C1-2 prolotherapy

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clubdeac

clubdeac

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Check out this video. Through some late night internet research I went down a rabbit hole and stumbled upon this guy. Perused his clinic website and apparently he trained under the father/founder of prolotherapy. He also does a lot of PRP and stem cell injections. Anyone see anything awry in this video? I mean how on earth does he know where he is when only using lateral? Seems dangerous no?

 
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Nopes. Nah.

www.caringmedical.com

Ross Hauser, MD

Prolotherapist and Medical Director and co-founder of the comprehensive Prolotherapy and natural medicine clinic, Caring Medical.
www.caringmedical.com www.caringmedical.com

Physiatrist.

Watching the video it is clear he is not using the DMX ??? Xray like a fluoroscope. Needle deep enough to hit cord.
Unsure on training.
 
I was told 25 + years ago to learn Prolotherapy by a spine surgeon. Eventually I gave it up. But I did go to some conferences and watch some skilled people do it. To do it safely the way the experts do it you need to know the surface anatomy way better than most of us, and the technique is totally different than using imaging. You would almost have to become an apprentice to a Prolotherapist to be able to learn the difficult stuff. The easy stuff is not that difficult especially if you use imaging which I did (mostly for SI joint issues). Eventually I decided that Prolotherapy is simply a mild denervation procedure that stuns nerves for at least a month. I do not think it makes ligaments/tendons stronger. It can facilitate PT however.
 
willabeast said:
I was told 25 + years ago to learn Prolotherapy by a spine surgeon. Eventually I gave it up. But I did go to some conferences and watch some skilled people do it. To do it safely the way the experts do it you need to know the surface anatomy way better than most of us, and the technique is totally different than using imaging. You would almost have to become an apprentice to a Prolotherapist to be able to learn the difficult stuff. The easy stuff is not that difficult especially if you use imaging which I did (mostly for SI joint issues). Eventually I decided that Prolotherapy is simply a mild denervation procedure that stuns nerves for at least a month. I do not think it makes ligaments/tendons stronger. It can facilitate PT however.
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And how is the literature for all of this blind magic shots?
 
lobelsteve said:
And how is the literature for all of this blind magic shots?
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Never able to tell good lit from bad. To be truthful judgement is not one of my strong points. I am a keen observer however. Got to go with one's strengths. 🙂
 
lobelsteve said:
And how is the literature for all of this blind magic shots?
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The guy in that video apparently had published a bunch of studies that you can find in his website. I got too tried last night to read them. May do that during my flight tomorrow
 
I'd like to see the XRAY views.

Why are they not being shown?
 
MitchLevi said:
I'd like to see the XRAY views.

Why are they not being shown?
Click to expand...
He does show a couple laterals in that video. But without AP I don’t know how the hell he really knows where he is. Plus he’s performing multiple passes pretty fast. Too fast to get pics of every needle stick
 
clubdeac said:
He does show a couple laterals in that video. But without AP I don’t know how the hell he really knows where he is. Plus he’s performing multiple passes pretty fast. Too fast to get pics of every needle stick
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He's just peppering the hell out of everything and hoping for the best.
 
watched a video of another guy tonight do prolotherapy

patient set up under fluoro, and then received bunch of TPI injections with 1.5 in needle...

prolo isn't nonsense. i wasn't a "believer" until i started using dextrose in my practice. primarily medicaid population.

but the old school palpation guided stuff is really bad when it comes to accuracy. this guy in the video along with a lot of folks are just dangerous and don't realize they dont know what they dont know... they are fooling themselves and their patients with the skillset they think they have
 
on that video, he looks like he is lateral, but the needles are going down to the spinous process and no further.

as far as i am aware, the spinous processes of the spine are not lateral.


in the above clip - it is a static image and he is doing blind injections. if you watch closely as soon as the screen comes up, there is no needle at the location that he is doing the injection, the marker he uses is not on his supposed sterile field, and most importantly his hands are not showing up on the image screen and they are all over the field.
 
i should note that these are private practice doctors who are writing paychecks and doing excellence every day......


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Cost of Regenerative Medicine Stem Cell Prolotherapy & PRP Treatments

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lobelsteve said:
All this guy proves is that people are stupid and you can get away with trying to murder them by stabbing them in the neck, repeatedly, and failing to do so.
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Blame the charlatans don’t blame the patients

Bury your ethics, morals, sense of pride in your work and you too can be richly rewarded for bad work
 
The marketing on his website is very convincing. It’s extensive. If I were a medically uneducated patient desperate for relief I’d buy into it, at least initially. Very sad people are getting away with this kind of stuff. You’d think however if he consistently has poor outcomes or no results whatsoever he’d go out of business. That’s what confuses me
 
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clubdeac said:
The marketing on his website is very convincing. It’s extensive. If I were a medically uneducated patient desperate for relief I’d buy into it, at least initially. Very sad people are getting away with this kind of stuff. You’d think however if he consistently has poor outcomes or no results whatsoever he’d go out of business. That’s ever confuses me
Click to expand...
Strength of the placebo effect and luck of regression to the mean.
 
clubdeac said:
The marketing on his website is very convincing. It’s extensive. If I were a medically uneducated patient desperate for relief I’d buy into it, at least initially. Very sad people are getting away with this kind of stuff. You’d think however if he consistently has poor outcomes or no results whatsoever he’d go out of business. That’s what confuses me
Click to expand...

no way. how good are chiro "outcomes"? they have lines out the door.

i really wish it were the case, but financial success in medicine is not dependent on how good a job you do
 
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I was just about to bring up chiropractors
 
DOctorJay said:
I was just about to bring up chiropractors
Click to expand...
Allow me...

I saw a 44 yo woman today with bilateral trochanteric pain who was sent over by a chiropractor.

On 10/14/2022 she underwent MRI evaluation of CTL spine + both hips.

THAT IS FIVE FREAKING STUDIES.

...should lose their ability to order advanced studies IMO.
 
MitchLevi said:
Allow me...

I saw a 44 yo woman today with bilateral trochanteric pain who was sent over by a chiropractor.

On 10/14/2022 she underwent MRI evaluation of CTL spine + both hips.

THAT IS FIVE FREAKING STUDIES.

...should lose their ability to order advanced studies IMO.
Click to expand...
As much as i want to dump on the chiros, There are many md/dos who do same thing.
It seems daily that people will work up sciatica with an mri hip and knee. Oh your pain goes from your hip to your knee?
 
geauxg8rs said:
As much as i want to dump on the chiros, There are many md/dos who do same thing.
It seems daily that people will work up sciatica with an mri hip and knee. Oh your pain goes from your hip to your knee?
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True, but when I get chaotic imaging it is usually chiropractors through American Health Imaging, to include an occipital to coccygeal US evaluation once.
 
That is Ross Hauser, he is very experienced. I was trained and "apprenticed" in blind prolotherapy, and there is a reason I don't do it blind, especially in the spine. Most of these guys need to treat a spine region multiple times (3-7 times or so), primarily because they are randomly hitting targets (sometimes).
 
Ligament said:
That is Ross Hauser, he is very experienced. I was trained and "apprenticed" in blind prolotherapy, and there is a reason I don't do it blind, especially in the spine. Most of these guys need to treat a spine region multiple times (3-7 times or so), primarily because they are randomly hitting targets (sometimes).
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So would you say is it/he legit or is this all quackery?
 
One interesting thing; his patient appears to be seated, in a massage chair type device. I can see some benefits in imaging the c-cpine this way. Has anybody used fluoro in a seated position for c-spine work in non-obese patients?
 
Ligament said:
One interesting thing; his patient appears to be seated, in a massage chair type device. I can see some benefits in imaging the c-cpine this way. Has anybody used fluoro in a seated position for c-spine work in non-obese patients?
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One of my nearby colleagues does this. How he trained. Pretty cool.
 
oreosandsake said:
Blame the charlatans don’t blame the patients

Bury your ethics, morals, sense of pride in your work and you too can be richly rewarded for bad work
Click to expand...
treatments like these are why we as a profession have to be diligent about what we do and do more research
 
Ligament said:
That is Ross Hauser, he is very experienced. I was trained and "apprenticed" in blind prolotherapy, and there is a reason I don't do it blind, especially in the spine. Most of these guys need to treat a spine region multiple times (3-7 times or so), primarily because they are randomly hitting targets (sometimes).
Click to expand...
When they started recommending fluoro for epidurals the old dinosaur anesthesiologists mocked them.
Do you not know how to feel it?
When the young anesthesiologists wanted fluoro the old dinosaurs said did we not teach you how to use your hands?

Then the studies came out and non image guided injections were only in the epidural space 40 percent of the time. Experience counts if it’s good experience. A lot of bad experience just reinforces how crappy you can be and still think the world of yourself
 
Brought this up with a senior partner, he said he used to do prolo for posterior ligament pain with good results in select patients but it was a lengthy/expensive/painful process. He stopped many years ago. He relayed a case he reviewed in which a young lady underwent cervical prolo and ended up hemiplegic after a cord injury.
 
Ligament said:
One interesting thing; his patient appears to be seated, in a massage chair type device. I can see some benefits in imaging the c-cpine this way. Has anybody used fluoro in a seated position for c-spine work in non-obese patients?
Click to expand...
an attending of mine, a world class anesthesiologist pain doc i greatly respect, wanted to show me a bedside CESI.

i grabbed all the materials and we brought it to the exam room. we flipped around a chair, and had the patient sit down and hug some pillows bent over the back of the chair. we palpated spinous prominence and the SP of the level above. he went midline straight down. he got LOR. there was 3 ml of injectate in a 5 ml syringe. before injection, he aspirated.

the syringe filled with clear fluid.

I dont remember if i gasped or not, but I looked at him in alarm. it didn't even faze him. he looked at me, I looked at him. he pulled the needle back a few mm and injected. I put a bandaid on the patient.

i followed my attending out of the room after making sure the patient was okay. I asked my attending, what do you do when that happens? He said, don't worry, he'll be fine. I watched him for a bit, he never developed a headache as far as I knew of. for those of you who think you know who this is, It's not him.
 
yes, this was the standard practice.

nothing to be alarmed about. nothing to see. move on to the next one.

one attending noted that epidurals in which fluid came back - not optimal - she was more convinced the needle was epidural.

very few people developed headaches.
 
oreosandsake said:
an attending of mine, a world class anesthesiologist pain doc i greatly respect, wanted to show me a bedside CESI.

i grabbed all the materials and we brought it to the exam room. we flipped around a chair, and had the patient sit down and hug some pillows bent over the back of the chair. we palpated spinous prominence and the SP of the level above. he went midline straight down. he got LOR. there was 3 ml of injectate in a 5 ml syringe. before injection, he aspirated.

the syringe filled with clear fluid.

I dont remember if i gasped or not, but I looked at him in alarm. it didn't even faze him. he looked at me, I looked at him. he pulled the needle back a few mm and injected. I put a bandaid on the patient.

i followed my attending out of the room after making sure the patient was okay. I asked my attending, what do you do when that happens? He said, don't worry, he'll be fine. I watched him for a bit, he never developed a headache as far as I knew of. for those of you who think you know who this is, It's not him.
Click to expand...
What size needle were you using?
 
Whatever Ross Hauser wrote on cranio-cervical instability became a pain in the ass to me for one patient. I'm the only doc local in my system who does prolotherapy although very rarely in the cervical spine. Some patient saw an outside chiropractor who "specializes" in high cervical stuff and he recommended prolotherapy. Then patient looked this up, asked her spine doctor about it, and somehow my name got out. (Disclaimer: I'm salaried in an HMO system. I get no extra incentive from a productivity/financial/scheduling standpoint to do prolotherapy - only potential benefit is to the selected patient.)
 
melancholy said:
Whatever Ross Hauser wrote on cranio-cervical instability became a pain in the ass to me for one patient. I'm the only doc local in my system who does prolotherapy although very rarely in the cervical spine. Some patient saw an outside chiropractor who "specializes" in high cervical stuff and he recommended prolotherapy. Then patient looked this up, asked her spine doctor about it, and somehow my name got out. (Disclaimer: I'm salaried in an HMO system. I get no extra incentive from a productivity/financial/scheduling standpoint to do prolotherapy - only potential benefit is to the selected patient.)
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Ughhh that sucks. I'm sorry. Out of curiosity where exactly are you injecting prolo in the cervical spine? facets? supraspinous ligament? mutifidi? and more importantly do you see good results
 
I had a “discussion” with a PA about how fluoro was unnecessary for knee injections. I said for steroids sure cuz it spreads into the capsule if you miss. But for PRP I can’t miss. I brought up a study from 2012 where 20% of blind knee injections missed.
 
Doctodd said:
I had a “discussion” with a PA about how fluoro was unnecessary for knee injections. I said for steroids sure cuz it spreads into the capsule if you miss. But for PRP I can’t miss. I brought up a study from 2012 where 20% of blind knee injections missed.
Click to expand...

there are studies where in well trained hands, (sports med, ortho) anatomically based injection for the KNEE is not in the joint capsule 40% of the time...

ask the PA to define what the capsule is... people grasp onto a small piece of knowledge and think it's the entire iceberg. they really do not realize how little they know. humility goes a long way. same with hubris
 
clubdeac said:
Ughhh that sucks. I'm sorry. Out of curiosity where exactly are you injecting prolo in the cervical spine? facets? supraspinous ligament? mutifidi? and more importantly do you see good results
Click to expand...

people do everything. shotgun... especially the prolo anatomically based techniques. palpation is great, but it's often also blind poking when you watch them perform these things. selection bias in these patients and practitioners as well. (as with all interventions)

but i've had some surprising results with facet capsule and ligament injections with dextrose, all US guided.
 
saw a guy boasting on a post of him using a 18G RF cannula and doing pRF via C TF for the DRG. guy injected a ton of contrast and used DSA. it all ran to the subclavian vein. he didn't even recognize that all of his contrast was running away. and a tiny pinch of it stayed at the end of the fluoro run. wonder if he would have recognized it if the contrast ran up towards the brain before the patient stroked out
 
clubdeac said:
Check out this video. Through some late night internet research I went down a rabbit hole and stumbled upon this guy. Perused his clinic website and apparently he trained under the father/founder of prolotherapy. He also does a lot of PRP and stem cell injections. Anyone see anything awry in this video? I mean how on earth does he know where he is when only using lateral? Seems dangerous no?

Click to expand...

I do this same procedure in my clinic sometimes.

Mine is a little different however.

I don't use fluoroscopy.

I don't touch OS.

I use a 30g 1/2 inch needle.

I only use local.

OH, and also, I call mine a trigger point.

But other than that, exactly the same.
 
epidural man said:
I do this same procedure in my clinic sometimes.

Mine is a little different however.

I don't use fluoroscopy.

I don't touch OS.

I use a 30g 1/2 inch needle.

I only use local.

OH, and also, I call mine a trigger point.

But other than that, exactly the same.
Click to expand...
If a 1/2 inch needle gets into muscle, you've got a different patient population than I do.
 
clubdeac said:
Ughhh that sucks. I'm sorry. Out of curiosity where exactly are you injecting prolo in the cervical spine? facets? supraspinous ligament? mutifidi? and more importantly do you see good results
Click to expand...
Don’t do C-spine much these days but if you go based on traditional landmark based prolotherapy, injectate goes to ligamentum nuchae/supraspinous ligaments, multifidi and proximity of the facets. Tendinous attachments to the superior and inferior nuchal lines are fair game if significant tenderness as well. The main prolotherapy organization (IART which has generated from the Hemwall-Hackett Patterson foundation) is working on updated protocols to define more basic vs advanced structures to address.
Pretty picky about my cervical spine patients I do prolotherapy on and set expectations early on. I’d say majority get some functional improvement (improved activity tolerance) but pain relief is variable. Def not a one size fit all and use it within context of a rehab plan. Often times have to address other overlapping pain generators (myofascial pain, nerve entrapment) or take a step back and look at adjacent regions.
Depending on size of neck and location, I’ll use anywhere from 30g 1in to 27g 1.25 inch.
 
epidural man said:
I do this same procedure in my clinic sometimes.

Mine is a little different however.

I don't use fluoroscopy.

I don't touch OS.

I use a 30g 1/2 inch needle.

I only use local.

OH, and also, I call mine a trigger point.

But other than that, exactly the same.
Click to expand...
I owe my middle finger callus to the 30g 1/2 inch needle
 
clubdeac said:
So would you say is it/he legit or is this all quackery?
Click to expand...
oreosandsake said:
There are charlatans in every profession. Hard to regulate. Buyer beware
Click to expand...
Amen to that...he has been sued at least seven times for medical malpractice and once for wrongful death, and has injured many trusting patients, here are several links of interest, highlighting the tactics of this PT Barnum. Oh and by the way, he used to cure cancer...

Ross Hauser

Ross Alan Hauser practices an quack medical practice called prolotherapy[1] in Florida. He is a physiatrist, a physician who specializes in physical rehabilitation.[2] He has promoted an unproven[1] and potentially dangerous prolotherapy injections as treatments for a large assortment of...
rationalwiki.org rationalwiki.org
web.archive.org

Ross Hauser Review - How to Ruin Your Life with Prolotherapy

Here you can read my Caring Medical review and side effects from Ross Hauser's prolotherapy treatments. Plus, many other patients' feedback.
web.archive.org
 
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