What is in Prolotherapy injections?

Prolotherapy Knee Examination

Katie Worsnick, PA-C

When you get a Prolotherapy treatment or “prolo,” as some call it, you are getting injections. What type of injections?

Katie Worsnick, PA-C

These are the type of questions our staff gets via phone and email and if you are reading this article, it is likely the same questions you have.

Prolotherapy is a customizable treatment. It can be all these injection solutions and more. Prolotherapy can give given with stem cells. Prolotherapy can be combined with Platelet Rich Plasma Therapy. Prolotherapy can be simple dextrose. At Caring Medical our philosophy is to always offer the least complicated and simplest methods first and then move on to blood platelets and stem cells if there is not sufficient response.

Prolotherapy Solution Progression

The videos throughout this page will demonstrate the many different types of Prolotherapy

However, fitting all this under the term Prolotherapy can be confusing to patients, doctors and researchers and can lead some to questioning of Prolotherapy’s effectiveness

Not only are patients confused, but researchers as well.

Doctors at Ohio State University wrote in the medical journal Physical Medicine and Rehabilitation that Prolotherapy is a technique that involves the injection of an irritant, usually dextrose solution for the treatment of chronic painful musculoskeletal conditions. Despite its long history and widespread use as a form of complementary therapy, there still are disparities over its optimal indications and injection preparations.(1)

In one paper, even the researchers were not sure if the patients received Prolotherapy or some other procedure called Prolotherapy. Doctors at the Chonnam National University Hospital, Korea wrote in The journal of alternative and complementary medicine:

“Controversy exists regarding the efficacy of ligament Prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies.”(2)

In other words, success for Prolotherapy was dependent on technique. So when someone says “Prolotherapy did not work or was not supported in the research,” was it Prolotherapy or some other procedure called “Prolotherapy?”

The effectiveness of Prolotherapy does depend upon the technique of the individual doctor, as well as the overall health and dedication of the patient to encourage the healing process after each treatment.

This was pointed out by research from the University of Wisconsin School of Medicine and Public Health and our friend and colleague David Rabago, MD. Publishing in the medical journal Primary care clinics in office practice Dr. Rabago wrote:  “Prolotherapy techniques and injected solutions vary by condition, clinical severity, and practitioner preferences.”(3)

What do we use in our Prolotherapy injections?

Prolotherapy Knee Injection SitesThe Prolotherapy technique we use at Caring Medical Regenerative Medicine Clinics is called Comprehensive Prolotherapy or Hackett-Hemwall Prolotherapy. This type of Prolotherapy incorporates the teaching and techniques of doctors George S. Hackett, MD, and Gustav A. Hemwall, MD, two of the pioneers in the field.

The primary ingredient in Prolotherapy injections used at Caring Medical is dextrose, a corn extract. How does a corn extract accelerate healing?

This technique involves using the simple and safe base solution dextrose as the primary proliferant, along with an anesthetic (such as procaine or lidocaine), that is given into and around the entire painful/injured area(s). Many injections are given during each treatment, versus just a few injections. Most treatments are provided every 4 to 6 weeks to allow time for growth of new connective tissues.

In this basic Prolotherapy injection solutions we also use an alkaline extract of the pitcher plant called Sarapin. Almost all pain issues have some kind of nerve component, which Sarapin helps to relieve. In our experience, Sarapin enhances the healing effects of injection treatments and has an excellent safety profile. It is one of the few materials found in the Physicians’ Desk Reference that has no known side effect. Also in the basic solution, to help ease the pain of the injection procedure, as well as provide pain relief to the area, procaine or lidocaine is added in very small quantities. Often, this helps to ease the pain right away after the procedure, but is used in such a small amount to not cause any adverse effect to the joint repair/wound healing cascade.

Prolotherapy Hip Injection SitesWith a comprehensive approach, we utilize many different types of Prolotherapy solutions, individualizing each treatment according to the patients’ unique needs. The solutions are changed depending on the individual patient and the amount of inflammatory reaction required to produce sufficient healing and new collagen growth. We also use cellular proliferants such as blood, PRP (platelet rich plasma), bone marrow, and stem cells.

For more information on these treatments please see our articles:

As with other medical procedures, Prolotherapy is a specialty. If you are looking into Prolotherapy, you first want to make sure that the Prolotherapy doctor or Prolotherapist in experienced in the Comprehensive Prolotherapy procedure and has successfully treated cases like yours.

Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katie Worsnick, PA-C | David Woznica, MD

1. Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R. 2011 Jun;3(6 Suppl 1):S78-81. [Google Scholar]
2. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90. [Google Scholar]
3. Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010 Mar;37(1):65-80. [Google Scholar]

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