Prolotherapy

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 for visitors to this web site 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.

Ligaments are the structural "rubber bands" that hold bones to bones in joints – acting like the body’s shock absorbers. Ligaments can become weak or injured and may not heal back to their original strength or endurance. Ligaments also will not tighten on their own to their original length once injured. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose.

Prolotherapy uses a sugar-based solution that is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas, which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself, strengthening and tightening and thereby stabilizing the area.

The response to treatment varies from individual to individual, and depends upon one's healing ability. Some people may only need a few treatments while others may need 30 or more. The best thing to do is get an evaluation by a trained physician in your area. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate.

List of Conditions that can be treated using Prolotherapy

Chronic Pain resulting from injuries to the ligaments and tendons of the appendicular skeleton has been well recognized. However, soft-tissue injuries to the ligaments, tendons and fascia of the lower back have been largely ignored as a potential source of chronic back pain. Prolotherapy is a collagen-strengthening injection technique that targets the soft tissues of the lower back.

The treatment is excellent for many different types of musculoskeletal pain, including:

• Arthritis
• Back pain
• Neck pain
• Fibromyalgia
• Sports injuries
• Unresolved Whiplash
• Carpal Tunnel syndrome
• Torn Tendons, Ligaments and Cartilage
• Degenerated or Herniated discs
• TMJ
• Sciatica
• Barre-Lieou syndrome
• Cluster Headache
• Deep Aching
• Degenerative Disc Disease
• Disc Herniation
• Heel Spurs
• Knee Injuries
• Migraine Headaches
• Multiple Sclerosis
• Muscular Dystrophy
• Osteoporosis
• Polio
• Rotator Cuff Tears
• Tennis Elbow

How was Prolotherapy Developed?

Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the front of the joint, and it would then miraculously heal normally. Of course, we don’t use hot pokers today, but the principle is essentially the same – get the body to repair itself, an innate ability that the body has.

The injection of sclerosing agents first began in the 1830’s, when potent chemical irritants were used to treat hernias non-surgically. Prolotherapy in its most current form has been used for over 40 years and is currently used at 5 University centers.

How it Works

Prolotherapy uses a sugar based solutions, which are injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas, which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

The area where the ligament attaches to the bone or other structures is injected with a proliferant. Normally 15% Dextrose (sugar) mixed with Lidocaine, a local anesthetic. The proliferant solution causes a local reaction or inflammation. The body reacts by laying down collagen that in turn becomes new ligament or tendon tissue. We apply local anesthetics to numb the area to reduce the discomfort of the procedure. The patient may be a little sore for a day or so, but this usually goes away. The injection process is repeated every 2-3 weeks. Patients should not expect results for about 6 weeks. After that the patient will notice the pain level diminishing. The good thing about prolotherapy is that the results are more of a permanent nature. You may need a “booster" injection every year or so after the initial series. If prolotherapy is administered correctly by a trained medical practitioner and the patient is chosen well, there is a 75% chance for the chronic pain sufferer to becoming pain free and for most people to have significantly less pain. Prolotherapy is injection of any substance that promotes growth of normal cells, tissues, or organs. Prolotherapy is performed in all major hospitals but not by the name prolotherapy. An example is injection of red blood cell growth stimulator (erythropoietin) in patients with anemia. The three types of prolotherapy are:

1. Growth factor injection prolotherapy: Injection of a growth factor (a complex protein) that specifically begins growth of a certain cell line (erythropoietin example). This type of prolotherapy is in early stages of study for arthritis (growing cartilage cells) and sprain and strain (growing fibroblasts) and will advance substantially in years ahead. It will be a more expensive option however than the latter two types.
2. Growth factor stimulation prolotherapy: Injection of something that causes the body to produce growth factors. Non inflammatory (10% or less) dextrose is an example of this. Two double blind studies have now shown that simple 10% dextrose injection is effective in arthritis. (1,2) (Large and small joint) Humans cells exposed to as little as 0.3% dextrose produce growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFB), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and connective tissue growth factor (CTGF).
3. Inflammatory prolotherapy: Injection of something that causes activation of the inflammatory cascade to produce growth factors. These solutions often include dextrose for a growth factor stimulation effect, but the inflammatory signals that result causes a more vigorous growth response. Examples of solutions in current use are 12.5%-25% dextrose, phenol-containing-solutions, and sodium-morrhuate-containing solutions. Double blind studies did thus far have been treatment comparison studies rather than placebo controlled studies (3-5) as the control groups received injection with multiple bone contacts which itself will stimulate growth factor release. Despite this, the inflammatory proliferant groups did better except for one study in which the technique used was questionable. (5) Inflammatory prolotherapy will likely be the most cost effective form of prolotherapy in the future as it is an inexpensive medical technique for stimulation of the natural wound healing cascade.

Since the primary pathology in chronic sprain/strain is best described as connective tissue insufficiency, connective tissue laxity and/or weakness (the term connective tissue insufficiency has been utilized), it will be imperative to correct the primary pathology. The primary pathology in arthritis however, is a combination of too little growth factors and too much disrepair factors, and how to limit disrepair factors is currently under investigation. (6)

References:

1. Reeves, K.D., and K. Hassanein. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Hlth Med, 2000; 6(2): 37- 46
2. Reeves, K.D. and K. Hassanein. Randomized prospective placebo controlled double blind study of dextrose prolotherapy for osteoarthritic thumbs and finger (DIP, PIP and Trapeziometacarpal) joints: Evidence of clinical efficacy. Jnl Alt Compl Med, 2000; 6(4): 311-320
3. Ongley, M.J., et al. A new approach to the treatment of chronic low back pain. Lancet, 1987; 2: 143 - 146.
4. Klein, R.G., et al. A randomized, double blind trial of dextrose-glycerine-phenol injections for chronic low back pain. Journal of Spinal Disorders, 1993; 6: 23- 33.
5. Dechow, E., et al. A randomized, double blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology, 1999; 38:1255- 9.
6. Reeves, K.D., Prolotherapy: Basic science, clinical studies, and technique. In Lennard TA (Ed). Pain procedures in clinical practice (2nd Ed.). Philadelphia; Hanley and Belfus; 2000:172-190.

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