What Is Prolotherapy
Prolotherapy is a method of injection treatment designed to stimulate healing. Prolotherapy owes its origins to the innovation of Dr. Earl Gedney, an osteopathic physician and surgeon.
In 1937, Gedney published “The Hypermobile Joint,” the first known article about Prolotherapy (then called “sclerotherapy”) in the medical literature. The 1937 article gave a preliminary protocol and two case reports – one of a patient with knee pain and another with low back pain – with both successfully treated with this method. Gedney followed up this paper with a presentation at the February 1938 meeting of the Osteopathic Clinical Society of Philadelphia which outlined the technique. The solutions used then (and now) are primarily dextrose-based, although other formulas are used and can be effective. Prolotherapy is practiced by physicians worldwide and has been shown effective in treating many musculoskeletal conditions – such as tendinopathies, ligament sprains, back and neck pain, tennis/golfers elbow, ankle pain, joint laxity and instability, plantar fasciitis, shoulder, knee pain and other joint pain.
Prolotherapy (Proliferative Therapy), know as Regenerative Joint Injection, is a recognised procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the joint is stabilized, pain usually resolves. Traditional approaches with surgery have more risk and may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only act temporarily.
How Does It Work
Prolotherapy works by stimulating the body’s natural healing mechanisms to lay down new tissue in the weakened area. This is done by a very directed injection to the injury site, “tricking” the body to repair again. The mild inflammatory response which is created by the injection encourages growth of new, normal ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual regeneration of tissue to restore the original strength to the area.
What Is In The Solution Injected
Prolotherapy injections contain natural substances that stimulate the healing response. Traditional formulas include ingredients such as hypertonic dextrose (12.5% concentration), saline, saran and/or lidocaine. In the last several years newer formulas including Platelet Rich Plasma (PRP) and autologous (from the same person) adult stem cells have begun to be used as other treatment options.
The dextrose makes the solution more concentrated than blood (hypertonic), acting as a strong proliferant. Sarapin is used to treat nerve irritation and, in our experience, acts as a proliferant. Sarapin is an extract of the Pitcher plant and is one of the few materials listed in the Physicians’ Desk Reference that has no known side effects.
Is Treatment Painful
Any pain involving an injection will vary according to the structure or joint treated, the choice of solution, and the skill of the practitioner administering the injection. The treatment may result in a temporary increase in pain with mild swelling and stiffness. The discomfort usually passes fairly quickly and can also be reduced with pain relievers such as paracetamol. Anti-inflammatory drugs, such as aspirin and ibuprofen, are not recommended for pain relief because their action suppresses the desired inflammatory healing process produced by the prolotherapy injections.
Can It Help Everyone
Each patient must be evaluated thoroughly with patient history, physical exam and radiological or ultrasound exam. With this information, your practitioner can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patient’s overall health and ability to heal, and any underlying nutritional or other deficiencies that would impede the healing process. In appropriate patients, prolotherapy has a high success rate.
What Areas Can Be Treated
Areas/problems treated include: Low back or mid-back pain including degenerative disc disease and sacro-iliac joint instability/dysfunction, neck pain, knee pain, knee meniscal tears, wrist or hand pain, osteoarthritis, shoulder pain including rotator cuff tears, elbow pain including golfers or tennis elbow, foot pain including plantar fasciitis, ankle pain or instability, hypermobility, osteitis pubis, IT band syndrome, piriformis syndrome, temporal mandibular joint syndrome (TMJ), or other musculoskeletal pain or injury.
Many body parts can be treated at the same visit, which is convenient and cost-effective for patients who have multiple painful joints or more complex chronic pain.
How Often Is Treatment Needed
Treatment intervals vary depending on the specific problem and severity of the area being treated, as well as the protocol of the practitioner. Typical intervals between treatment are every three to six weeks. However this can vary and may be more frequent, or take longer, depending on the condition being treated and dependent upon the person’s overall health status, the extent of the condition, injury, tear, or arthritis. In our clinical experience, as well as in our research, we find the number of treatments that helps a person attain their goal averages 5 to 7 visits.
Because we treat a wide variety of cases, from young athletes with acute injuries to the elderly who have suffered through numerous surgeries and decades of anti-inflammatory pain medication, we work to tailor the treatment plans to the patients’ individual goals and needs.
While most patients have the goal of becoming pain-free and having increased stability and mobility in the joint, their activity goals must also be taken into consideration.
High level athletes may have more aggressive treatment needs than a retiree who does not desire to do a lot of activity. Thus, it is imperative to seek a practitioner who not only practices a thorough technique and has access to all types of solutions, but also who understands sports medicine and rehabilitation for patients to do between treatments.
How Does Prolotherapy Wrok?
Inflammation
The natural attempt by the body to heal damaged tissue is through inflammation. Because joint injuries involve tissues with poor blood supply (including ligaments, tendons, cartilage, discs) and the body tries to bring more blood flow to the area because it contains ingredients necessary for healing. However, people often try to stop this effect by taking anti-inflammatories or receiving cortisone shots. Therefore, the injury persists. Prolotherapy, on the other hand, restarts this healing cascade.
Proliferation
The second phase of the healing cascade is proliferation, for which Prolotherapy is named. Here, a cellular reaction takes place involving various cells, including fibroblasts, endothelial cells, and myofibroblasts, that form new blood vessels and ultimately lay down the collagen necessary to repair and strengthen the tissue.
Tissue Remodeling
The final phase of healing is tissue remodeling. For many months after prolotherapy, tissue continues to remodel the new tissue that results looks and functions very closely to the original tissue before the injury. Once the tissue strength approaches that of the normal parent tissue, pain resolves and function is fully restored.
Upper Cervical Instability of Traumatic Origin Treated with Dextrose Prolotherapy: A Case Report
Dextrose prolotherapy was associated with progressive symptomatic relief and functional gain, beginning one month after initiation of treatment, and also with improvement of upper cervical stability. The findings support an approach to chronic neck pain based on the facilitation of ligamentous repair.
Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees After Prolotherapy
Degenerative joint disease is the most common form of arthritis. The condition is marked by progressive destruction of the articular cartilage which is easily documented by standard X-ray studies. The regeneration of this articular cartilage in clinical practice has been difficult. Five knees with articular cartilage degeneration were treated with Prolotherapy in this report. Each of the five knees showed improvement of their standard clinical X-rays after the Prolotherapy, signifying articular cartilage repair with Prolotherapy.