Prolotherapy is a nonsurgical approach to treating chronic pain due to ligament and tendon injury or instability. It is a very specific and helpful treatment for many types of musculoskeletal pain in numerous areas of the body. In many cases it can resolve the problem and eliminate the need for frequent and continuous anti-inflammatory medication and extreme steps such as surgery.
Ligaments are like strong elastic bands connecting bone to bone in a joint. They are crucial for structural stability (especially in the spine) while at the same time their elasticity allows flexible movement. Tendons connect muscles to bones and are also involved in movement of the joint. Both ligaments and tendons are prone to injury, weakness and overstretching which can cause pain.
Why does ligament and tendon injury hurt so much? The area where ligament attaches to bone is called the fibro-osseous junction. Periosteum, which covers the bone is one of the most sensitive structures in the body and is the reason injury at these junctions is so painful. In addition and due to a decreased blood supply to these traumatized tissues they may not be able to heal completely following an injury. This results in the normally taut fibrous and connective tissue becoming loose or lax and the cycle of chronic pain and weakness begins.
How does prolotherapy work? “Prolo” is short for proliferation which means growth or reproduction of new parts. The fundamental action of prolotherapy is simple. A combination of procaine (local anesthetic) and dextrose (sugar water) solution is injected into the affected tissue where it attaches to the bone. This solution is a mild irritant (proliferant) creating a localized inflammation and increase in blood supply to the area. This stimulates the flow of nutrients which initiates the healing process. In short it provokes the body into healing itself. The result is the growth of new ligament and tendon tissue that is as least as strong if not stronger than normal healthy tissue.
A bit of history: There is record of similar, albeit crude types of prolotherapy-like treatments dating back as far as Hippocrates’s time. In recent history there is a more definite correlation to how prolotherapy was integrated into medicine. More than 50 years ago the number of medications available to physicians was very limited compared to today. In the American Midwest doctors were seeing many local farmers with acute injuries or back pain and the only treatment in those days was bed rest for 6 or more weeks. Of course this was unacceptable to the farmers who had no option but to work long hard hours during that season. Doctors at the time experimented by injecting sore muscles with dental anesthetic (novacaine). Results were generally good but only lasted a short time. In attempting to increase the duration of the therapy they added hypertonic dextrose to the injection which at that time was being used for treating diabetic coma following an overdose of insulin. To the great satisfaction of both the doctors and the farmers this combination had very good and long lasting results. It wasn’t long before they were utilizing this technique for the treatment of pain in many other areas of the body.
The most common reason for treatment with prolotherapy is chronic pain that doesn’t go away.
Prolotherapy has the potential to alleviate pain and induce healing in a long list of conditions such as arthritis, back pain, carpal tunnel syndrome, dislocations, headaches, heel spurs, hip degeneration, fibromyalgia, knee injuries, osteoporosis, plantar faciitis, rotator cuff tears, sacroiliac sprain, sciatica, scoliosis, spinal defects, tennis elbow, TMJ dysfunction and whiplash injuries to name a few.
The average number of treatments is between 3 and 6 and they are usually given at three to six week intervals. Healing begins 3 – 12 hours following a prolotherapy treatment.
Patients experiencing long term pain relief with this modality of treatment range from athletes to the very sedentary.
Although the theory of how prolotherapy works is simple the technique requires a well trained and skilled practitioner who has vast experience in this field. The current practice of prolotherapy is based on the following principles; a good knowledge of human anatomy, skillful injection technique and choice of appropriate and amount of solution to inject.
What to expect during and after a prolotherapy treatment? After an initial exam including medical history and evaluation of a patient’s condition as to whether prolotherapy would be appropriate the first treatment appointment is scheduled. Before that appointment it is recommended that use of anti-inflammatory medication be stopped as it may interfere with the healing process of the treatment. At the first appointment the painful or injured area is identified, cleansed and marked for anatomical landmarks (no x’rays are necessary). Next the affected area is injected with a local anesthetic to numb the area and then the prolotherapy solution is injected into the site. The injection may bring on a deep ache, lasting approximately 5 – 10 minutes. This is normal.
Healing begins between 3 – 12 hours. It is normal, following a prolotherapy treatment to be stiff and sore for a few days. If those first sensations of healing are intense Tylenol would be the only medication that is recommended.
Following prolotherapy treatments, movement of the treated area is also highly recommended as it can aid in the healing process.
Reduction of pain and stiffness in the affected area as well as increased range of motion are good signs that the treatment is helping. Individual situations, depending on the severity will respond differently and some patients will require more treatments than others before seeing results.
In summary prolotherapy is a safe medical procedure that has been very successful in treating pain in many areas of the body. It has shown to be helpful in eliminating the necessity (long and short term) of harmful anti-inflammatory medications as well as surgery, including joint replacement surgery.