligaments around L5, or the iliolumbar, supraspinous, lumbosacral, or sacroiliac ligaments that are really referring the pain. Treating those areas with Prolotherapy or Prolopuncture can completely alleviate it.
Also, the pain referring down the leg from L5 would also cause any muscle in the referral pattern to shorten. This shortened muscle is a huge cause of pain and immobility. Over time, this reflexive tightness of muscles can lead to tendon damage, which makes the tightness even worse. So chronic pain is a vicious cycle leading to severe fatigue and depression. The good news is that Prolotherapy and Prolopuncture can repair these ligaments and tendons, allow the muscles to lengthen, and restore health and happiness.