Prolotherapy for Plantar Fasciitis- does it work???

As most of you already know I have been working out with Innovative Fitness Kits for over a year now as one of their sponsored athletes. (and I LOVE IT!) One of the things I do for them is write a monthly blog for their newsletter. Most recently I blogged about my experience with Plantar Fasciitis this year, and more specifically on whether or not Prolotherapy was an effective treatment. So I thought I would share it on my own blog for ya'll to read:)

Plantar Fasciitis- Just Go Away Already! Does Prolotherapy Help?

Plantar Fasciitis is one of the most frustrating injuries I've ever endured. In fact it isn't “one of”, it is by far the most frustrating of them all. If you've ever dealt this this injury you know what I'm talking about. It can stick with you for months and sometimes years. This is because there is no tried and true way of getting rid of it. There are certain forms of rehab that work for some, and for others are completely ineffective. I'm gonna talk about everything I've tried so far, including my most recent treatment- Prolotherpy, and give you my 2 cents on its helpfulness in healing my heel.

PF (plantar fasciitis) is one of the most common and painful injuries runners encounter. For those of you that don't know what PF is, here is a quick definition from Wikipedia- “Plantar fasciitis (also known as plantar fasciopathy or jogger's heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot's plantar fascia. “. In my own words- PF is a nasty angry devil bitch in your heel. It starts off as a “soreness” in your heel. Maybe you wore the wrong shoes out for a run? No, you wish it was as simple as that. It's an annoying (often excruciating) pain on the inside of your heel (sometimes feels like your entire foot hurts....) that is with you each and every step. For a lot of people the pain is the worst in the morning and it gets better as the day goes on. Not for me- mine just hurt all the time, walking or running. Ok so that pain in your heel is getting worse and you go to your physio and he gives you the devastating news that you have PF. Here are some of the things he or she will tell you to do in hopes of getting rid of it.... all of which I have tried and will tell you about.

1. Wear some sort of night splint or Strassberg sock. They are designed to keep tension on the tissue (plantar fascia) so it heals in a stretched position at night. Yeah, that did nothing for me except annoy me while I was sleeping. But many people have found success with this simple method
2. Strengthening exercises and rolling your foot out with a ball. After 6 months of this, I still have PF, so not sure how helpful they have been....
3. New shoes or orthotics....tried about 8 pairs of shoes and 3 pairs of orthotics..... nothing seemed to make a difference for me.
4. Icing and ibuprofen. Icing helped relieve the soreness/pain after a run, but it would quickly return the next day when I ran. Advil just helps with the pain...doesn't actually help it go away.
5. Get your foot adjusted. I saw a chiropractor, he adjusted my foot/heel. This did not help, it only hurt while he was doing it.
6. Take time off. Completely unload your Plantar Fascia. Limited walking and definitely no running or other weight bearing activities. I took 6 full weeks off of running and work. When I first started running again (very limited amounts at first), the pain was definitely diminished. But within a month of being back into my full time training, the pain was almost unbearable again.
7. Shock wave therapy- I have not tried this myself, but know a few people who have. There conclusion is that it helps initially- for a few days...but the pain then returns. And the treatment itself is quite painful.

So this brings me to the last method of treatment that I tried- Prolotherapy. After 3.5 months of dealing with this terrible injury and trying so many things that just weren't working, I was feeling frustrated and hopeless. My sports med doctor presented me with a few more “advanced” options. By advanced I mean last resort kinda stuff. She was hoping one of the more simple methods would have worked by now, but since they were not helping we had to try something new....

1. Platelet-Rich Plasma (PRP) Therapy- “It utilizes platelets from your own blood to rebuild a damaged tendon or cartilage. It has been successful in not only relieving pain, but also in jump starting the healing process. Your blood is drawn and placed in a centrifuge for 15 minutes to separate out the platelets. The platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage with the guidance of an ultrasound machine.” (www.emoryhealthcare.org).
2. Corticosteroid Injection- “Cortisone is a hormone that is naturally produced by your body's adrenal gland as a response to stress. Cortisone injections contain a synthetic version of this substance and are given as a shot directly into the injured plantar fascia ligament, or into the side of the heel. Cortisone is a powerful anti-inflammatory substance. In the case of Plantar Fasciitis, bringing down the inflammation surrounding the plantar fascia ligament can then lead to relief of pain” (www.heelthatpain.com)
3. Prolotherapy- is a regenerative injection therapy. It involves injecting an otherwise non-pharmacological and non-active irritant solution into the body for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. Thanks Wikipedia for that definition.

So I was presented with these three options, knowing that they would all require 2 things that scared me- 1. more time off of running and 2. needles into my heel. We decided that Cortisone injections would be my last resort, as the possible side effects were the worst of the 3. So it was between the PRP therapy and the Prolotherapy. We decided on the Prolotherapy treatment, as it was a bit less invasive.

The following week I had my first appointment with Dr Bovard who would be giving me the Prolotherapy. I would be getting the injections once every week for 6 weeks. During this 6 weeks I was still allowed to run, but very limited. No longer then 45-50 mins, 5 times a week and only if the pain level in my heel was less then 4 out of 10. I was very happy I was still allowed to run at all.

I knew that the injections were going to hurt. Even though there was a numbing drug put in with the prolo solution, the first 20 seconds were pretty painful. The entire procedure is less then a minute, so really its not so bad. For the first few hours my heel felt good...cause it was numb! But then the next 24 hours it was very sore and tender. My heel was more inflamed then before....but this was the point- now my PF will start healing faster. That's kinda how prolotherapy is supposed to work...I think....hahaha I can't explain all the science behind it, so please goggle it if you really want to know exactly how it works.

So every Monday for 6 weeks I went in and got the injection. It has been almost 7 weeks since my last injection. Each week my heel was supposed to get better, and by the 6 weeks after my last injection, my heel should be much better. Well not sure that this is what has happened. I knew that Prolotherapy wasn't a miracle cure and that I wouldn't be 100% pain free. But I was hoping for close to that....Each week after the last injection I began to increase my mileage and the intensity of some of my runs- as long as the pain wasn't getting worse. Some days I felt almost nothing when I ran- it was amazing. I really felt like I was making progress, and that I was gonna kick this PF once and for all! But then there would be days where my heel was angry and painful again. In the last few weeks, progress has come to a standstill, and the pain remains on a daily basis. It is not bad like it was in the spring or summer, its manageable....but none the less there is still pain.

So did the Prolotherapy work? I definitely think it helped, but not to the extent I had hoped for. I am running pain reduced, but not pain free, which is obviously where I want to be. People who have had PF tell me that one day I will wake up and it will just be gone. It is hard to imagine just waking up one morning and having no pain in my heel. Just the thought of this happening brings a smile to my face. While I wait for this miracle to happen, I will continue to do my exercises, ice my heel, get regular massage and physio, and pool run on days when my heel is extra sore. As long as it's not getting worse....I feel like I'm making progress. And if things start getting bad again- well then I still have 2 treatments to try- PRP therapy or Corticosteroid injections..... Let's hope we don't have to try either of these....

For those of you that don't like needles....don't watch this.  Here's a video of Prolotherapy.  It's hard for me to watch, and think that I had that done to me!  Yikes. ouchy.