Hackett Hemwall Prolotherapy: The Prolotherapy technique used at Caring Medical & Rehabilitation Service
Hackett Hemwall Prolotherapy: The Prolotherapy technique used at Caring Medical & Rehabilitation Services
Hackett-Hemwall Prolotherapy is a type of Prolotherapy that incorporates the teaching and techniques of doctors George S. Hackett, MD and Gustav A. Hemwall, MD. Dr. Hackett was one of the original inventors of the technique, and Dr. Hemwall, one of his first “Prolotherapy students,” mastered the technique, expanded its use, and subsequently brought Prolotherapy to other physicians, training many of the Prolotherapy physicians who are practicing today. This technique involves using a safe and simple base solution containing dextrose as the primary proliferant, along with an anesthetic (procaine or lidocaine), that is given into and around the entire painful/injured area (many injections vs one injection.) Most treatments are given every four to six weeks to allow time for growth of the new connective tissues. The average person requires 3 to 6 visits total. The treatments are done in the office and do not require imaging or X-ray guidance or conscious sedation. Many body parts can be treated at the same visit. Sometimes additional proliferants (stronger Prolotherapy solution additives) may be added to the base solution, depending on the individual case.
Prolotherapy Pioneers: Prolotherapy doctors Hackett and Hemwall:
George S. Hackett, MD , was a graduate of Cornell Medical School, class of 1916. He was a busy consulting trauma surgeon at Mercy Hospital in Canton, Ohio. He was often called upon for special examinations by approximately 70 accident insurance companies to report accurate diagnoses and prognoses. In 1939 he arrived at the conclusion that relaxation of the articular ligaments was responsible for a considerable number of low back disabilities. Dr. Hackett then coined the term ligament relaxation which he described as a condition in which the strength of the ligament fibers has become impaired so that a stretching of the fibrous strands occurs when the ligament is submitted to normal or less than normal tension. He called a similar situation in tendons, tendon relaxation. He then decided to try strengthening the ligaments by injecting a proliferating solution into the fibrous bands to stimulate the production of fibrous tissue. The treatment proved to be successful from the beginning and it was cautiously extended to articular ligaments of the entire spine, pelvis, and other joints.(1) He then coined the term Prolotherapy, which is the treatment that causes the ligaments and tendons to strengthen and tighten, fine-tuned the technique, and taught it to other physicians.
Dr. Hackett describes Prolotherapy as, “the treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.” To the treatment of proliferating new cells, I have applied the name Prolotherapy from the word proli (Latin), meaning offspring; proliferate - to produce new cells in rapid succession (Webster’s Dictionary.) My definition of Prolotherapy as applied medically in the treatment of skeletal disability is ‘the rehabilitation of an incompetent structure by the generation of new cellular tissue’…I have developed special techniques, particularly for lumbosacral and sacroiliac joint stabilization, that make possible the injection of a small portion of the solution at from 10 to 15 places against bone from one insertion of the sharp needle through the skin…I am so confident of my diagnosis, the depth of the ligament, and my tactile sensation that I usually only use the proliferant combined with anesthetic solution and no anesthetic solution alone before entering the ligament or tendon. Usually the needle is inserted at the trigger point of either ligament or tendon until the point of the needle contacts bone. The local pain is reproduced, confirming the diagnosis. The proliferating solution is injected while the point of the needles is held against the bone.”(2)
Dr. Hackett then wrote the book Ligament and Tendon Relaxation Treatment by Prolotherapy and this book is still used today by physicians learning the technique of Prolotherapy. The book is available at www.hacketthemwall.org.
Dr. Hackett performed a good amount of research over his Prolotherapy years. He published a landmark study in the 1950s on rabbit tendons. The injections of proliferating solution were shown on microscopic slides of rabbit tendons. The solution was distributed throughout the tendon from its origin in the muscle to its insertion into the bone. No destruction of nerves, blood vessels or tendinous bands was seen and it became evident that Prolotherapy stimulated the normal healing inflammatory reaction. (1)
Dr. Hackett also studied his patients and reported on their results with Prolotherapy. In his words, “In approximately 5,000 injections, no unfavorable incident occurred. During a 21-year period, 1,857 patients with ligament/tendon disability were treated by Prolotherapy in our clinic and hospital. The technique of diagnosis and treatment was improved and extended from the low back to the occiput and into the extremities in collaboration with our colleagues to include several thousand patients in which a high degree of success continues.” Good to excellent results were reported in 90% of 82 consecutive patients with occipito-cervical disability treated by Prolotherapy during the past four years. There were no unfavorable sequellae.”(2)
In another study of 206 traumatic headache patients, Dr. Hackett found that 79% were completely relieved of their headaches and 89% in total achieved some relief from their headaches with Prolotherapy. He also performed a large study of back pain patients. He found that about 90% of the patients had evidence of some type of ligament laxity, typically in the sacroiliac joint. One of his studies involved 1,857 patients treated for ligament laxity in the lower back, of which 1583 experienced sacroiliac ligament laxity. His study revealed that 82% were cured of their back pain with Prolotherapy and the pain relief continued 14 years after their last treatment when a follow-up study was done. This was published in the Journal of the American Medical Association in 1957. Interestingly enough, here a physician reported that 82% of chronic low back pain was CURED with a simple, in-office, non-surgical injection technique and nobody paid much attention – except one man – Gustav A. Hemwall, MD. (1)
Dr. Hemwall learning about Prolotherapy from
Dr. Hackett at a medical conference.
Gustav A. Hemwall, MD. Fortunately for us, Dr. Hemwall met Dr. Hackett at that 1957 AMA meeting and was fascinated with Prolotherapy. Dr. Hemwall observed Dr. Hackett in his office in the 1950s and became an expert Prolotherapy physician. Dr. Hackett passed away at the age of 81 in 1969, but it was Dr. Hemwall who, until his death in 1998, taught the majority of physicians the technique of Prolotherapy. Dr. Hemwall trained hundreds of physicians at a medical missionary clinic that was held every March in Honduras – and did this for over 35 years. He also held a Prolotherapy conference in Wisconsin every October for the many years. Both of these continue to this day under the direction of the Hackett-Hemwall Foundation. (www.hacketthemwall.org).
Dr. Hemwall lecturing at the Hackett Foundation Prolotherapy Conference
Dr. Hemwall treated more than 10,000 patients worldwide. He also reported his clinical experiences with Prolotherapy in a study on 8,000 of those patients. In 1974 Dr. Hemwall presented his largest survey of 2,007 Prolotherapy patients to the Prolotherapy Association. More than 99% of the patients who completed treatment with Prolotherapy found pain relief, which were similar results to those published by Dr. Hackett. He too found that Prolotherapy was completely curative in many cases and provides some pain relief to nearly all. (1)
Here are some of the highlights of Dr. Hemwall’s discoveries with Prolotherapy that have shaped the way we provide Prolotherapy treatments to this day.
Expanded Prolotherapy’s Use
- Expanded Prolotherapy’s effectiveness at eliminating chronic pain to every joint of the body, not just the spine.
- Documented that Prolotherapy could be done safely in the office and did not even require conscious sedation (because the original technique was often done in the hospital under anesthesia or conscious sedation).
- Showed that Prolotherapy could be done on multiple body parts at one time.
- Discovered that simple dextrose worked great as a proliferant. This was an important discovery because it meant patients could receive treatments to multiple areas at once and did not require sedation, which obviously brought the cost per treatment down.
Teacher, Researcher, and Missionary – A Legacy
Gus and Helen Hemwall
- From the late 1960’s until his death in 1998, Dr. Hemwall was the main teacher of Prolotherapy in the world.
- Dr. Hemwall and his wife Helen led mission trips to Honduras for over 35 years, which provided a great venue for doctors to be trained (also called Honduras University).
- Dr. Hemwall set up the Hackett Foundation, which has been renamed The Hackett-Hemwall Foundation and continues to be involved in training physicians in Prolotherapy around the world, as well as carrying out research on Prolotherapy.
- Dr. Hemwall published the largest survey (involving 1871 patients) of which 75.5% stated Prolotherapy cured them and 99.8% reported some improvement. Only 0.2% reported no improvement.
- Dr. Hemwall defended Prolotherapy three times before the Chicago Medical Society, one of the largest branches of the American Medical Association. Each time Prolotherapy was found to be an acceptable procedure that should be covered by insurance.
- Dr. Hemwall treated his good friend C. Everett Koop, MD with Prolotherapy. Dr. Koop subsequently became Surgeon General of the United States and continued to defend Prolotherapy because it helped get rid of his intractable pain. He also performed Prolotherapy on some of his patients.
- Dr. Hemwall trained Jeff Patterson, DO who now runs the Hackett-Hemwall Foundation and carries on the work of training physicians in not only Honduras, but other countries as well. Dr. Patterson also teaches Prolotherapy at the University of Wisconsin, Madison.
- Dr. Hemwall trained K. Dean Reeves, MD, who has published a great amount of research on Prolotherapy and is one its finest practitioners and most talented supporters.
- Dr. Hemwall trained Ross Hauser, MD, who resumed Dr. Hemwall’s practice and subsequently wrote Prolo Your Pain Away! with Marion Hauser, which was dedicated to Dr. Hemwall, who was able to see the book prior to his death.
Gustav Hemwall, MD and Ross Hauser, MD
Why Hackett-Hemwall Prolotherapy?
We feel that the Hackett-Hemwall technique of Prolotherapy is not only an effective treatment, but also cost effective for the patient. What these pioneers discovered is still the most applicable form of Prolotherapy today.
Dr. Hackett taught the technique of Prolotherapy to Gustav A. Hemwall, MD. Dr. Hemwall brought the technique to the Chicagoland – Oak Park, IL area. At the age of 83, Dr. Hemwall hired Dr. Hauser take over his practice when he retired. Dr. Hauser had the opportunity to work side-by-side with Dr. Hemwall for five years. What a blessing and an honor! One of Dr. Hemwall’s favorite things to say was, “If the area has pain, inject it!” Simple. Dr. Hemwall retired at the age of 88 in 1996 and subsequently passed away at the age of 90 in 1998. We certainly miss him but are privileged to carry on his legacy.
Unique features of Hackett-Hemwall Prolotherapy that make it so successful:
- The major cause of degenerative arthritis and chronic pain is joint instability. It needs to be treated with Prolotherapy.
- Most structural chronic painful conditions involve ligament injury and these injured ligaments need to be sufficiently treated in order to fully restore joint stability.
- The ligament laxity must be intensely stimulated to induce enough proliferation to produce a clinical effect.
- Most tendinopathies (for example, supraspinatus tendinosis) are caused by joint instability (ligament laxity). To cure most tendinopathies, the underlying joint instability needs to be treated.
- It is typically best to treat all or most of the ligaments of an unstable joint if that joint or its surrounding structures are painful.
- Many, many injections are needed to produce enough of a healing reaction to restore proper joint function to an unstable painful joint (like spot welding).
- Multiple joints and structures can be treated with each visit.
- The neck, thoracic, and low back facet joints can be thoroughly and safely treated without the need of fluoroscopy which subsequently keeps cost way down.
- Tendinopathies can be easily and effectively treated without the use of ultrasound, again keeping costs way down.
- Many different types of solutions can be used, but they must provide an ample inflammatory reaction to induce enough healing to cause stabilization of the joint.
- The treatments are generally given every three to six weeks to allow sufficient time for new collagen growth. Most commonly in our office, most patients receive monthly treatments, but in certain urgent healing situations, they can be given up to weekly.
- Prolotherapy is given without the use of narcotic medications, anti-inflammatory medications, and steroid solutions, as these inhibit healing.
- For the appropriate case, Hackett-Hemwall Prolotherapy has a greater than 90% pain relief rate.
The technique of Prolotherapy as taught by these two pioneers has been named the Hackett-Hemwall technique of Prolotherapy. Dr. Hauser was privileged to learn Prolotherapy directly from Dr. Hemwall and work with him side-by-side, and subsequently take over his practice in 1993. We all owe a great debt to these pioneers whose contributions to the field of pain and Prolotherapy have been monumental. They have changed the face of pain management – to pain treatment! Thus, we strive to carry on the work that they so humbly and honorably began.
This is why we practice the Hackett-Hemwall technique of Prolotherapy – because it works! If you have any questions about Hackett-Hemwall Prolotherapy or would like us to clarify any information for you, please give our office at call at 708-848-7789 or email us at firstname.lastname@example.org. If you would like to make an appointment, please complete this contact form.
- Hauser, R. et al Prolo Your Pain Away! Curing Chronic Pain with Prolotherapy. Oak Park, IL. Beulah Land Press. 2007.
- Hackett, G. Ligament and Tendon Relaxation Treated By Prolotherapy. Third Edition. Springfield, IL: Charles C. Thomas, 1958.