Prolotherapy is an injection technique that has been shown to grow cells and tissue that help stabilize and strengthen weakened joints, cartilage, ligaments and tendons. Prolotherapy injections cause controlled inflammation which increases blood circulation to chronically damaged and injured areas in the joints. Increased blood circulation stimulates the tissue to heal and regrow new tissue.
Introduction to Prolotherapy
A basic introduction and information article for new Prolotherapy patients. In this article the most common questions about the Prolotherapy treatments and injections are explained.
What is Prolotherapy?
Prolotherapy is also known as non-surgical ligament reconstruction, and is a permanent treatment for chronic pain. Prolotherapy is derived from the Latin word “proli” which means to regenerate or rebuild. It is important to understand what the word PROLOTHERAPY itself means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.
10 Tips to Determine if You Are A Good Prolotherapy Candidate
“Good” Prolotherapy candidates often possess many, if not all, of the above 10 criterion.
Prolotherapy Safety
Side effects related to prolotherapy for back and neck pain, such as temporary post-injection pain, stiffness, and bruising, are common and benign
How Does Prolotherapy Work?
The term “Prolotherapy” is short for “proliferation therapy.” Proliferation, of course, means “rapid production.” What Prolotherapy rapidly produces is collagen and cartilage. Collagen is a naturally occurring protein in the body that is a necessary element for the formation of new connective tissue—the tissues that holds our skeletal infrastructure together. These tissues include, tendons, ligaments, muscle fascia and joint capsular tissue.
Prolotherapy in Primary Care Practice
Many doctors have begun using Prolotherapy in their practice. Many times these doctors begin their initial treatments on themselves, friends, and relatives. For many patients who complain that Prolotherapy was not an effective treatment for them, many times the reason is the expereince of the doctor using Prolotherapy in Primary Care Practice as oppossed to a Prolotherapy Care practice.
When Prolotherapy Does Not Work
Prolotherapy is effective in markedly reducing or curing musculoskeletal pain 80-90% of the time. Many end-stage medical problems are worth a trial of prolotherapy, especially if the only alternative is a destructive or permanent alteration of a joint, such as a surgical fusion or the destruction of a nerve. The greater the anatomical injury, the more difficult it is resolving the problem.
The History of Prolotherapy
The concept of Prolotherapy originated in the non-surgical treatment of hernias, varicose veins, and hemorrhoids, all conditions which are due to connective tissue weakness. If the connective tissue in the veins becomes weakened, hemorrhoids and varicose veins form. Weakness in the collagen, of course, causes ligament laxity and tendon degeneration with resultant chronic pain.
Prolotherapy: Creating Inflammation in an Area that is Already Inflamed
Our bones and muscles are held together by the aptly named connective tissue. Connective tissues are ligaments, which connect bone to bone, and tendons, which connect the bones to muscles. It is also the fascia covering muscles and the joint capsule tissue.
The Growth Factor Basis For Prolotherapy
For many years, the positive effects of Prolotherapy were thought to be mainly based on the concept of inflammation and minor damage induced by the injection of irritating solutions, with subsequent healing of the injured areas. The benefit of solutions containing strong alcohol solutions, ground-up pumice stone, and other such recipes suggest that this is indeed one of the mechanisms of the strengthening and healing response seen with Prolotherapy.
Can Any Research Prove That Prolotherapy Works?
Before double-blinded studies, doctors would ask patients if they felt better. If patient after patient told the physician they felt better, than it was presumed and accepted that the therapy was effective. If it was a new therapy, then it was taught doctor to doctor and eventually it was taught in medical schools. If this was still the standard upon which medical therapies were judged, then clearly Prolotherapy would be taught in all the medical schools, but it is not. Why not?
What’s the Proof Prolotherapy is Working?
This is a common question asked by people just about to receive Prolotherapy for the first time. Typically there are several variables that are looked at to make sure the Prolotherapy is achieving the results the person desires.
Prolotherapy
Stephen W. Blievernicht, MD, FACS
George S. Hackett, M.D., and two Philadelphia osteopathic surgeons discovered Prolotherapy in the 1920’s. Since its inception, it has been called Proliferative Therapy, Reconstructive Therapy and Sclerotherapy.
Prolotherapy is an injection technique that has been shown to cause proliferation (growth) of cells and tissue to stabilize and strengthen weakened joints, cartilage, ligaments and tendons. The injected solution intentionally causes controlled irritation in the injected tissue. This irritation is an inflammatory response, which increases the blood supply and thereby stimulates the tissue to heal and regrow new tissue.
For example, let’s look at the spine. It is composed of bone, tendons, ligaments, discs and cartilage. Discs and cartilage serve as shock absorbers and keep bones from rubbing against one another. Ligaments function as the primary stabilizers of joints. They connect bones to each other and function to limit the range of motion that bones can move. Tendons connect muscles to bones in order to provide motion. In acute injuries, the ligaments and tendons become torn and are unable to stabilize joint areas. This causes the discs or cartilage to become worn down from increased stress, pressure and friction. Discs and cartilage may also be worn down by repeated motion. This ultimately leads to joint instability resulting in constant pain, less and less mobility, and lack of endurance.
Stimulating repair of the supportive tissues of the spine (or any joint) through Prolotherapy can result in greatly improved stability, mobility and decreased pain. Each treatment session results in the stimulation of more and more tissue repair in the treated areas. Thus, the natural functions of the body are regained. In almost all cases, pain reduces significantly or disappears entirely. Prolotherapy can be administered wherever ligaments, tendons, cartilage and/or discs are torn and worn. It is not effective for all joint pain. Rheumatoid arthritis, for example, is not helped by Prolotherapy, but Osteoarthritis and degenerative arthritis often respond well.
Physician assessment of the appropriateness of any particular condition for Prolotherapy will occur during the first office visit.
Addressing energetic disturbances created by scar tissue on the skin from injury or surgical incisions is also part of Prolotherapy, which a trained physician will address by the injection of a local anesthetic into reactive scar tissue.
The therapies currently available to persons with chronic joint instability and pain are anti-inflammatory medication, cortisone, pain medications, exercise, surgery, and chiropractic care.
Persons treated with Prolotherapy are unable to use non-steroidal anti-inflammatory drugs or NSAIDS (like Aleve, Ibuprofen, aspirin, Celebrex, Vioxx) or Cortisone during the course of their treatment with Prolotherapy. The desired inflammatory response to the injections is critical to Prolotherapy success and cannot be blocked by such drugs without risking failure of the Prolotherapy treatment. In addition, the innate risks of the long-term use of NSAIDs have been demonstrated clinically in the impairment of organ systems as well as the breakdown and deterioration of the musculoskeletal system.
Cortisone drugs (steroids) have numerous serious local and systemic effects. Their chronic use weakens natural defenses, risks further deterioration of joint tissues when injected locally, can be associated with a progressive lack of blood supply to the head of the femur called avascular necrosis which may necessitate hip joint replacement, increases the risk of acquiring diabetes, and has the potential for psychiatric side effects.
Drugs to treat muscle spasm may be used concurrently with Prolotherapy, but those which are compounded with anti-inflammatory drugs, as many are, should be avoided.
Pain medications generally alleviate symptoms while leaving the pathology unaltered. This is akin to someone putting tape over the red engine light on the dashboard of his car. During Prolotherapy, analgesic (pain-relieving) medications may be prescribed for short term use during the immediate post treatment period to relieve the discomfort that may occur during the acute inflammatory process the treatment produces in order to heal.
Exercise can strengthen muscles but further weaken tendons, ligaments and cartilage that have poor blood supply, worsening the joint instability. Specific stretching exercises, however, can increase blood supply to tendons and ligaments and preserve mobility.
Surgery often leaves the joint mechanically compromised as removal of tissue permanently alters complex joint physics consisting of levers and pulleys. Surgery remains the method of choice for severed tendons and ligaments, and replacement of eroded bone necessitating joint prosthesis.
Chiropractic optimizes structure by enhancing nervous system functioning and is capable of removing obstacles to healing. However, it has inherent limitations to effect healing to the degree necessary to stop pain by regenerating new tissue.
The “Pros and Cons” of Prolotherapy
First, the “Cons”:
The injections are experienced as being uncomfortable by many patients. (Some of this discomfort during treatment can be ameliorated by a variety of techniques including pre-medication, conscious sedation, guided imagery, and breathing and relaxation exercises. We are happy to explore these adjunct comfort therapies with you).
The injections typically need to be repeated a number of times over a period of a few months.
The person treated will likely experience a few days of increased swelling and discomfort at the injection site-a necessary part of the healing process.
Not all insurance companies reimburse for the treatment.
And now, the “Pros” and benefits:
It promotes the body’s own natural healing ability.
The natural functions of the body are regained and optimized.
No drugs or surgery are used.
It relieves pain.
In a double blind human study where neither the patients nor the researchers knew specifically who was receiving the treatment, 88.5% of those injected with the Prolotherapy solutions showed improvement.
Results are permanent (though aging continues).
It is a conservative treatment.
The solutions used are made from natural ingredients.
It is considerably less expensive than surgical intervention.
Enhancing the body’s innate ability to heal is characteristic of many treatments offered at the Phoenix Medical Center and is often the hallmark of a well thought out medical approach, which minimizes adverse effects. Personalizing and tailoring the course of Prolotherapy to the needs of the individual client and his or her physical and emotional constitution are essential elements of our integrated and holistic approaches to pain care.
Adapted from “Prolotherapy for Chronic Joint and Spine Pain” by
Stephen W. Blievernicht, M.D., F.A.C.S., published in Carolina Health and Healing,1999.
Conditions treated by Prolotherapy
Ross Hauser, MD
Prolotherapy helps relieve the chronic pain of many conditions but here are the top ten.
Prolotherapy for Chronic Low Back Pain
Chronic low back pain encompasses a lot of different conditions including degenerative disc disease, spondylosis, spondylolisthesis, sacroiliac ligament laxity and others. Since these conditions generally have as their etiological basis ligaments being stretched, torn, and weakened Prolotherapy is needed. Typically three-six visits are all that is needed to relieve the pain.
Prolotherapy for Chronic Neck Pain
Like chronic low back pain, chronic neck pain has ligament weakness as a common underlying cause. This can lead to Degenerative Disc Disease in the neck, herniated discs, and myofascial pain syndromes. Typically three-six visits are all that is needed to relieve the pain.
Prolotherapy for Chronic Headaches
I believe because most of us are spending more and more time looking at a computer screen with our necks in poor posture, headaches are on the rise. The forward head posture puts a strain on the posterior ligaments. As these weakened, neck muscles spasm and referral headaches occur. Prolotherapy helps all types of headaches including tension, cluster, and migraine headaches.
Prolotherapy for TMJ Syndrome
Perhaps the most used joint in the body is the TMJ. The tempomandibular joint is stressed every time a person talks or eats. Anyone who has clicking in the joint has a good chance of having ligament injury in the jaw. Prolotherapy is a great alternative for TMJ syndrome. It helps strengthen the TMJ ligament, often resolving a chronically painful, clicking joint.
Prolotherapy for Knee Arthritis
Athletes are especially prone to knee arthritis. It is also a very large joint which orthopedic like to inject with steroids. These facts combined with the massive use of anti-inflammatories, make knee arthritis very common. About 250,000 Americans each year get knee replacement. A much better option for knee arthritis is Prolotherapy. Depending on the extent of the arthritis anywhere from 3-15 sessions of Prolotherapy are needed.
Prolotherapy for Rotator Cuff Injury
Most shoulder pain is from an injury to the Rotator Cuff. The most common muscle/tendon of the rotator cuff that gets injured is the supraspinatus. The supraspinatus muscle/tendon is an external rotator of the shoulder. It gets a lot of strain/stress when the shoulder ligaments are weakened. This, in addition to the fact that the blood supply to the supraspinatus tendon attachment on the humerus is poor make injury likely especially in people who use their shoulders a lot. Prolotherapy to the rotator cuff attachments onto the shoulder, as well as the shoulder ligaments, is extremely effective at helping chronic shoulder problems resolve. Typically three-six visits of Prolotherapy are all that is needed.
Prolotherapy for Annular Ligament Injury
People understand the term ‘tennis elbow’ but most chronic elbow problems are annular ligament injury. This ligament is stressed during rotation of the elbow. So any athlete who throws or a person who has an occupation using the elbow, such as carpenters and people who type a lot, are prone to annular ligament injury. Generally again three-six visits of Prolotherapy are needed to resolve the problem.
Prolotherapy for Chronic Ankle Sprains
The most common ligament injury in the body is an anterior talofibular ligament injury or ankle sprain. People don’t realize it but one third of all ankle sprains don’t heal completely. Eventually if the ligament injury is not healed, arthritis occurs in the ankle. It is best to treat ligament injuries early before arthritis develops. Again three-six visits of Prolotherapy are needed. If there is arthritis in the ankle then up to 15 visits may be needed.
Prolotherapy for Trochanteric Pain (Hip Pointer)
It is common for people to have pain on the side of the hip. There is a big bone upon which ‘the pain’ sits called the greater trochanter. This is where the gluteal muscles attach. Typically a person is diagnosed with trochanteric bursitis, but the pain is not from a true inflammation of the bursa (fluid filled sac) but just weakness in the muscle/tendon attachments at this site. Prolotherapy onto the greater trochanter bone typically resolves the problem in three-six visits.
Prolotherapy for Fibromyalgia
Yes even people with body pain need Prolotherapy. If a person has whole body pain, they will often have one to three areas that hurt a lot more than others. These are the ones that need Prolotherapy. To get rid of the rest of the body pain the person needs a good nights sleep and to balance body chemistry. So for fibromyalgia typically Prolotherapy is combined with natural medicine. The whole process takes typically a year.
Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951.
Kim E, Lee JH. Autologous Platelet-Rich Plasma Versus Dextrose Prolotherapy for the Treatment of Chronic Recalcitrant Plantar Fasciitis. . PM R. 2013 Jul 19. pii: S1934-1482(13)00369-9. doi: 10.1016/j.pmrj.2013.07.003.