Irwin Abraham, M.D. & 

Chronic Injury Medicine

Prolotherapy

Prolotherapy is the injection of a growth-stimulating dextrose/glucose, the body’s own natural substance, into the body’s tissues to create new natural tissues. We inject into tendons, ligaments, some muscles, and joints. The most common substance used in Prolotherapy is dextrose, the same sugar that is in the blood. We use dextrose mixed with a local anesthetic and sterile water. This safe substance is introduced with a local anesthetic into the areas of injury.

It takes time for traditional Prolotherapy injection to work in the body. First, the solution injected will send a signal for cells to come to the site of injections. Then these cells mature and divide to become the tissue-creating cells needed to grow new fibers. This process takes about 6 weeks for most people to experience a good result. Some areas, such as the shoulder or the elbow, take longer, and some areas, like the wrist, improve more quickly.

Dr. Abraham uses prolotherapy for these areas:

  • The back of the head
  • The jaw joint-known as the TMJ
  • The cervical spine & joints
  • The thoracic (upper back) spine and ribs
  • The lumbar (lower back) spine
  • Hips, buttocks, sacrum, and tailbone
  • Shoulders and collarbone
  • Elbows, Wrists, hands, and fingers
  • Knees and kneecaps
  • Legs, ankles, feet, and toes

Timeline of injection, recovery, and improvement:

  • Day 1: Day of Prolotherapy injection.
  • Day 1: After injection expect soreness and perhaps pain.
  • Day 2: Decreasing soreness or pain.
  • Day 3: Further decease of soreness.
  • Days 3-7: Usually all soreness is gone and mild improvement is felt.
  • Weeks 2-3: Usually the same as the original level of discomfort before the Prolotherapy.
  • Weeks 3-4: More discomfort as part of the healing process, possibly more than the original level of discomfort. Often patients experience little to no increase in pain, but some patients experience much pain.
  • Weeks 5-6: Expect gradual improvement.
  • Weeks 7-8: Expect improvement week by week.
  • Months 2-3: If you fail to keep improving, then another set of Prolotherapy is needed. The patient may benefit by the use of a stronger solution for the second and possibly later sets.

Neural Prolotherapy

In recent years, Dr. Abraham and other physicians have been utilizing a process called either neural prolotherapy or as it has become more commonly known, PSI, for perineural subcutaneous injection. This is a process which relies on the same principles of the deeper injections associated with prolotherapy, but instead primarily targets the nerves near the surface of the skin.

Neural prolotherapy is a very new type of prolotherapy. The rationale is that that chronic pain will switch on the activities of certain nerves. These specific nerves are in every bundle of nerves traveling under the skin throughout the body. These switched-on nerves, known technically as “C” fibers, will then transmit messages of pain for months to years. We can turn off the pain message by injecting a small amount of a dilute sugar (glucose) solution into the nerves in the skin over an injury. Dr. Abraham has utilized this therapy for 3 years now and neural prolotherapy has gained quite a prominent place in his practice.

The relevant nerves for treatment are found by gently patting on the skin. Neural prolotherapy uses 5% concentration of glucose injected to the near vicinity of the nerves. The glucose literally turns off the pain message of the C fiber, and this can work very quickly. Most often the patient notices that she or he feels better as soon as the injections are completed.

The Fascial Distortion Model

THIS IS AN INTRODUCTION TO A NEW NON-INVASIVE ( NO NEEDLES! ) that uses deep massage technique, for IN-OFFICE THERAPY FOR CHRONIC OR ACUTE MUSCULOSKELETAL PAIN.

A very thin but important layer of tissue is present skin throughout the body. Each layer is known as: Fascia.

This Fascia is best thought of as a tube of tissue over and around all the muscles in the body; the fascia connects closely to the outside borders of muscles and assists in proper movement. Damage to the Fascia can cause pain and this pain can last for years.

FASCIA can itself undergo local damage. Then this FASCIA becomes a unique and chronic source of pain. This damage can present in a variety of ways: a little depression under the skin; a ribbon of tenderness: a restriction of joint movement; an area that is tender to touch in a larger area (such as part of the thigh or arm).

We first find the areas of pain in the FASCIA by asking the patient to show the pattern of pain with thumb, fingers and hands. Each patent demonstrates with fingers and hands where the pain starts and where it ends. Either single or multiple different types of fascial damage can be present in the same area or adjacent.

Treatment is ‘non-invasive”. no needles are used. We use our fingers and hands to essentially push in or rub away the pain by smoothing out the FASCIAL layer. It has been amazing for me to see how fast the pain can be improved or resolved merely by the pressure of my hands. We measure the duration of the pressure in a time period lasting from seconds to a few minutes.

Sometimes the applied pressure by the thumb, finger, or hand will cause a temporary increase in pain. Fortunately, the amount of pain produced in the processes of treatment, is brief, not severe, unbearable, or damaging. getting a bruise is unusual. Good improvement follows rapidly while still in the office.

This treatment, like many others, may need several repetitions to be permanent.


NO insurance company will reimburse me for this work, so there will be a charge.
There will a separate Charge for Fascial Distortion (FDM) work in this office, in addition to any insurance co-pay, and for any injection therapy is that is extensive on same day.

DIRECT NEURAL TREATMENT

This treatment is a NEW addition to FASCIAL DISTRACTION MODEL THERAPY.

We are using the same nerves lying just under the skin that we treat with dextrose (glucose ) solution to stop pain and promote healing. We Lightly touch a single nerve; then we determine if the nerve is stiffer than normal, painless, and/or swollen. My teacher for this work, Dr. Everett Johnson, has developed a method of direct gentle treatment of these nerves.

Each nerve is connected on either side to the loss layer of tissue under even bit of skin, known as the FASCIA. the nerves just under the skin can be pulled by an irritation of the fascia: think of a tiny wrinkle in a shirt.

Using one or two fingers, we press in different ways on the fascia connected to the nerve, not the nerve itself. This is a DIRECT NERVE TREATMENT. After a minute or so, any pain is much less; the fascia relaxes it’s hold on the nerve; and the nerve itself becomes softer, less painful, more normal, and feels softer. Like every type of treatment we do, one or more related sessions may be needed.

This treatment has the ADVANTAGE of using fingers or thumbs only, gently and NO NEEDLES, NO INJECTION OF ANY SOLUTION.