Prolotherapy is a regenerative injection treatment used to stimulate the healing mechanism to repair damaged or injured areas in the spine and joints.
Prolotherapy is considered a viable alternative to surgery, as an option to pain medications and anti-inflammatory injections such as cortisone and other steroidal injections.
Prolotherapy is considered a safe, affordable option that allows the patient to keep working and/or training during treatment.
The effectiveness of Prolotherapy does depend upon the technique of the individual Prolotherapist, as well as the overall health and dedication of the patient to encourage the healing process after each treatment.
The Research and Growth of Prolotherapy
Dr. Arthur Steindler, a world renowned orthopedic surgeon, co-published a fundamental work related to the diagnosis of lower back pain. Using procaine injections as a diagnostic tool (by numbing the area and measuring pain aleviation), Dr. Steindler and his fellow researcher Dr. JV Luck tackled the problems of poor and misdiagnosed back pain. What they found was strong evidence that all structures in the lower back, including the ligaments, fascia, tendons, and muscles, receive sensory nerve impulses (in other words cause pain). They pointed out that these structures are all interrelated anatomically and functionally, and they came up with a list of criteria that had to be met to prove that an injured structure was causing a pain symptom. Steindler and Luck were the first to point out the extreme complexities of back pain.1
Injections for back pain and the birth of Prolotherapy
This work was monumental in the development of Prolotherapy. Now a method to definitely prove what was causing the pain existed. A person came to the physician with low back pain radiating to the legs. The doctor, with a needle, then tried to reproduce the pain and the radiating pain down the leg. When the exact site was found, an injection of procaine was given. If the correct structures were injected, all of the pain would be completely removed. The latter part of this concept is followed to this day. Prolotherapy can completely remove chronic pain immediately, if the correct structures have been injected, because of the anesthetic part of the solution.
The First Prolotherapy Treatment
In 1937, Dr. Louis W. Schultz, both a dentist and a medical doctor, published a paper in The Journal of the American Medical Association on the treatment of subluxation of the temporomandibular joint (TMJ). In this paper he described how common TMJ syndrome was, and that the traditional treatments of rest, appliances in the mouth, physical therapy, and surgery were only partially successful. He described a simple method of shortening and strengthening the TMJ capsule by injection of Sylnasol, a five percent solution of fatty acid. This was the first true Prolotherapy treatment. Dr. Schultz collected extensive data from both animal research and clinical practice , and concluded that the method he discovered was simple, safe, and essentially 100 percent effective.2
What Doctor Schultz and those who followed found was that the basic mechanism of Prolotherapy was simple and centered around the promotion of inflammation. When we inject Prolotherapy solutions into the affected ligaments, tendons, and/or joints, it leads to local inflammation in the injected area. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger.
As research continues, Prolotherapy has adapted and evolved into Comprehensive Prolotherapy. The ingredients used in Prolotherapy are, in the simplest terms, designed to create an inflammatory healing response and help to ease pain. One of the many benefits of coming to a Prolotherapy center like Caring Medical is we have decades of experience with various ingredients. Some patients have injuries that respond best to very strong solutions, such as adding a fatty acid or hormones to the solution. Sometimes Cellular solutions using Platelet Rich Plasma (PRP) or even Stem Cell therapy, using a person’s own bone marrow or fat cells to the basic dextrose Prolotherapy solution. Other patients respond best to a solution with additional anesthetic to help ease acute pain more immediately.
A potential problem with going to just any physician is you may get the “one solution fits all” approach. One of the reasons patients come to visit us is for “Comprehensive Prolotherapy.” An important part of this approach is getting a strong enough solution to help the body repair, as well as technique.
Prolotherapy for Knee Pain
In this study, Caring Medical doctors investigated Prolotherapy in patients with unresolved knee pain at a charity clinic in rural Illinois. Eighty patients, representing a total of 119 knees, were treated quarterly with Prolotherapy. On average, 15 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment. The results of this study showed that patients had:
- Statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
- More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy.
- Ninety-six percent of patients felt Prolotherapy improved their life overall. 3
Other researchers have shown that Prolotherapy injections resulted in safe and substantial improvement in quality of life in knee osteoarthritis patients.4 Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.5 In Caring Medical research, Dr. hauser was able to document articular cartilage regeneration.6
In patients with symptoms of anterior cruciate ligament laxity and weakness, intermittent Prolotherapy injections resulted in clinically and statistically significant improvement in pain, swelling, and knee range of motion.7
Main page> Prolotherapy for knee pain
Anterior Cruciate Ligament (ACL), Articular Cartilage Tears, Baker’s Cyst, Chondromalacia Patella, Collateral Ligament Injuries, Knee Tendon Bursitis, Meniscal Tears, Osteoarthritis, Osteochondritis Dissecans, Patellar Tendinitis, Patellar Tendon Tear, Patellofemoral Pain Syndrome, Runner’s Knee (Patellofemoral Pain)
Prolotherapy and PRP (Platelet Rich Plasma) Injections for Knee Pain
Comprehensive Prolotherapy is an injection technique utilizing many healing factors. They can include or be used in conjunction with Dextrose, Blood Platelets, and stem cell injection therapy. The stem cells and blood platelets are drawn from the patient.
In research, PRP by itself has been shown to be a remarkable treatment for knee osteoarthritis. However, other research points out that PRP’s effects may not be long lasting or beyond six months.8 At Caring Medical we developed comprehensive Prolotherapy and inject the supportive structures of the knee with dextrose Prolotherapy and other growth factors. Simply, while PRP can address and repair damaged cartilage, it is not addressing the ligament and tendon weakness that contributed to the cartilage deterioration. Comprehensive Prolotherapy seeks to repair the entire knee.
Prolotherapy and Stem Cell Therapy for Knee Pain
In this study, Caring Medical doctors examined the use of a simple, cost-effective regenerative treatment using direct injection of bone marrow stem cells into osteoarthritic joints in combination with dextrose Prolotherapy. Seven patients with hip, knee or ankle osteoarthritis received two to seven treatments over a period of two to twelve months. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise.9
Prolotherapy for Back Pain
Caring Medical patients are often surprised to learn that Prolotherapy can heal most disc problems in neck and back. While we talk about Prolotherapy healing joint pain that results from ligament and tendon injuries, most people are unaware that disc problems results from ligament injuries or instability along the spine. Patients with degenerative disc disease,herniated discs, bulging discs, bone on bone, etc can all be healed with Prolotherapy. Prolotherapy works to stabilize the ligaments of the spine allowing discs to get back into position and can even create space to a person who has lost space due to one or more degenerated disc.
In Prolotherapy research from the doctors of Caring Medical, patients with more than four years of unresolved low back pain were shown to have had their pain improved, stiffness, range of motion, and quality of life measures even 12 months subsequent to their last Prolotherapy session. 10
Prolotherapy for Shoulder Pain
In published research from Caring Medical doctors, The optimal long-term, symptomatic therapy for chronic shoulder pain has not been established. Accordingly, we investigated the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved shoulder pain at a charity clinic in rural Illinois. We studied a sample of 94 patients with an average of 53 months of unresolved shoulder pain that were treated quarterly with Prolotherapy. An average of 20 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment. The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, and crunching sensations (crepitation), to the p
How many Prolotherapy injections are given at each treatment?
Most people do not want to receive a lot of injections. Injections hurt. However, if you want to achieve a curative result with Prolotherapy, your Prolotherapy doctor must take a comprehensive approach and give you alot of injections. Every area of your body must be treated that is causing pain. Thus, Comprehensive Prolotherapy involves
- Injecting all of the injured structures (IE not just the joint, but also the surrounding support structures)
- Using a strong enough proliferant (Prolotherapy solution)
If you go to a Prolotherapy doctor who only give you two or three shots, it is highly likely you will not get better. Most people understand conceptually that if you injure a structure in a joint that over time that injury will affect all the structures of the joint. Most patients come to see a Prolotherapy doctor after having pain for at least several years. What may have started out as a simple ligament sprain, after 3-6 years is now a total joint problem. All the structures of the joint and around the joint (or at least the majority of them) must be treated with Prolotherapy to completely alleviate the pain.
Some Prolotherapy doctors only provide 1-3 injections. Often patients who receive this type of Prolotherapy will eventually seek out a doctor who provides Comprehensive Prolotherapy. While in the most technical sense, the patient did receive Prolotherapy, it may not be effective. To be effective, the Prolotherapy doctor must do the following:
- Stimulate all the structures that are injured to heal.
- Use enough solution per structure to induce a sufficient healing reaction.
- Use a strong enough solution per structure to induce a sufficient healing reaction.
- Help the person obtain maximum health if their health is not good.
- Assist the person in getting off medications, supplements, or traditional hormones (like birth control pills) that inhibit healing.
Can Prolotherapy help you?
If you are interested in Prolotherapy at our office, and would like to ask us specific questions about your case, we’d love to help! Contact us online or give us a call at 708-848-7789.
1. Low back pain research: Steindler A, Luck JV. Differential diagnosis of pain low in the back JAMA. 1938;110(2):106-113. doi:10.1001/jama.1938.02790020020007.
2. Louis W. Schultz. A Treatment for Subluxation of the Temporomandibular Joint JAMA. 1937;109(13):1032-1035. doi:10.1001/jama.1937.02780390034012.
3. Hauser RA, Hauser MA. A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois Journal of Prolotherapy. 2009;1(1):11-21.
4. Rabago D et al. Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil. 2013 Nov;94(11):2075-82. doi: 10.1016/j.apmr.2013.06.025. Epub 2013 Jul 10.
5. Rabago D. et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013 May-Jun;11(3):229-37. doi: 10.1370/afm.1504.
6. Hauser RA. The Regeneration of Articular Cartilage with Prolotherapy. Journal of Prolotherapy. 2009;1:39-44.
7. Reeves KD, Hassanein KM. Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity. Altern Ther Health Med. 2003 May-Jun;9(3):58-62.
8. Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy. 2013 Dec;29(12):2037-48. doi: 10.1016/j.arthro.2013.09.006.
9. Stem Cell Therapy and Prolotherapy research Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013.
10. Hauser RA, Hauser MA Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study
Journal of Prolotherapy. 2009;3:145-155.