Prolotherapy is an injection procedure that stimulates the body’s natural healing processes. Its goal is to strengthen ligaments or tendon attachments that are stretched , torn, or fragmented, and have caused a joint to become hypermobile and painful. Traditional approaches such as surgery or anti-inflammatory drugs often fail to address the soft tissue structures that serve to stabilize the joint. Prolotherapy, with its focus on addressing joint instability, can strengthen fibrous soft tissues around the joint, resulting in improve stabilization and thus less pain and better durability.
Injection of a mild irritant such as Dextrose directly into the torn or stretched ligament or tendon creates a mild, controlled inflammatory response that stimulates the body’s natural healing response to lay down new connective tissue fibers, resulting in a tightening and strengthening of the painful soft tissues. Therefore anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the prolotherapy injection, and could suppress the healing signal the prolotherapy is trying to provide.
There are numerous substances, but the most common solution is Dextrose 12.5-25 % . Anesthetics are sometimes used, but there are concerns that these "cain" type anesthetics may be toxic to tendon and cartilage cells, so in my practice I try to minimize anesthetic concentration and use the much more expensive but also more cell friendly ropivicaine.
Prolotherapy can be used to treat joint instability such as in the hip, knee or shoulder, and painful tendons or ligaments. Essentially all of the conditions treated by PRP could likely respond to Prolotherapy. In fact the hot interest in PRP has served to validate the utility and benefit of Prolotherapy. In comparing Prolotherapy to PRP, prolotherapy is more affordable, doesn't involve a blood draw, it may be more beneficial for soft tissue tightening whereas PRP likely has a stronger stimulus for a regenerative response in the tissue, and is essentially a larger dose of growth factors.
In patients with low back pain with hypermobility, 85% to 95% of patienst treated experience remission of pain with prolotherapy. In comparison, the Journal of Bone and Joint Therapy reports on a 52% improvement in patients treated surgically for disc involvement. See the knee study and additional links below.
In 1926, a group of physicians met with great success using injection therapy to treat hernias and hemorrhoids. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints with these newer injectible medicines in the 1940s and 1950s. George Stuart Hackett, M.D., wrote a book on Prolotherapy injections in 1950. His 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 effect, which restores the weakened joint to its original level of stability, without loss of flexibility and function.
Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x.
We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32.
Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint.
The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96).
Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups' WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores.
The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.
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