Prolotherapy is also known as “nonsurgical ligament reconstruction” and is a treatment for chronic musculoskeletal pain. The word “Prolo” is short for proliferation as Prolotherapy treatment enhances the growth and formation of new ligaments, tendons and cartilage in areas where there is weakness or excess scar tissue. Any joint in the body can be treated successfully with Prolotherapy regardless of when the injury happened. The treatment is also beneficial for most types of musculoskeletal pain.
Prolotherapy incorporates the use of a specialized dextrose (sugar) solution which is injected into a ligament or tendon where it attaches to the bone. The initial reaction of the treatment is localized inflammation triggering a wound healing cascade leading to increased blood supply and flow of nutrients and growth factors. This stimulates the tissue to repair itself by deposition of new collagen, the material that ligaments and tendons are made of. The new collagen then shrinks as it matures leading to ligament/tendon tightening and increased strength.
Platelet Rich Plasma or PRP is injected in the same manner as Prolotherapy; however, the substance injected is different. About 60ml of blood is drawn from the patient and spun in a specialized centrifuge to separate the blood components and from this platelets are extracted. This platelet component is then injected back into the joint for treatment. This platelet component already has concentrated growth factors which lead to healing of the joint. The treatment is slightly more painful than Prolotherapy, however the healing power is faster, more enhanced and requires less treatments.
Ligaments can be described as “rubber bands” that actually hold bone to bone and allow flexible movement of joints. Injury, overstretching and degeneration/weakness of ligaments can cause them to become weak and damaged to a state of disrepair. The reason that ligaments don’t heal easily is largely due to a lack of blood supply to the area. As a result, healing is slow and not always complete. In addition, the nerve endings to ligaments can become impaired or damaged, so you may feel acute intense pain. This pain can then become chronic.
Tendons are the name given to tissue which connects muscle to bone. Tendons may also be damaged in the same manner as ligaments which can result in pain and scar tissue development if not treated appropriately.
With Prolotherapy, an important concept to understand is that chronic joint pain (knee, shoulder, ankle or elbow) and cortisone injections lead to tissue destruction and acute pain leads to tissue regeneration. With this treatment, patients often say “I already have inflammation and you want to give me more?” The idea behind this is that acute inflammation leads to healing. The ligament and tendon tissue which forms as a result of Prolotherapy and PRP is thicker and stronger than normal tissue, up to 40% stronger in some cases.
- Any joint pain in the body (hip, knee, ankle, shoulder, wrist, TMJ etc)
- Torn ligaments, tendons and cartilage
- Herniated / Degenerated discs
- Post injury / Trauma pain
- Yoga overstretch injuries
- Post fractures
- Pain conditions: neck, low back, sciatica, arthritis, etc.
- Frozen shoulder
- Whiplash injuries
- Sports injuries
- Rib pain
The basic Prolotherapy solution is 12.5% to 20% dextrose with 1% procaine. The dextrose makes the solution more concentrated than blood, acting as a strong proliferant. Procaine is an anesthetic that helps reinforce the diagnosis because the patient may experience immediate pain relief after the injection.
The dextrose solution, in addition to being safe, will not affect a diabetic’s blood sugar level. Other injectables may be added such as hyaluronic acid or Vitamin B12 (methylcobalamin). The hyaluronic acid would be added in cases of osteoarthritis where cartilage regeneration is the desired outcome and methylcobalamin is used in nerve regeneration. Homeopathic remedies may also be added to help speed the healing process, these will vary depending on the type of injury.A number of benefits come from using a biomedical approach to treatment including: increases in language complexity, social awareness/interaction, cognition/learning, eye contact/responsiveness, normalized behaviours and understanding/feeling emotions.
The response to treatment varies with each individual and the extent of trauma to the ligament, tendon or cartilage, as well as individual rates of healing. Some people require a few treatments (ie 3 to 6) while others may need 10 or more. Once you begin treatment, you will be able to assess how you are responding. Wound strength studies show that it takes 6-12 months for maximum tensile strength to occur without Prolotherapy and even then the resultant wound has approximately 60% of the original strength. With a Prolotherapy treatment every 2 weeks, healing can occur in 1-2 months. And with a PRP treatment, the rate of healing is reduced even further.
Prolotherapy can be combined with PRP, Ultrasound, Acupuncture, Physiotherapy, Laser therapy, Chiropractic treatments, Homeopathy and nutritional supplements to obtain the best results.
Not every patient experiences pain with the injection. Nevertheless, the injections can be painful, particularly in the first two to three visits. After an injection there is usually a significant change in sensation with some contraction or release of muscles and changes in blood flow. For this reason, it may be helpful to have someone drive you home after the treatment so you can rest. After the second or third treatment, these functional changes are usually not as profound.
Soreness and bruising at the injection site and temporary muscle stiffness are normal and may last for 1-2 days. The use of over-the-counter anti-inflammatories is discouraged as these will defeat the purpose of the injections which is to temporarily increase inflammation. You can apply alternating hot and cold compresses over the affected area. Traumeel cream or a “deep heat” like Tiger Balm can be used if additional relief is needed. Using MSM and glucosamine sulphate may also lessen the secondary pain reaction. Natural anti-inflammatories, such as bromelain, curcumin, proteolytic enzymes, fish oils etc. will help the healing response; however, it is recommended that they be stopped the day before, day of, and day after a prolotherapy treatment to allow the natural inflammatory response to occur.
In order to align the new collagen correctly with the existing ligament tissues, it is very important for the structure to heal in the presence of movement. As such, gentle walking is recommended after treatments. This will protect the ligament from forming adhesions to neighboring structures and increase the correct formation of the new collagen.