It is a technique consisting of injecting tissue irritating substances, such as hypertonic glucose (sugar water), among others, into the tissues. The theory behind it is that these tissue irritating substances called proliferants, stimulate healing, tissue regrowth, and repair when injected into precise points called the enthesis. Basically, the enthesis is the point where tendons and ligaments attach to the bone. The prolifereant, when injected into these very precise points, theoretically stimulate tissues to proliferate (therefore the name Prolotherapy) and hopefully heal the injured tissue.This technique shows promise but more research is needed.
This may not sound like a cutting-edge medical technique, but a growing number of doctors are now following the teachings of the father of Prolotherapy, Dr. George Hackett, MD from Canton, Ohio. He is considered the father of Prolotherapy because he brought this technique to mainstream medicine. His research was published in some of the main medical journals of his time and presented at the prestigious American Medical Association meetings starting in June of 1955. These technique shows promise although more research is needed and is ongoing.
Some of the statistics on Dr. Hackett's research include: 1) Sample size: 1,656 patients, 2) Patient age range: 15 to 88 years old, 3) Duration of the discomfort: three months to 65 years, 4) Average duration of symptoms: four and a half years, 5) Duration of study: 19 years, 6) Number of injections given: 18,000.mmm
Another physician with major contributions to Proliferative therapy and who has written extensively on the subject is Dr. Felix Linetsky, a Russian physician now practicing in West Florida. I consider him my mentor in this field. I have to admit that the first time he mentioned to me this technique, I took it as a joke. I could not see how it possibly could work. Well he has made a believer out of me. The first patient I used it on was our own daughter for an ankle injury and it worked very well. She had suffered with ankle pain for a long time after a soccer injury and had tried other conventional conservative therapies with no permanent relieve. She has had no pain in the last six years after the Prolotherapy treatment.
There is, to say the least, an amazing amount of convincing enecdotal evidence that the technique can provide long lasting results although more research is needed.
A more familiar name to you is that of former United Stated Surgeon, General, C. Everett Koop MD. He was himself a patient treated with Prolotherapy, and later wrote the Preface of the book “PROLO YOUR PAIN AWAY !”. It is considered “A MUST READ FOR ANYONE EXPERIENCING CHRONIC MUSCULOSKELETAL PAIN.”
In one of Dr. Hackett's study, done twelve years after treatment to his patient, an impressive 82 percent of the patients considered themselves cured.
Dr. Hackett also proved in the laboratory that prolotherapy induces the growth of ligament and tendon tissue and is especially effective at strengthening the weld of these structures to the bone, by proliferating their fibro-osseous junction. Dr. Gustav Hemwall from Oak Park, Illinois continued the studies of Dr. Hackett after his retirement and again he found that the great majority of patient who completed treatment with proliferative therapy obtained relief although not always complete relief.
The theory behind it is that when injuries occur, the area may not heal completely due to lack of proper treatment or poor blood supply. For this reason, ligaments, joints, and tendons heal very slowly and poorly. If left untreated or not treated correctly, damaged ligaments become loose, allowing bones in the joint to shift with excessive movements, causing discomfort, muscle spasms, and eventually arthritis. Aging can have the same effect. Arthritis occurs in the joints and spine as a result of instability in the structures supporting them and ware and tear.
Prolotherapy can intervene by stabilizing the structures and decreasing the progression of pain, and degeneration, that comes with aging. When stretched, small nerve fibers in the damaged ligaments transmit discomfort impulses to the brain. Through a subconscious reflex, the surrounding muscles go into painful spasms in an attempt to stabilize the joint. This causes the region to feel tight, stiff, achy, burning, tingling, numb, fatigued and uncomfortable. The individual often notices achy knots in the surrounding muscles. These muscles become tight and achy as they try to compensate for the weak and damaged underlying structures. Spasms in the muscles decrease blood flow and nutrient delivery to the tissue, further contributing to the breakdown. Also, the chronic tension from the muscle in spasm leads to deterioration of the tendon attachments, leading to tendinosis (degeneration without inflammation). Not only is discomfort felt locally, but also it is referred to other areas. Injecting a stimulating solution to the sites of the tissue breakdown stimulates the body’s own healing mechanism to repair and rebuild. This process leads to a stronger and more supportive structure.
For those interested on the text written by George Stuart Hackett MD FACS titled " Ligament And Tendon Relaxation Treated by Prolotherapy here is a link to it:
We encourage those patient interested in this technique to do their research on the internet and also try to speak to some patient who has had it. Here is another more recent supporting evidence article about Prolotherapy:
Prolotherapy and the stages of healing after an injury.
1. INFLAMATORY STAGE: Occurs during the first week. There is increased blood flow, swelling,and discomfort as the healing process begins. Immune cells remove damaged and unhealthy tissue from the treated area.
2. FIBROBLASTIC STAGE:Starts about day three and continues for six weeks. Swelling and discomfort begin to subside. New blood vessels form with an improved blood and nutrient supply. Tissue repair cells (fibroblast) form new collagen, repairing the injured and unstable tissue.
3. MATURATION STAGE: Continues from six weeks to 18 month. New blood vessels mature. The tissues now become stronger with more organized and healthy fibers. discomfort subsides. Collagen density and tissue strength increases. When the injured areas are injected with a Proliferant solution, a reaction begins, re-starting the three stage healing process described above. Studies have shown that the strength of the injected ligament can increase up to 40% above normal. Dicomfort and muscles spasms decrease as stability increases.
If during the three stages of the healing process, anti-inflammatory drugs (NSAID), ice and or immobilization are used to reduce discomfort and inflammation, complete and normal healing will be inhibited. Most people are taught that inflammation is bad and don’t realize that, without inflammation, no healing will occur. Unfortunately, most physicians, when they see a patient with an injury immediately want to decrease the inflammation with elevation, ice and anti-inflammatory medication such as Advil, Aleve, etc. The end result is poor healing with weak loose joints and ligaments.
Prolotherapy strengthens the joints, ligaments, and tendons, and decreases the discomfort by stimulating the body’s own repair and healing process. There is no covering up the discomfort as tissues heal naturally and become stronger, without forming scar tissue. Several treatments (average about 5) spaced apart by about two to six weeks, are usually required to get the full benefits. Each treatment builds on the previous until the desired outcome is obtained. The procedure itself is a safe procedure when performed by a trained and skilled physician who has in-depth knowledge of the anatomy and experience using this injection technique. Prolotherapy does not “cure” every condition, nor always eliminate 100% of one’s discomfort.And neither does it work on everyone. However the vast majority of the patients who receive prolotherapy (usually two to ten sessions) will receive at least 50% relief of their discomfort. Many even report complete resolution of their discomfort after a series of treatments. It is also important to know that Prolotherapy treatment only strengthen tissues. No structure is weakened like when using cortisone and no scars are formed.
Chronic problems do not occur overnight and they do not heal that way either. It is important to remember that to obtain the full effect of prolotherapy treatments it takes approximately six month.
Differences Between Prolotherapy and Cortisone shots.
Proliferative Therapy Cortisone
Strengthens bone Yes No
Strengthens tendon-bone attachments Yes No
Strengthens muscles Yes No
Strengthens and rebuilds ligament tissue Yes No
Leads to progressive and harmful arthritic changes No Yes
Suppresses the immune system No Yes
Inhibits growth hormone No Yes
Inactivates Vitamin D No Yes
Inhibits calcium absorption in the digestive tract No Yes
Bad effects of cortisone shots.
Cortisone's bad effect include lowering of the rate of full recovery and you are 67% more likely to have a relapse of your injury !
Cortisone shots can permanently damage bones, ligaments, muscles, cartilage, and tendons,resulting in a weakening of the joint and resultant degenerative joint disease (DJD), orosteoarthritis, osteoporosis, fractures, and muscle weakness. This structurally weakens the joint,increasing the production of more discomfort, which leads to more cortisone shots and eventually surgery. Choose wisely!