Definition

Injection prolotherapy is the injection of a solution for the purpose of tightening and strengthening loose or weak tendons, ligaments or joint capsules through the multiplication and activation of fibroblasts (primitive connective tissue cells that are work horses of repair and growth). The fibroblasts synthesize precursors to mature collagen, which reinforces the connective tissue area. The result is thicker, stronger connective tissue, not scar formation or sclerosis. The most common proliferant is 15% dextrose solution, which creates an osmotic gradient in the area of the injection. Prolotherapy is also known as sclerotherapy and reconstructive therapy.

Understanding prolotherapy

To understand prolotherapy, one must first understand certain things about human anatomy. Ligaments function as the primary stabilizers of joints in the body. They connect bones to each other and also limit the range of motion of each bone. Further, tendons connect muscles to bones in order to provide motion.

Our spines are composed of bones, tendons, discs and cartilage. Discs and cartilage serve as shock absorbers and keep bones from rubbing against each other. In acute injuries, the ligaments and tendons become torn and are unable to stabilize joint areas. This causes the discs and cartilage to wear down, which ultimately leads to joint instability, resulting in constant pain, decreased mobility and lack of endurance.

Prolotherapy stimulates the healing mechanism of our body's tissues. It promotes the body's own natural healing ability by injecting irritant solutions into the troubled area, causing a proliferation of present tissue. Each treatment results in more and more tissue being "laid down" in the needed areas in a natural, structural formation. The joints continue to become stronger and more stabilized. Thus, the natural functions of the body are regained. Conversely, pain lessens until, in most cases, it disappears entirely. Prolotherapy can be administered whenever ligaments, tendons, cartilage and/or discs are torn or worn.

There are numerous positive factors in prolotherapy. First, it promotes the body's own natural healing ability. Second, it restores and optimizes the body's natural functions. No heavy drugs or surgery are used. Perhaps the most wonderful thing about prolotherapy is that it actually relieves pain.

How effective is prolotherapy? In 1987 the Lancet, a respected British medical publication, reported that 35 out of 40 patients in an experimental prolotherapy group showed greater than 50% improvement. Another study, published in the U.S.'s Journal of Spinal Disorders in 1993, found similar results.

Select conditions treated with prolotherapy

The most common conditions treated with prolotherapy are, by far, related to the neck and lower back. However, any body part involving ligament and/or tendon injury will respond to prolotherapy. The mid-back, shoulder, elbow, forearm, wrist and hand; the hip, knee, ankle and foot; the chest wall and the temporomandibular joint are all likely to do well with the treatment.

The role of prolotherapy

The typical medical approach to "whiplash" injury and "sciatica" pain is the use of anti-inflammatory medications, analgesics and muscle relaxants. Also typically used are soft collars, cervical and lumbar pillows and local massage. Various physical therapy modalities are frequently used. However, with significant whiplash injury and low back pain, all of these therapeutic efforts may tend to be a disappointment for the physician and patient alike. Both, therefore, become discouraged, causing the patient to seek medical care outside the traditional medical approach.

The osteopathic and chiropractic schools have long taught that these soft tissue spinal injuries are genuine and are worthy of the physician's focus. All physicians, whether osteopathic, chiropractic or allopathic, who have become experienced with manipulative treatment, recognize that there is a role for spinal manipulation in certain painful conditions.

Cervical and lumbar manipulation frequently gives dramatic relief of headaches as well as neck and lower back pain. Patients who give a history of temporary benefit from cervical and lumbar manipulation have an excellent chance of receiving lasting benefit from prolotherapy.

Because soft tissue spinal injuries, including ligament and tendon injuries, are not able to be detected by conventional diagnostic tests such as x-rays or even MRIs, frequently the patient with these injuries becomes discouraged because "nothing can be found" to account for his or her complaints. These are the ideal patients who will benefit from prolotherapy.

Summary

Prolotherapy has been used for more than 50 years by allopathic and osteopathic physicians. The term "prolotherapy" was first used by George S. Hackett, M.D., in the 1950's. He defined it as "the rehabilitation of an incompetent structure by the generation of new cellular tissue." He is also credited with the statement, "A joint is only as strong as its weakest ligament." There are only about 250 medical and osteopathic doctors in the U.S. who are currently performing this therapeutic treatment. Prolotherapy has a great potential for patients suffering from acute or chronic musculoskeletal pain. Only an experienced physician trained in this technique may be able to determine whether you are a candidate for this treatment modality.