Dr. Stephen G. Cavallino Prolotherapy /Neuralprolotherapy Ferrara, Italy
BACKGROUND
•1989 - Graduated Medical School at the Università di Bologna, Italy
•Residency in Emergency Medicine -Ferrara, Italy
•Fellowship-Musculoskeletal &Rihabilitation at Rizzoli Ortopedics’s Istituto, Bologna, Italy
•Prolotherapy Training 2001
2001 Started private practice
CHRONIC PAIN
•Shoulde
•Low back
•Elbow
•Midback
•Wrist
•Neck
•Hand
•Headaches
•Hip
•TMJ
•Knee
•Ankle
•Foot
SOUNDS FAMILIAR?
Frustration with chronic pain. Negative workup deemed nonsurcial. Frustrated with the results of the usual traditional and conservative measures. This includes rest, NSAIDS. Analgesics, modaliteis, physical therapy, massage, acupuncture, movement classes, indlucing alexander , Pilates, yoga….still, many patients continued to have pain.
More courses
•Manipulations
•Steroid injections
•Epidurals fluoroscopy
•Prolotherapy
Prolotherapy is the best treatment for
musculoskeletal pain
What is Prolotherapy?
•Prolo----Proliferate
•Ligament regenerative injections
•Causes mild inflammation, which is the body’s own way of healing itself. This is by stimulating the fibroblasts to lay down of collagen, thickening and tightening ligaments and tendons, stabilizing joints and reducing pain.
CHRONIC NECK PAIN
Most chronic neck pain occurs either in the neck or the back regions, most likely because we carry stress o life that seems to accumulate in these two areas. Unfortunately, many people get diagnose with sprain/stress and given muscle tension is given. As with other pain, most are caused by weakness in ligaments and tendons, which account form most chronic headaches neck and ear pain. Prolotherapy has been able to
POSTURAL DISTORTION
PROLOTHERAPY PEARLS
•Always Inject on Bone
–“Weakness is at the Weld”
•Know Anatomy
–Anatomy, Anatomy, Anatomy
The anterior portion of the vertebral column provides weight
bearing and shock absorbing and mobility in all directions.
Ligaments are the structure that binds the bones together Tendons are the structures that bind the muscle to the bones.
In the skull, the ffng structures are identified:
superior nuchal line
Inferior nuchal line occiital condyle
Jugular process- attaches posterior neck muscles.
Recurs capitals lateralis
Basilar process of the occipital bone
serves as the attachment of the ligamentum nuchae,
strong lgmt that extends from C7 vertebrae to the skull.
Muscles of the head—longus capitis and rectus capitis anterior
ALL and PLL extends the entire length of the column Ligament flavum are between the laminae of adjacent vertebrae Ligament intertransvese, interspinalis and supraminalis and Ligamentum nuchae, which Is
MUSCLES OF CERVICAL SPINE 
•Flexors
–Scalene
–longus cervicus
–sternocleidomastoid
Superior nuchal ridge serves as the attachment of the
trapezius and sternocleidomastoid.
MUSCLES OF CERVICAL SPINE
•Extensors
–Iliocostalis cervicis
–Longissimus cervicus
–Splenius cervicis
–Semispinalis cervicis
–Spinalis cervicis
Extensor of head: subocccipital muscles
connect the cerv vert to the occipital
bone
splenius capitis.
Semispinalis capitis and semispinalis cervices
are extensor muscles.
—Covered by the splenius
BARRE LEIOU SYNDROME
CERVICAL SYMPATHETIC SYSTEM
•Rich anatomical network of autonomic fibers
•Supports brain function and high density of pain afferents
•Head, neck and upper extremity interconnected through
BARRE-LEIOU SYNDROME POSTERIOR CERVICAL SYMPATHETIC SYNDROME
•Barre-Leiou 1926
–Irritation of cervical sympathetic chain by disease or trauma, blocking the supply and causing myriad symptoms
Cervicogenic Headache
•Barre: Posterior sympathetic cervical syndrome--dysfunction of the vertebral nerve
•Compression of vertebral artery and its perivascular nerve supply
•Injury of the cervical spine
CERVICOGENIC HEADACHE
•Autonomic changes
–Dizziness
–Skin feeling woody or swollen
–Disturbances of equilibrium
–Vertigo
–Nausea, vomiting
–Auditory phenomena
–Visual abnormalities
CERVICOGENIC HEADACHE
•Pain reproduced by palation of upper cervical spine or by specific neck positions or movement
•Presence of typical trigger points
HEAD- POSTERIOR OCCIPUT
•Muscle Attachments
–Superficial -Superior Nuchal Line
•Trapezius
•Sternocleidomastoid
HEAD- POSTERIOR OCCIPUT
•Muscle Attachments
–Intermediate
•Spinalis Capitus
•Semispinalis Capitus
•Splenius Capitus
•Longissimus Capitus
•Superior Obliquus Capitus
HEAD- POSTERIOR OCCIPUT
•Muscle Attachments
–Deep -Inferior Nuchal Line
•Rectus Capitus Posterior Minor
•Rectus Capitus Posterior Major
HEAD- POSTERIOR OCCIPUT
•Injection Technique – Biconvex Curve
–Superficial/Intermediate
•Superior Nuchal Line
•30-45 Degree Angle
•Increase Angle Toward Midline as you Move Laterally
HEAD- POSTERIOR OCCIPUT
•Injection Technique – Biconvex Curve
–Deep
•1-1.5 Cm. Caudal to Superior Nuchal Line
•45 Degree Angle
•Increase Angle Toward Midline as you move Laterally
NECK-SKELETAL LANDMARKS 
A.Spinous Processes
1. C2 – Midline Below Occiput
2. C7 – Vertebra Prominens
Use Head Extension Technique to - IdentifyC7—T1
3. C3 – C6 – About a Fingerbreadth Apart
-From C2 – C7
NECK-SKELETAL LANDMARKS
B. Lamina/ Facets
With the Neck in Flexion, Lamina and Facet are
Vertically Aligned
with the Spinous Process at the Same Level
NECK-SKELETAL LANDMARKS
C. Transverse Processes
1. C1 – Easily Palpable Between the Mastoid
and Mandible
2. C7 – Very Prominent Laterally Just Above First Rib
3. C2 – C6 About One Fingerbreadth Anterior to
Facets, and One Fingerbreadth Apart
NECK –INJECTION TECHNIQUE 
A.Spinous Processes
1. Midline; 45 Degree Angle in Caudad Direction
2. Patient MUST Maintain Cervical Flexion
NECK –INJECTION TECHNIQUE 
B. Lamina
1. One Fingerbreadth from Midline
2. Maintain 45 Degree Angle Toward Midline
NECK –INJECTION TECHNIQUE
C. Facets
1. Two Fingerbreadths from Midline
2. Maintain 45 Degree Angle Toward Midline
NECK –INJECTION TECHNIQUE
D. Transverse Processes C1
1. Place Index Finger on TP
2. Move Finger Caudally Until it Touches the
Inferior Aspect of TP
3. Insert Needle Straight in Above Finger Until it Contacts
NECK-SKELETAL LANDMARKS
D. Transverse Processes-C2 to C7
1. Isolate TP Between Two Fingers
2. Needle Orientation is Toward Posterior Cervical
3. ALWAYS Aspirate Before Injection
4. Spinal Nerves and Basovertebral Artery are in Close Pro
Studio Medico ed Ambulatorio Fisiokinè P.le Finzi n°2 42015 Correggio(RE)- Tel-0522 637256
Info@proloterapia.it