Prolotherapy (Proliferative Therapy), also know as Non-Surgical Ligament and Tendon Reconstruction and Regenerative Joint Injection, is a recognized orthopedic procedure that stimulates the body’s healing processes to strengthen and repair injured and painful joints and connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the joint is stabilized, pain usually resolves. Traditional approaches with surgery have more risk and may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only act temporarily. The original term used for this therapy was “sclerotherapy”, coined in the 1930’s when this treatment was discovered, and included both joint and vein injections. Today the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.
Prolotherapy works by stimulating the body’s natural healing mechanisms to lay down new tissue in the weakened area. This is done by a very directed injection to the injury site, “tricking” the body to repair again. The mild inflammatory response which is created by the injection encourages growth of new, normal ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area.
Any pain involving an injection will vary according to the structure or joint treated, the choice of solution, and the skill of the physician administering the injection. The treatment may result in a temporary increase in pain with mild swelling and stiffness. The discomfort usually passes fairly quickly and can also be reduced with pain relievers such as Tylenol or other prescribed medication. Anti-inflammatory drugs, such as aspirin and ibuprofen, are not recommended for pain relief because their action suppresses the desired inflammatory healing process produced by the prolotherapy injections.
Each patient must be evaluated thoroughly with patient history, physical exam and radiological or ultrasound exam. When indicated, laboratory work, should be ordered or evaluated prior to treatment. With this information, your physician can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patient’s overall health and ability to heal, and any underlying nutritional or other deficiencies that would impede the healing process. In appropriate patients, prolotherapy has a high success rate.
Areas/problems treated include: Low back or mid-back pain including degenerative disc disease and sacro-iliac joint instability/dysfunction, neck pain, knee pain, knee meniscal tears, wrist or hand pain, osteoarthritis, shoulder pain including rotator cuff tears, elbow pain including golfers or tennis elbow, foot pain including plantar fasciitis, ankle pain or instability, hypermobility, osteitis pubis, IT band syndrome, piriformis syndrome, temporal mandibular joint syndrome (TMJ), or other musculoskeletal pain or injury. Some areas or problems can be more challenging than others, and it is therefore important to be evaluated by a physician trained and experienced in this procedure so that an accurate assessment and treatment plan can be given.
The anticipated rate of success depends on a number of variables, including the patient’s history and ability to heal, and the type of solution used. In patients with low back pain, studies have shown a 85% to 95% of patients experience improvement with prolotherapy (compared to studies showing a 52% improvement with back surgery). Many studies done over the years show a high success rate when prolotherapy is used for various ligament, tendon or joint pain/injuries.