Prolotherapy (Proliferative Therapy), also know as Non-Surgical Ligament and Tendon Reconstruction and Regenerative Joint Injection, is a recognized orthopedic 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. The original term used for this therapy was “sclerotherapy”, coined in the 1930’s when this treatment was discovered, and included both joint and vein injections. Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.
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 buildup of tissue to restore the original strength to the area.
Prolotherapy injections contain natural substances that stimulate the healing response, as well as local anesthetic agents to help with the pain of the injection. Traditional formulas include ingredients such as dextrose, saline, sarapin and procaine or lidocaine. In the last several years newer formulas include Platelet Rich Plasma (PRP) and autologous (from the same person) adult stem cell sources, typically taken from bone marrow or adipose (fat) tissue. Each treating physician tailors the selection of the appropriate formula according to the patient’s need.
Any pain involving an injection will vary according to the structure or joint treated, the choice of solution, and the skill of the physician 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 Tylenol or other prescribed medication. 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.
Each patient must be evaluated thoroughly with patient history, physical exam and radiological or ultrasound exam. When indicated, laboratory work, should be ordered or evaluated prior to treatment. With this information, your physician 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.
Physicians who administer this form of therapy receive training by The American Osteopathic Association of Prolotherapy Regenerative Medicine, or other authorized training group or physician. Postgraduate training is a prerequisite before treating any patient with a medical orthopedic problem which might benefit from prolotherapy.
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. Some areas or problems can be more challenging than others, and it is therefore important to be evaluated by a physician trained and experienced in this procedure so that an accurate assessment and treatment plan can be given.
Treatment intervals vary depending on the specific problem and severity of the area being treated, as well as the protocol of the physician. Typical intervals between treatment are every three to six weeks, with an average interval of once a month, for a total of four to six treatments. However this can vary and may be more frequent, or take longer, depending on the condition being treated.
The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used. In patients with low back pain, studies have shown a 85% to 95% of patients experience improvement with prolotherapy (compared to studies showing a 52% improvement with back surgery). Many studies done over the years show a high success rate when prolotherapy is used for various ligament, tendon or joint pain/injuries.
Injection of varicose veins and other similar abnormalities creates a mild inflammatory response causing these veins to contract so that they become smaller or even vanish. When sclerotherapy is used for varicose veins, these can usually be 90% to 100% eliminated. Spider veins can usually be improved 70% to 90%.
Prolotherapy/sclerotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the shoulder joint. Advances in medicines greatly improved on this process, and led to the modern techniques of strengthening the fibrous tissue and creating new, normal collagen, rather than producing scarring to fuse tissues. Hippocrates described vein sclerotherapy around 400 B.C. using “slender instruments of iron” to treat varicose veins. Injection sclerotherapy of veins was first reported in 1623, and modern forms of injection sclerotherapy for varicose veins, hernias and hermorroids has been performed since the early 1900’s. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints in the 1940s and 1950s, and spent the rest of his life researching and publishing on the subject. Also, George Hackett, M.D., wrote a book on this injection therapy, with Gustav Hemwall. MD adding to that publication in the 1950’s. Both Gedney and Hackett’s work is still used today in training physicians. In the years since this early work, techniques and medications have advanced to move from a scarring or fusing effect to a strengthening, regenerative effect, which restores the weakened joint to its original level of stability, without loss of flexibility and function. Advances in Regenerative Medicine have made the use of more advanced formulas possible, such as Platelet Rich Plasma (PRP) which contains growth factors, and autologous Adult Stem Cell sources, for even more enhanced healing.