Did Fred Couples really have to go to Germany to get his back fixed? Not really. We have been doing a very similar treatment here in the U.S. for almost four years now. We call this field Regenerative Medicine and the technique and science of injecting precise points of injury has actually been around for many years and is known as Prolotherapy. This little known but highly effective treatment has been used for many years (most commonly using an inert dextrose solution). C. Everett Koop, M.D. was a proponent for Prolotherapy and he used this to fix his long-standing backpain.
The main difference with PRP (Platelet Rich Plasma) is that we inject a patients own stem cells and growth factors (isolated from their blood), as the proliferant. In a way, PRP could be considered a super-Prolo and is indeed a powerful tool to repair injuries and degenerative problems. If a person is a suitable candidate for PRP, our success rate is approximately 85%. It usually takes four or five sessions spaced two to four weeks apart. This minimally invasive procedure is very safe and there is virtually no downtime, making it a particularly attractive option for those with sports-related injuries who are anxious to return to their sport.
To start with, it is important to recognize that, in most golf-related injuries the source of the pain is not damage to bones, cartilage, discs or nerves but rather damaged ligaments and tendons. These connective tissues are strong, whitish tissues that hold bones together and muscle to bone. It is these highly innervated attachments that are so vulnerable to injury and when damaged (or stretched), become very vocal pain generators and quite debilitating.
Regardless of the age of the patient, the reason these structures are so prone to injury is due to the fact that the blood supply is often poor, leading to problems in healing and repair. It is the direct goal of PRP therapy to enhance the blood flow to these structures. It is a principle of connective tissues that the body cannot heal what it can’t get blood flow to. Conversely, by enhancing the blood flow to damaged attachments, we can often stimulate the body to heal itself and re-establish full functionality.
Let’s use the example of low back pain since this is one of the most common golf-related injuries. These days, MRI is often done quite early in the course. Unfortunately, MRI’s show disc and bony abnormalities but they are not sensitive enough to show stretched ligaments and tendons. In many cases the pain radiates, leading those who don’t understand connective tissue problems to misdiagnose the problem as sciatica or a spinal/nerve issue. In fact, the pain from pelvic strains radiate just like nerve pain and are by far the most common cause of a sciatica-type syndrome.
Since there is often a misdiagnosis, it follows that counter-productive treatments are often suggested. Physical therapy, epidural injections and even surgery are inappropriate and even contraindicated if the source of the pain is a pelvic strain. Furthermore, the only way to heal the pain is several treatments of Prolo or PRP to the affected regions. With correct treatment, the problem should be resolved within a couple of months.
Shoulder rotator cuff injuries are also a fairly common golf injury. Because the shoulder is such a shallow joint, it is actually quite vulnerable to injury. Again, MRI here is limited because, as before, it fails to show the strains and sprains that are so commonly the real underlying cause of the pain. The proper approach is palpation of all major structures and certain maneuvers to stress the various ligaments. Once identified, the weakened ligament and tendon insertions can be injected with dextrose or PRP to begin the healing process. During rehab I recommend swimming as this gives movement without loading the insertions. Movement encourages the blood flow that is needed for healing. During this period physical therapy and particularly any kind of weight work is contraindicated. As always with Regenerative Medicine I recommend against pharmaceutical anti-inflammatories because these block the healing response at the injection site. Tylenol,Tylenol with codeine or Tramadol can be used for pain control if required without adverse effect.
Another common problem is knee arthritis/sprain. It is important to realize that the capsular ligaments around the knee not only hold the knee together but also hold the knee apart i..e the joint space of the knee is largely created by the ligaments and not just the cartilage. Cartilage tears are really only a problem if they cause mechanical obstruction of the knee joint, in which case arthroscopic surgery may be necessary.
As before, it is important to carefully palpate all major structures in the region. For the knee, the most common problem is medial collateral sprain. When we treat the knee we generally inject intra-articularly to get the cruciate ligaments as well as the medial and lateral structures as required. For rehab, again no anti-inflammatories; swimming and/or light cycling is suggested. In addition, the patient should be evaluated for othotics and if needed, fitted with optimal custom orthotics. Here I cannot stress how important it is to find a good orthotist- to fit and adjust orthotics properly is half science and half art. In my own community, I have found only one orthotist who makes them properly.
Two other common golf injuries bear mention. Elbow strain, usually medial, is known as golfer’s elbow, generally from hitting the ground too forcefully with a stiff shaft. Also fairly common is a wrist sprain. Steroid injection is contraindicated in both since it can further weaken the affected structures. Prolo/PRP are the treatments of choice. I have found a good quality Arnica gel massaged in a couple of times per day to be helpful. Sometimes I suggest taping or a forearm strap if the symptoms are severe. I usually suggest that the patient continue playing if at all possible. In connective tissue injuries, rest does not do much to heal the problem. Continued movement and heat is helpful to encourage blood flow and healing hence we usually recommend an active rehab.
Finally, it is very important that anyone suffering from a golf-related injury work with a good teaching pro to make sure that their swing is optimized to avoid further aggravation of the injuries. It is common that people lapse into poor swing habits that tend to cause injuries. They will enjoy the game more and have fewer injuries if their swing is tuned up. I have forged a relationship with a local pro that I refer my injured golfers to for evaluation.
In conclusion, the important thing is to realize that the vast majority of golf-related injuries can be quite easily and safely healed with Regenerative Medicine. Apparently Fred Couples suffered from back problems for years. It is unfortunate that he was not aware of and/or did not consult an expert in Regenerative Medicine much earlier. Nevertheless I am pleased that he finally got to a doctor knowledgable in connective tissue problems who could address the problem properly. PRP and Prolotherapy is not magic, but it is a safe and a highly effective treatment. Since there is virtually no down time associated with the treatments, I consider PRP treatment of choice for most types of golf-related sports injuries.