Subcutaneous Peri-neural Injections

Subcutaneous means “under the skin.”

perineural handout

What is Subcutaneous?

Subcutaneous means “under the skin.” A very new wrinkle on prolotherapy has been proposed and advanced by a physician in New Zealand, named John Lyftogt (pronounced “Lift-off.”) In the center,you see a needle (very small,almost hair-thin) penetrating just under the skin into the subcutaneous layer.

What runs right under the skin? The photo to the left shows nerves just under the skin of the knee joint and to the right nerves just under the skin from the lower back and upper buttock areas behind the hip joint. Through the fascia you see some smaller nerves that run right under the skin which are subcutaneous nerves.

Hilton’s Law

There is a principle called “Hilton’s Law” that says that the nerve that supplies sensation to a joint also supplies sensation to the skin over that joint and the muscles that move that joint. This law suggests, if a nervethat supplies sensation to the skin over a joint is irritated, thenit may affect (cause pain and change function) in the joint or muscles around that joint.

What Dr. Lyftogt did?

He knew of the concept that nerves under the skin can be a source of pain. Instead of injecting only anesthetic, which is a typical nerve block but has no long term benefit, he injected dextrose along with a small amount of anesthetic around the nerves just under the skin. He did this because nerves are soft tissue also, and because they are composed of a lot of connective tissue. He reasoned that dextrose heals other connective tissue and may help nerves function better.

What Dr. Lyftogt found?

When he injected just under the skin along the course of the nerve in small increments rather than in one or two locations, he found that local swelling improved in the area, the pain reduced, and function improved. The reason for abnormal nerve function is thought to be a kinking or other change in the nerve as it penetrates muscle or fascia. Then the nerve begins to develop abnormalities all along its length.

What Dr. Lyftogt Proposed

Nervi nervorum are small nerves that supply the subcutaneous nerves themselves and connect with the subcutaneous nerves at intervals. Because they connect at intervals with the nerve, they are suspected as being the primary target of subcutaneous peri-neuralinjection prolotherapytreatment.

How does subcutaneous prolotherapy relate to regular prolotherapy?

Prolotherapy is injection to promote regeneration or repair in connective tissue.

Subcutaneous peri-neuralprolotherapy is injection to promote regeneration, repair or other functional restoration in subcutaneous nerves which are composed largely of connective tissue

Why is subcutaneous prolotherapy potentially so important?

Treating subcutaneous nerves may make it unnecessary, at least in part, to treat deeper structures, as the source of persistent lack of healing in deeper structures and their pain appears to be directly connected to dysfunction in the subcutaneous nerves. Much needs to be learned and studied about this treatment and the ideal combination of deep and subcutaneous prolotherapy. It may be that healing in deeper structures will take place spontaneously if the nerves above the deeper structures are returned to normalcy.

Frequency of Treatment

The treatment has been proposed as a weekly or bi-weekly treatment until the pain generators are shut down or required results are obtained.

How Subcutaneous Prolotherapy Is Used In Our Practice?

When providing care for different types of joint pain the approach must be comprehensive. The key to a comprehensive approach is understanding what happens with painful joints.

There is a sequence that must be understood to resolves chronic or acute joint pain. When a joint is painful for whatever reason, a reflex occurs called the Arthrogenic Muscle Inhibition Reflex. This reflex weakens the muscles that support a painful joint. This is why you can’t exercise away a painful joint, because the reflex prevents the muscle from strengthening. Next in the line is the Kinetic Chain. You remember the saying the ankle bone is connected to the knee bone etc. This means that a painful knee joint will affect the joints that are adjacent to it, and so on along the chain of connected joints.

Along with many other treatments we provide, subcutaneous peri-neural prolotherapy injection SPPI, also called Peri-neural Prolotherapy PNP is one of many new tools used to treat joint pain.



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