WHAT IS PROLOTHERAPY?
Prolotherapy is a highly effective, minimally invasive injection technique that stimulates tissue healing. Depending on the type of tissue involved, Prolotherapy may be practiced in either of two distinct forms which, while superficially similar, are actually two independent therapies:
- Traditional Prolotherapy stimulates healing of dense connective tissues, permanently strengthening ligaments and tendons to reduce and often eliminating pain at its source.
- Neural Prolotherapy is a new and promising treatment that addresses the neurogenic component of the pain cycle by promoting regeneration and repair of nerves.
These two forms of Prolotherapy are complementary and may be applied in conjunction with each other. They are each discussed in greater detail below.
PROLOTHERAPY FOR LIGAMENTS AND TENDONS
Ligaments and tendons are bands of tough, fibrous connective tissue that link structures in your musculoskeletal system and provide the underlying support for the spine and joints throughout the body:
- Ligaments connect bones, providing stability to joints and preventing overextension.
- Tendons attach muscles to bones, and thus transmit "muscle power" to bones.
Normally tough and taut, ligaments and tendons can be damaged through injury and/or overuse. Strains and sprains, overuse injuries, and microtrauma from repetitive stress may cause these tissues to become relaxed and weak, allowing too much movement of joints.
Because dense connective tissues have limited blood circulation, they often lack the oxygen and nutrients they need to fully heal on their own. Incomplete repair of these important structures leads to a loss of tissue strength, pain, and instability of the spine and joints. Nerves often become irritated, resulting in a cycle of degenerative changes, arthritis, and both local pain and referred pain, which is pain felt elsewhere in the body.
While ligaments and tendons are frequently involved in painful conditions, they are often overlooked in the traditional medical workup and treatment. Injured areas may remain painful for months or years because these tissues fail to heal properly or completely. The result is often chronic pain and disability.
HOW PROLOTHERAPY HELPS
Traditional Prolotherapy injections permanently strengthen vulnerable and sensitive ligaments and tendons, reducing and often eliminating pain at its source. Prolotherapy achieves this by stimulating the repair of collagen, which is the structural protein that forms tendons, ligaments, and cartilage, and is responsible for the strength of these tissues. The injected solution creates a temporary inflammatory reaction that stimulates the body's own chemical growth factors, activating fibroblasts (connective tissue cells) that promote collagen regeneration. The result is improved joint stability and permanent relief of many painful conditions.
TRADITIONAL PROLOTHERAPY TREATMENT
Traditional Prolotherapy treatment involves the injection of weakened or stretched ligaments with a dextrose-based solution or other natural "proliferant" substance. First the skin is numbed with a local anesthetic to lessen the discomfort of injection. The Prolotherapy solution is then injected with a very thin needle at the precise points of tissue damage. This process initiates a local proliferative reaction that increases blood flow to damaged ligaments.
Standard Prolotherapy solutions contain 15-20% dextrose (sugar) with Lidocaine (local anesthetic). Additional solutions may also be employed including the use of sodium morrhuate (fish oil derivative) and P2G (phenol). The solutions used in Prolotherapy make it distinct from trigger point injections, joint injections, and other treatments that involve the use of cortisone or other medications.
SUBCUTANEOUS PROLOTHERAPY DIRECTED AT NERVES
Neural Prolotherapy is a new and promising treatment for pain. This system identifies areas of neurogenic inflammation in the superficial nerves that are often responsible for pain in connective tissues and underlying joints. Using a subcutaneous technique, a dextrose solution is injected just under the skin at multiple points of identified inflammation. The result is rapid and lasting relief of pain. It is thought that this occurs by a direct action of dextrose to down-regulate receptors responsible for pain and inflammation.
Subcutaneous Prolotherapy promotes regeneration and repair of nerves. These nerves are also believed to be involved in promoting and perpetuating pain involving deeper structures such as joints and ligaments. Neural Prolotherapy rapidly breaks the cycle of pain, and may help to make traditional Prolotherapy more effective by addressing the neurogenic component of the pain cycle.
Neural Prolotherapy is very safe and is well tolerated in the vast majority of patients.
TREATMENT: WHAT TO EXPECT
At the initial office visit a complete history and examination is done for accurate diagnosis and to determine the most beneficial and appropriate treatment. X-rays, MRI and other pertinent information may be reviewed. The risks and benefits of Prolotherapy are discussed and any questions are entertained.
For at least three days prior to the treatment, patients should refrain from taking anti-inflammatory medication such as aspirin, ibuprofen (Motrin) or naproxen (Aleve). Low-dose aspirin for cardiac prophylaxis should be maintained. Other medications may be taken normally. Adequate fluid intake should be maintained before and after the treatment.
Following the treatment patients may expect soreness and mild to moderate discomfort. This may last for 12-36 hours. Light activities are appropriate, although extended or strenuous workouts should be avoided during this time. Acetaminophen (Tylenol) can be taken for pain, and additional pain medication may be prescribed if needed. Ice is generally not recommended.
The treatments are repeated at 2-3 week intervals. A typical course of Prolotherapy involves 3-6 treatments, although some complicated or advanced conditions may require up to 10 sessions for optimum response.
The resources at the following links provide valuable additional information about traditional Prolotherapy and neural Prolotherapy, including first-hand accounts and discussions of the scientific literature: