PROLOTHERAPY FOR BURSITIS
Ross Hauser, M.D.

Almost everyone who comes to my office for Prolotherapy for the treatment of bursitis doesn’t have bursitis.  Once in my life I had a true bursitis and when I did, I couldn’t let anything even touch the skin over it because it was that painful. The person who lets a doctor palpate the area with a lot of pressure with the thumb does not have bursitis. They have ligament sprain or tendon strain or other soft tissue injury. 

Regardless if the person has a true bursitis or some other injury causing the pain, the structure that needs treatment is either a ligament, muscle or tendon.  True bursitis is an Inflammation of the bursa or fluid filled sac that is between a bone and a soft tissue structure.  One can have an olecranon bursitis (bursal sac inflamed between the elbow bone and the triceps tendon), greater trochanteric bursitis (bursal sac inflamed between the hip bone and glutei muscle attachments), calcaneal bursitis (bursal sac inflamed between the calcaneus and Achilles tendon), and numerous other bursitis’s.  The bursal sac becomes inflamed because of injury to the soft tissue structures.  The bursal sacs are there to decrease the friction of the soft tissue structure and the underlying bone.  They let the tendon or muscle glide across the bone more easily.

As mentioned above, most people diagnosed with bursitis don’t have it.  Most have been given Steroid injections by the orthopedist to decrease the inflammation of the bursitis.  Since they didn’t have a true bursitis it is no wonder the steroid shot didn’t work to eliminate the pain. What it did do though is cause degeneration of the ligament, tendon, or muscle around which it was injected.  That is what steroids do to soft tissue structures, they weaken them.  They inhibit fibroblastic proliferation or the process by which soft tissue structures such as ligaments, tendons and muscles grow and repair. 

Prolotherapy is the treatment to stimulate the body to repair painful areas. True bursitis is painful as is ligament, tendon and muscle injuries.  For the person diagnosed with bursitis, consider that the diagnosis maybe incorrect.  If you can touch the area, a visit to a Prolotherapy doctor will reveal what structure is causing the pain. 

In the elbow it is typically the extensor tendons or annular ligament, in the ankle region it is the Achilles tendon and in the hip it is the soft tissue structures that attach to the greater trochanter including the glutei muscles.  Prolotherapy to these soft tissue structures stimulates them to repair.  Once they are fully repaired the ‘bursitis’ pain resolves.  In our opinion, a better approach for true bursitis is Prolotherapy and neural therapy.  It can take up to six sessions, but most often three or four sessions.