What Is Prolotherapy?
Prolotherapy is the injection of a mild irritant, often dextrose (a simple sugar), into a specific area of the body that is arthritic, worn down, or injured. The newer, far more effective techniques of Stem Cell Therapy and Platelet-Rich Plasma (PRP) Therapy are actually more advanced versions of Prolotherapy, which is short for “proliferation therapy” (the proliferation of new cells following the injection of a substance that will stimulate new tissue growth).
When the irritant is injected into the knee or other area, it causes the body’s immune system to stimulate the inflammatory process. While it may seem counterintuitive to create more inflammation, it is in fact inflammation that is part of the body’s natural healing response.
This burst of increased inflammation attracts fibroblasts (immature cells present in connective tissue) and chondrocytes (cells that produce cartilage) and brings them to the area of degeneration or injury.
These cells rebuild the collagen (more specifically, what is called the “collagen matrix” of the tissue) and enable it to strengthen and restore the body part in many cases to pre-injury status.
There is a long history of medical studies on the effectiveness of Prolotherapy for knee pain. Recent research done at the University of Wisconsin School of Medicine and Public Health concluded that Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function, and stiffness scores among most participants through a mean follow-up of 2.5 years. The researchers reported that Prolotherapy may be an appropriate therapy for patients with knee osteoarthritis that did not respond to other conservative treatments.
I used Prolotherapy for patients in the past, and at a patient’s request rarely employ this technique. The fact is that traditional Prolotherapy has been overtaken by newer, far more effective forms of regenerative medicine, Stem Cell Therapy and Platelet-Rich Plasma(PRP) Therapy. It is these techniques that are shifting the paradigm in the treatment of osteoarthritis and other orthopedics-related conditions.
I love competition and was once one of the top gymnasts in the state of Illinois. Every sport I participated in, including golf and tennis, was performed with the precision of a gymnast. I am still not fulfilled unless I drive a golf ball 300 yards or ace my opponent with a rocket-speed tennis serve. I also lifted a lot of weights, occasionally until my arms turned black and blue.
By the time I was in my 20′s I had racked up my share of injuries. A fall during gymnastics landed me on my tail bone; a high-speed water skiing fall, among many other injuries, left me with back, neck and joint pain that persisted for years.
Advance Magazine By Marc Darrow, Md, Jd
The idea of introducing an irritant to an injured joint certainly isn’t new. In ancient Greece, Hippocrates used heated metal probes to treat dislocated and painful shoulders of javelin throwers. He believed this technique created tough scar tissue that tightened the shoulder capsule and kept the joint in place.
George S. Hackett, MD, continued to build on Hippocrates’ theories in 1939. While working with car accident survivors, he realized that patients experienced pain when ligaments and tendons were injured. He believed that repairing connective tissue could resolve most of the pain. Dr. Hackett introduced an irritating compound to activate the body’s natural mechanisms and prompt production of new collagen tissues—a proliferation process that became known as Prolotherapy.
Also known as proliferation therapy, Prolotherapy is a pain management technique that can treat degenerative or chronic injury to ligaments, tendons, muscle fascia and joint capsular tissue. It also can be effective for areas that are painful, but not tender to the touch, such as the inside of a joint.
Through injections, Prolotherapy allows rapid production of collagen and cartilage. Collagen, a naturally occurring protein in the body, is a crucial element to the formation of new connective tissue. And healthy connective tissue creates a solid foundation to hold the skeletal infrastructure together.
Injection Ingredients
Before administering prolotherapy, you should examine a patient by carefully and gently pressing on an area suspected of causing pain. You’ll know where to apply the prolotherapy injection when your touch elicits an intense pain reaction—a trigger or tender point.
Most of the prolotherapy solutions have a “double-edged” effect and should produce anesthetic and proliferant qualities. For example, the anesthetic agent alleviates the “pain trigger” and lets you know a solution was placed in the proper area. Simultaneously, the proliferant agent begins strengthening ligaments and tendons at the trigger point or tender point site with the Prolotherapy Injections.
Injections at trigger points cause irritation that stimulates the body’s natural process for repairing damaged tissue. It does so by causing an influx of fibroblasts and chrondroblasts, the healing cells that create collagen and cartilage. Joints are gradually pulled back into proper alignment as newly produced collagen reinforces muscles, tendons and ligaments. Then, as collagen shrinks, it tightens the joint capsule and prevents excessive, unnatural movement.
The number of treatments and injections required per treatment are based on the type of injury. For example, two Prolotherapy treatments for patellofemoral syndrome of the knee (runner’s knee) will usually eliminate the pain. But for a more complex problem, such as bone-on-bone arthritis, it may take six to eight treatments over two months. Back and neck pain may call for a series of four to eight Prolotherapy Injections treatments overall.
Anti-inflammatory medications are contraindicated during Prolotherapy. And higher doses of NSAIDS, such as aspirin, ibuprofen, Celebrex or Vioxx, may inhibit the necessary inflammation and reduce the positive effects of Prolotherapy. Studies on chronic NSAID users actually show greater joint destruction, compared to patients who don’t take these medications.
Remember that every patient heals differently, and recovery depends on overall health status and how frequently a patient uses an affected area. Regardless of health status, prolotherapy may be the answer to effectively reduce or eliminate chronic pain.
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