Prolotherapy started in the 1930s and the term was coined by Dr. Hackett in the 1950s for “proliferate” therapy. He defined it as “the rehabilitation of an incompetent structure by the generation of new cellular tissue”. Prolotherapy is when a stimulating substance (usually dextrose/sugar) is injected to stimulate the body’s intrinsic ability to heal an injury that incompletely resolved or a repetitive stress that is beyond self repair. It is usually focused at the weak “weld” points of tendon or ligament attachments to bone.
How it Works
There is a rich supply of nerves in the connective tissue that offer feedback to determine different types of pain. The weakest link is typically at the attachment, but can also occur in the zone where the tendon changes to muscle (musculotendinous junction). When an area is injured, the body reacts with "inflammation" to "clean" out the damaged tissue and bring in the elements for repair. Anti-inflammatories (Motrin, Aleve, steroids, etc.) interfere with this healing process if used incorrectly. Healing is not complete when the pain resolves. Studies have demonstrated that after 2 weeks there are no inflammatory cells so there is not continued inflammation, but if unresolved a degenerative process (tendinitis v. tendinosis) occurs. Weak areas cause overload to adjacent and remote regions in the body.
How it's Done
Since there is poor blood supply to most of these injured areas, they are at greater risk for impaired healing. The classical proliferant is dextrose (i.e. sugar). This substance stimulates healing in at least two ways. First, it is more concentrated where injected as opposed to the surrounding injured tissue. This causes water to shift from the inside to outside of the cell; leading to bursting and causing a minor injury. The cell substances as well as the dextrose itself stimulates the healing cascade of cells to clear the damage and use new substances to re-build the area (macrophages, growth factors, etc.). Rehabilitation is very important once the healing has begun to prevent recurrence. If the precipitating cause can be identified and altered, this should also be addressed.
The treatment depends on the extent of the problem, the ability to generate a healing response (one's own body health), duration of the pain/dysfunction, and other health issues that can affect healing. The typical number of sessions ranges from two to six. If the treatment is not affording relief after two to three sessions, either the solution is adjusted, there is a greater focus on the individual's health or healing response or both. After three to four sessions to a specific area without relief, either a related area is addressed or the treatment is considered a failure. As healing takes time, the injections are repeated in 4-6 week intervals. It is common to have increased discomfort for 1-3 days (increased pain can occur 70% of the time). Reduce activities during the initial painful post-treatment period. Anti-inflammatories are to be avoided and activity level should be no more vigorous than the preceding month.*
Prolotherapy is a safe, non-surgical treatment for chronic or acute orthopedic injuries. Common conditions treated with Prolotherapy include Tennis and Golfer's Elbow, Jumper's Knee, Achilles Tendinitis, Hip/Shoulder Bursitis, cartilage/ligament/joint damage and Plantar Fasciitis. The typical Prolotherapy solution usually contains dextrose combined with an anesthetic like Procaine or Lidocaine. Prolotherapy actually promotes healing and repair in the damaged area by stimulating the body’s healing mechanism to restore function and strength to the damaged area. It is important to note that Prolotherapy is not like Cortisone shots. Cortisone only decreases inflammation and either slows or stops the healing process while Prolotherapy heals the injury.*
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Results may vary based on individual’s overall health, lifestyle, severity of the orthopedic condition being treated and responses are not guaranteed. The information on this site is solely for purposes of general patient education, and may not be relied upon as a substitute for professional medical care. Consult your own physician for evaluation and treatment of your specific condition.