This article will cover information on Prolotherapy including general questions on Prolotherapy treatments, side effects, research, reviews and medical studies.
Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. This article will list many of these studies.
Empirically, what we have seen in our patients, is that comprehensive Prolotherapy is superior to many other treatments in curing chronic joint and spine pain. It helps get people back to a happy and active lifestyle without surgery, pain medications, and years of chronic care.
In our opinion, Prolotherapy is the best type of therapy for resolving the cause of almost all chronic pain: joint instability.
Since this page may be your introduction to Prolotherapy, let us present you with a scenario that is probably very familiar to you. In fact, it may be about YOU! Rest assured we have seen thousands of people with symptoms like yours. Your physical pain is standing between the activities you once enjoyed: golf, swimming, running. Eventually, it starts to stand between you and your ability to work or play with your children or grandchildren. Once you decide the pain is severe enough to seek a professional medical opinion, your medical journey may go something like this:
- You are seeing numerous allopathic and medical specialists without success
- You have undergone many chiropractic treatments
- You have tried physical therapy
- You have tried massage therapists
- You have been taking numerous prescriptions and anti-inflammatory medications
- You have requested stronger prescription of anti-inflammatory medications
- You have decided to get a cortisone shot(s)
- You have received a nerve block
- You have decided on surgery
- You have had numerous surgeries
The end result of this journey is that you continue to suffer with the painful conditions and the various therapies may have made the pain worse! On top of poor results, you have spent a lot of time and money and have had your pain worsen
Why does this happen to so many people?
The answer is that none of the other treatments actually fix the root cause of the problem: joint instability, the missing diagnosis. Prolotherapy is specifically designed to correct the instability problem in that it strengthens and repairs the ligaments and tendons. As a result, Prolotherapy offers patients a better chance of permanently curing their pain.
The basic mechanism of Prolotherapy is simple. The Prolotherapy solutions are injected into the painful areas, producing a reparative healing response there. This localized inflammation triggers a wound-healing cascade, resulting in the deposition of new collagen.
New collagen shrinks as it matures. The shrinking collagen tightens the ligaments that were injected and makes them stronger and more secure, thus stabilizing the unstable joint(s).
Prolotherapy has the potential of being 100% effective in eliminating sports injuries and chronic pain, as long as the treatment is comprehensive enough to cause complete tightening and strengthening of the ligaments.
Like cabinet doors, the musculoskeletal system of the human body breaks down at the hinges (joints). In this regard, Prolotherapy is akin to a Phillips screwdriver tightening the hinges on the cabinet door. The solution to fixing the loose door is not to replace the door or oil the hinge, but to tighten the screw that holds the hinge in place. This is what Prolotherapy does as it tightens the joint connectors.
One of the most important aspects of healing is injecting enough of the right type of solution into the entire injured and weakened area(s). If this is done, the likelihood of success is excellent.
Prolotherapy treatment information
Prolotherapy involves using a safe and simple base solution containing dextrose as the primary proliferant, along with an anesthetic (procaine), that is given into and around the entire painful/injured area (many injections vs only a few injections.)
This basic Prolotherapy solution used for over 70 years includes the above mentioned hypertonic dextrose (10-25% concentration) along with an anesthetic.
In our office, we often include other natural substances, such as Sarapin. The dextrose makes the solution more concentrated than blood (hypertonic), acting as a strong proliferant. Sarapin is used to treat nerve irritation and, in our experience, acts as a proliferant. Sarapin is an extract of the pitcher plant and is one of the few materials listed in the Physicians’ Desk Reference that has no known side effects. Procaine is an anesthetic that helps reinforce the diagnosis because the patient will experience immediate pain relief after the Prolotherapy injections.
The current Prolotherapy technique described here has been administered by Dr. Hemwall and is often referred to as Hackett-Hemwall Prolotherapy for the treatment’s founding proponents.
- Many body parts can be treated at the same visit, which is convenient and cost-effective for patients who have multiple painful joints or more complex chronic pain, or for patients who travel to us from out of the region or country.
- In our aggressive comprehensive Prolotherapy approach, we may add additional proliferants, this may be bone marrow or adipose derived stem cells and blood platelets as used in PRP or Platelet Rich Plasma Therapy.
- Most treatments are given every four to six weeks to allow time for growth of the new connective tissues.
We are often asked how many Prolotherapy treatments are needed?
This is dependent upon the person’s overall health status, the extent of the condition, injury, tear, or arthritis. In our clinical experience, as well as in our research, we find the number of treatments that helps a person attain their goal averages 3 to 6 visits.
Because we treat a wide variety of cases, from young athletes with acute injuries to the elderly who have suffered through numerous surgeries and decades of anti-inflammatory pain medication, we work to tailor the treatment plans to the patients’ individual goals and needs.
While most patients have the goal of becoming pain-free and having increased stability and mobility in the joint, their activity goals must also be taken into consideration.
High level athletes may have more aggressive treatment needs than a retiree who does not desire to do a lot of activity. Thus, it is imperative to seek a practitioner who not only practices a thorough technique and has access to all types of solutions, but also who understands sports medicine and rehabilitation for patients to do between treatments.
What is Prolotherapy? Prolotherapy patient information in detail
- Prolotherapy is a regenerative injection treatment used to repair incomplete healing of the ligament and tendons.
- The major cause of degenerative arthritis and chronic pain is joint instability which involve ligament injury. Injured ligaments need to be correctly treated in order to fully restore joint stability. Prolotherapy treats and rebuilds ligaments.
- 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 in instances of joint instability and osteoarthritis.
- Prolotherapy is given without the use of narcotic medications, anti-inflammatory medications, and steroid solutions, as these inhibit healing.
- The Prolotherapy procedure is considered a safe, affordable option that allows the patient to keep working and/or training during treatment.
- 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. Multiple joints and structures can be treated with each visit.
- 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.
- As regenerative medicine advances, Prolotherapy practitioners are taking notice of which methods can be incorporated into dextrose Prolotherapy treatments to help direct a person’s own stem cells and/or growth factors into the exact places where healing needs to take place within a joint. This is called Autologous (From your own cells) Prolotherapy, or Cellular Prolotherapy.
- In our office, we utilize Platelet Rich Plasma (PRP) Prolotherapy, which involves concentrating platelets/growth factors found in the blood and injecting them directly into the joint. We also offer Stem Cell Therapy or Stem Cell Prolotherapy using a person’s own bone marrow and/or fat cells, which are collected and injected during the same day procedure. With any Cellular Prolotherapy procedure done in our office, patients also receive dextrose Prolotherapy to the surrounding joint attachments, in order to ensure the area of pain and instability is comprehensively treated.Does Prolotherapy work? The research starts here:
For patients who are looking into Prolotherapy, please understand that this is a specialty procedure with technique and experience being a key component. What we present on our website is based on our experience and research and does not apply to all practitioners or injection therapies.
In July 2016, doctors at Caring Medical published findings on the effectiveness of Prolotherapy treatments in the medical journal: Clinical Insights: Arthritis and Musculoskeletal Disorders, here are the summary highlights:
Our doctors reviewed 32 studies on dextrose prolotherapy for chronic musculoskeletal pain. The following conclusions are made:
- Prolotherapy is supported in the treatment of tendinopathies in patients who fail conservative therapies;
- Prolotherapy is supported in the treatment of knee osteoarthritis
- Prolotherapy is supported in the treatment of finger joint osteoarthritis in patients who do not respond to conservative therapies;
- Prolotherapy is supported in the treatment of back pain and
- Prolotherapy is supported in the treatment of pelvic pain in patients who fail to respond to conservative therapies. . .
Overall, Prolotherapy has been demonstrated to be efficacious and should be considered as a treatment for pain and dysfunction associated with chronic musculoskeletal conditions, particularly tendinopathies and osteoarthritis.
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. [Google Scholar]
A discussion of Prolotherapy as an alternative to elective orthopedic surgery
Most of the joints in the body are synovial joints, or freely movable joints. These joints function as a result of the unique properties of the articular cartilage that covers and protects the ends of the bones. If the cartilage is damaged or removed, so is the functioning of the joint, which suffers as bone rubs against bone instead of cartilage over cartilage. This wearing of the cartilage is the end stage of degenerative joint disease. Before this bone on bone situation can develop, joint instability must be present. Joint instability can be tendon attachment tear and weakness, ligament attachment weakness or tear as well as over stretched ligaments.
Surgery can be broadly classified into open repair, in which a surgical incision is made for direct access and visualization of the injury site, and closed, or arthroscopic, repair, in which a miniature camera is used to look into the joint through a small hole, and specially designed tools are used to repair the tissue. Surgery almost always involves the removal of bone, ligaments and tendons. Many different types of surgery are common, including:
- rotator cuff surgery: arthroscopic surgery to clean scar tissue and damage to the joint surfaces, as well as repair the tear of the rotator cuff
- hip replacement: replacement of the joint in which the diseased bone tissue and cartilage is removed from the hip joint, replacing the head of the femur (the ball) and the acetabulum (the socket) with new, artificial parts; the healthy parts of the joint are left intact. Learn more about Prolotherapy as a hip replacement alternative.
- knee surgery, also called arthroscopy: although intended to “explore” the knee joint to determine the cause of the problem, it usually involves some scraping, burning and/or cutting of valuable cartilage
- laminectomy: the most common back surgery, which involves the surgical removal of the posterior arch of a vertebra; results in problems similar to those of a discetomy (see below)
- lumbar spinal fusion: fuses vertebrae together, which often leads to ligament laxity and spinal instability as other parts of the spine attempt to compensate for this new, rigid section
- ankle fusion: similar to a spinal fusion, it fuses the shinbone to the talus, immobilizing an area to eliminate pain, but often leading to more pain due to ligament laxity and compensation in other areas and joints
- discectomy: a disc is removed to alleviate lower back pain; this often results in more back pain as the surgery causes ligament laxity and instability of the spine
Reasons patients avoid surgery:
- Surgery is traumatic; it puts stress on the body and could cause the individual to feel less confident using the surgerized limb.
- Surgery irreversibly alters the individual’s anatomy.
- Surgery potentially involves all kinds of complications.
- Surgery can lead to long-term arthritis due to the removal of significant tissue that is needed to help the body bear weight, such as cartilage, meniscus and disc tissue.
- Rehabilitation is much longer after surgery than for more conservative measures, such as Prolotherapy.
- Surgery does not always resolve the pain, which either means it did not address the cause of the pain, or that it caused another problem.
Am I a Candidate? The Ideal Prolotherapy candidate has the following:
- Pain originating from a ligament or tendon
- Strong immune system
- Willingness to improve and receive follow-up visits
- Healthy diet
- Positive mental outlook
Prolotherapy Treatment Goals
What are the goals of Prolotherapy treatments?
- Function Is the patient’s ability to function in activities of daily living improved? Is the patient able to perform previously painful activities without pain? Is the person able to do things that he/she could not do prior to Prolotherapy?Patients are typically advised to continue to receive Prolotherapy treatments until able to stably perform that certain function pain and cracking-free. For example, if a patient can now climb two flights of stairs without knee pain after Prolotherapy, whereas prior to the Prolotherapy this would cause excruciating pain, then we know that Prolotherapy is helping improve function.
- Strength Ligament and tendon injury may cause muscle strength to decline. When a person receives Prolotherapy, one of the noticeable effects of the treatment is that strength improves in the injected areas.
- Pain Pain is one of the most common reasons patients receive Prolotherapy. Thus, a noticeable decrease in pain shows the benefit of successful Prolotherapy.
- Stiffness Patients commonly experience stiffness upon morning rising or after performing a certain activity. This stiffness is commonly felt in the lower back or neck, but could involve any area of the body. A great sign that Prolotherapy is working is that stiffness has subsided. Once Prolotherapy helps stabilize the area involved, the muscles no longer have to provide this stability so they relax. Once they relax, the stiffness subsides.
- Physical Examination An experienced Prolotherapy doctor should be able to assess whether the Prolotherapy is working by simple physical examination. The physician can also listen for crepitation or crunching in the joints which can often be audibly heard by moving the joint. The joint that doesn’t crunch is also improving. X-rays and MRIs are poor indicators that Prolotherapy is working, the reason being that most ligaments do not show up well on these tests. Some improvements from Prolotherapy can be seen with x-rays and MRI’s, but it isn’t always necessary or advantageous to rely solely on those indicators due to their high incidence of inaccuracies.
Questions about Prolotherapy injections at the time of treatment
We are asked by every patient: Do the injections hurt? This depends on the condition and a person’s own pain tolerance. Most people surprise themselves at how well they do during a treatment because it is over in a matter of minutes.
What are the options for providing a “painless” Prolotherapy procedure?
- Lidocaine cream for the skin. This is applied shortly before treatment and helps to reduce the pain when the needle pierces the skin. The needle piercing through the skin is generally the most painful part of the procedure.
- Pre-medication for anxiety and pain may be prescribed to help you relax and dull the pain from the treatment.
- Local anesthetic may be injected around the area prior to starting the treatment.
- Nitrous gas is an available option.
- Relaxing aromatic and topical essential oils are pleasant options for those who prefer a more natural approach.
- Sometimes squeezing a stress ball or deep breathing is all that is needed.
- Conscious sedation is an option for select cases in the Florida office location.
For those requiring Prolotherapy injections in many areas at one time or in delicate areas, some form of nitrous, sedation, or other medication is often suggested, such as with Ehlers-Danlos patients, or in cases where the pain of the condition itself already an excruciating “10 out of 10,” such as in cases of Chronic Regional Pain Syndrome. After treating thousands of patients who claim how much they “hate needles” (rest assured, these patients make it through just fine), it is good to remember that the goal of the treatment outcome should outweigh any hesitancy about the discomfort during the procedure, especially when there are now better options than ever to reduce procedural pain.
Most of our patients receive Prolotherapy without the help of medication and do just fine!
Prolotherapy Side effects and risks
Prolotherapy Side effects and risks
- Bleeding in the area
- Bruising in the area
- Increased pain
- Joint effusion
- Nerve injury
- Puncture of a lung
- Spinal headache
- Tendon/ligament injury
Because Prolotherapy causes inflammation, the person will often note some bruising, pain, stiffness and swelling in the area after receiving Prolotherapy. Typically this lasts 1 to 7 days. On rare occasions it lasts longer. Lasting longer is not necessarily bad, some people just inflame more easily. Since the treatment works by inflammation, lingering pain after Prolotherapy can be a sign of healing. If the pain is severe after Prolotherapy, then call the office where the Prolotherapy was done. Prolotherapy should not cause excessive, severe pain. Severe pain after Prolotherapy, especially accompanied by a fever, could indicate
The risk of infection after Prolotherapy is between 1 and 1000 to 1 and 10,000 procedures. The most common infection with Prolotherapy is an infection in the skin. This type of infection typically responds to an antibiotic taken by mouth. If a joint or blood infection results, then intravenous antibiotics will typically be needed for six weeks.
Since some of the risks with Prolotherapy relate to the actual technique done, it is important to go to a clinic with a lot of experience.
Research and validation studies
Prolotherapy, joint instability and degenerative joint disease
Your musculoskeletal system is largley comprised of bones and muscles which are connected together with ligaments and tendons. Ligaments connect bones to bones (joints), while tendons connect muscles to bone. All of these strucures combine to give your body stable form and harmonious movement when working optimally.
During normal use, ligaments gradually stretch when under tension, then return to their original length when the tension is released, similar to how a rubber band or spring works. However, when they stretch too far or stretch for too long, they cannot return to their original shape and stay stretched-out or loose. This ligament laxity causes a joint to be unstable, weak, and puts all of the structures in the joint at risk of becoming damaged. This weakened or damaged tissue causes pain.
Although associated with old age,osteoarthritis and degenerative joint disease are not simply a result of the aging process, nor are they a result of general wear and tear on joints.
Osteoarthritis and degenerative joint disease almost always begin as a
ligament weakness resulting from injury or wear and tear
- The purpose of a hinge on a cabinet door is to keep the door aligned in order to properly open and close. When one of the screws (or ligaments) loosens, more force is placed on the remaining screws (ligaments) to hold the hinge onto the cabinet door (1).
- Eventually, the other screws loosen and the entire hinge becomes loose. This then exerts more pressure on the remaining hinges, which also eventually loosen (2).
- The cabinet door ultimately starts hitting the adjacent door (bone on bone) and damage to both doors occurs (joint instability inspired osteoarthritis).
- The “treatment” to realign the door and stop ongoing damage is to tighten the loose screws (loose ligaments) with a screwdriver (Prolotherapy) (3). Prolotherapy to the ligaments is akin to tightening the loose screws on the hinge. Simple as that! All of the attachments must be treated in order to stimulate them to heal (or tighten).
This simple analogy is the basis for Comprehensive Prolotherapy treatment.
Our Caring Medical and Rehabilitation Services (CMRS) Research
Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature ReviewHauser R, Hauser M, Baird N. Evidence-based use of dextrose prolotherapy for musculoskeletal pain: a scientific literature review. Journal of Prolotherapy. 2011;3(4):765-789.
Objective: To evaluate, through a scientific review of the current literature, the efficacy of dextrose Prolotherapy in treating musculoskeletal pain.Data Sources: All possible internet sources, especially online medical databases including PUBMED, PREMEDLINE, EMBASE, AMED, HEALTHLINE, OMNIMEDICALSEARCH, MEDSCAPE and MEDLINE, were searched through October 2011 for scientific articles on dextrose Prolotherapy. The bibliographies of retrieved articles were also searched.Study Selection: All published studies that could be found on human subjects that included at least five subjects and at least one outcome measure related to pain intensity were included. Nonhuman studies and those studies (human and nonhuman) on Prolotherapy involving other solutions besides dextrose were excluded.
Main Results: Data from forty-four case series, two nonrandomized controlled trials (NRCT) and nine randomized controlled trials (RCT) were included in this review. A total of 2,443 patients were treated which included 2,181 in the case series, 27 in the NRCT and 235 in the RCT. In the 27 case series, involving 1,478 musculoskeletal structures treated, that used VAS or NRS in monitoring the response to treatment, dextrose Prolotherapy caused a decline of over 4.4 points (0 to 10 scale).
Seven of nine double-blind placebo-controlled studies showed statistically significant improvements in pain and/or function with dextrose Prolotherapy over placebo for myofascial pain syndrome, sacroiliac pain, knee osteoarthritis, Osgood-Schlatter disease and Achilles tendinosis.
There is level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritis pain and function, tendinopathies, myofascial pain syndrome, and sacroiliac ligament pain. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse musculoskeletal pain involving the spine, pelvis and peripheral joints. Using the U.S. Preventative Services Task Force guidelines there is fair to good evidence to support the use of dextrose Prolotherapy for musculoskeletal pain.
Conclusion: This scientific literature review shows there is level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis. Read full Article
Consensus Statement Prolotherapy for Musculoskeletal Pain
Journal of Prolotherapy International Medical Editorial Board Consensus Statement on the Use of Prolotherapy for Musculoskeletal Pain
Ross Hauser, MD, et al. Journal of Prolotherapy international medical editorial board consensus statement on the use of prolotherapy for musculoskeletal pain. Journal of Prolotherapy. 2011;3(4):744-764.
The purpose of this paper is to explicate the theory, scientific evidence, methods, and applications for the procedure of Prolotherapy in the treatment of musculoskeletal pain. The example of Prolotherapy for knee osteoarthritis is used as an example as to why Prolotherapy should be used compared to other invasive therapies.
The goal of Prolotherapy is the resolution of pain and dysfunction and the optimizing of health by the individual regaining the ability to do activities of daily living and exercise. Once this is achieved, the individual will potentially no longer need medical care for pain and disability. When this goal is not possible, Prolotherapy aims to help improve one’s quality of life by diminishing pain and improving mobility, activities of daily living, and/or exercise.
Prolotherapy as defined in Webster’s Third New International Dictionary is “the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferation of new cells.” Most Prolotherapy involves the injection of solutions at the fibro-osseous junctions or entheses, the point at which tendons and ligaments attach to the bone, to induce an inflammatory reaction. This induction of the inflammatory healing cascade initiates the regeneration and repair of the injured tissues in and around the joint, stabilizing and eliminating the sources of most musculoskeletal pain.* Prolotherapy can be an ideal treatment for chronic musculoskeletal pain caused by sprained, injured or torn tendons and/or ligaments in such conditions as joint instability, ligament laxity and tendinopathy including tendinosis; as well as other conditions such as enthesopathies and degenerative osteoarthritis involving the peripheral and spinal joints. Read full Article
A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain
Hauser R, Lackner J, Steilen-Matias D, Harris D. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016;9:139-159.
Objective: The aim of this study was to systematically review dextrose (D-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain.
Data sources: Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016.
Study selection: Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected.
Data extraction: Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated.
Data synthesis: Fourteen RCTs, 1 case–control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood–Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee osteoarthritis, finger osteoarthritis, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain.
Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings.
Conclusion: Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature. Read full Article
Prolotherapy as an Alternative to Surgery: A Prospective Pilot Study of 34 Patients from a Private Medical Practice
Hauser R, Hauser M, Baird N, Martin D. Prolotherapy as an alternative to surgery: a prospective pilot study of 34 patients from a private medical practice. Journal of Prolotherapy. 2010;(2)1:272-281. (Caring Medical and Rehabilitation Research Team)
Thirty-four patients with average musculoskeletal pain duration of 27 months who were told by their medical doctor/surgeon that surgery was needed, including 20 joint replacements and nine arthroscopic procedures, were treated with Hackett-Hemwall dextrose Prolotherapy in lieu of surgery. Patients were followed prospectively and asked questions regarding levels of pain, stiffness, and other physical and psychological symptoms, as well as questions related to activities of daily living before and after their last Prolotherapy treatment.
In this study, Prolotherapy caused a statistically significant improvement in their pain and stiffness. The average starting level of pain was 7.6 and stiffness 7.2, but after Prolotherapy they decreased to 1.3 and 2.5 respectively. Ninety-one percent of patients felt Prolotherapy gave them 50% or greater pain relief, and 71% felt the pain relief was greater than 75%.
Upon interview, an average of 10 months after their last Prolotherapy session, this study revealed improvement in patients’ quality of life parameters in addition to pain and stiffness including depression, anxiety, medication usage, as well as range of motion, sleep and exercise ability. Seventy-nine percent felt they had enough pain relief with Prolotherapy that they will not now or in the future need surgery. Four of the remaining seven patients noted 50% or greater pain relief from the Prolotherapy and plan on getting more Prolotherapy in the future.
In this study, Prolotherapy was able to eliminate the need for surgery realistically in 31 out of 34 patients. If Prolotherapy could eliminate 80% of musculoskeletal surgeries in the United States, this procedure alone could make a tremendous dent in cost savings to Medicare, private insurers, and patients. This does not include the money that is lost from productivity and additional expenses that accompany surgery such as future or revision surgeries, rehabilitation, physiotherapy, medications, or disability (from continued pain). Prolotherapy does not have the risks associated with surgery. Often patients can immediately return to work after receiving Prolotherapy. Since results with Prolotherapy are often permanent, no future treatments are needed. These are reasons enough for patients to consider a Prolotherapy evaluation before undergoing a musculoskeletal surgery.
As this pilot study found such significant improvements in these participants with chronic musculoskeletal pain who were told that surgery was needed, further studies under more controlled circumstances, with larger patient populations, should be done. Read full Article
Prolotherapy: Under-Recognized Treatment for Osteoarthritis Pain
Woldin B, Ross Hauser, MD. Prolotherapy: under-recognized treatment for osteoarthritis pain. The Pain Practitioner. 2014;24(3):16-22.
Pain is a highly charged and emotional experience that is hard to describe and even more difficult to quantify, and the pain experienced in osteoarthritis is no exception. Osteoarthritic pain is a complex issue for patients and their health care providers, the latter of whom have relatively few effective treatment options to offer in terms of pain resolution and return of function. Prolotherapy is an injection technique that aids in healing arthritic joints and relieving pain and is emerging as a promising treatment option in osteoarthritis…
In Hackett-Hemwall prolotherapy, a small amount of a proliferant solution such as hypertonic dextrose, sodium morrhuate, or polidocanol is injected into the painful entheses of ligaments or tendons, as well as at trigger points and adjacent joint spaces. This produces an inflammatory response involving fibroblastic and capillary proliferation, along with growth factor stimulation, that induces healing and strengthening of the damaged or diseased structure (40-42). When OA is advanced, cellular prolotherapy, which utilizes cellular and extracellular matrix components of the blood, fat, or bone marrow, is recommended. This cell-based technique consists of intra-articular injections of the PRP portion of the blood or progenitor cells from a lipoaspirate or bone marrow aspiration (43). The goal of this type of prolotherapy treatment is not only pain relief but also regeneration of joint structures including articular cartilage. Read full Article
Stem Cell Prolotherapy
Rationale for Using Direct Bone Marrow Aspirate as a Proliferant for Regenerative Injection Therapy (Prolotherapy)
Hauser R, Eteshola E. Rationale for using direct bone marrow aspirate as a proliferant for regenerative injection therapy (prolotherapy). The Open Stem Cell Journal. 2013;4:7-14.
Adult mesenchymal stem cells (MSCs) obtainable from autologous bone marrow aspirates have generated tremendous interest in the medical and scientific communities in the last two decades and are currently being investigated by a of interested physicians for use in point-of-care stem cell therapies due to their great potential to differentiate into multiple cell lineages such as bone, cartilage, muscle, tendon, and nerve. However, as these stem cells are found in very low numbers in adult tissue, centrifugal concentration or expansion through in vitro culturing has been pursued to obtain higher numbers of efficacious regenerative therapeutic applications. More recently, some physicians and scientists have chosen to explore use for direct injection of un-fractionated, native whole bone marrow aspirate as a strategy in regenerative treatment regimes. This review examines the potential merits and disadvantages of using either concentrated and culture expanded MSCs versus native whole bone marrow aspirate as key proliferant in direct regenerative injection therapy (RIT). Results from a number of published investigations have clearly shown high potential of various deleterious effects on manipulating MSCs obtained from native bone marrow aspirate either by centrifugal forces or expansion through in vitro culturing; moreover, currently used centrifugal concentration techniques do not significantly concentrate MSCs from bone marrow aspirate, thus, defeating the purpose of this manipulative step. On the other hand, preliminary results and observations of using un-fractionated whole bone marrow injection for treatment of various musculoskeletal joint diseases (for example, osteoarthritic joints) suggest that the procedure is safe and potentially efficacious, with no known deleterious effects as yet reported. Read full Article
Treating Osteoarthritic Joints Using Dextrose Prolotherapy and Direct Bone Marrow Aspirate Injection Therapy
Ross Hauser, MD, Woldin B. Treating osteoarthritic joints using dextrose prolotherapy and direct bone marrow aspirate injection therapy. The Open Arthritis Journal. 2014;7:1-9.Osteoarthritis is a chronic, progressive disease of the articular joints, and to date, has no cure or effective long-term treatment.
Objective: To determine if bone marrow prolotherapy (BMP), a combined treatment protocol employing separate injections of hypertonic dextrose prolotherapy and bone marrow aspirate, would be effective as a means of reducing joint pain and improving function in osteoarthritic joints.
Design: Patients with a clinical diagnosis of radiographic osteoarthritis who visited our pain clinic and underwent BMP treatments (N = 24, mean age 64.9) were asked to complete a questionnaire assessing their condition before and after treatment.
Methods: BMP treatments (average 3.6) were conducted at 6 to 8 week intervals and involved autologous harvesting and aspiration of the patient’s tibial bone marrow, after which a hypertonic dextrose solution was injected at sites in and around the index joint (prolotherapy), followed by injections of the bone marrow aspirate directly into and around the joint. At 6 months post-treatment, patients were e-mailed a questionnaire asking them to rate their condition before and after BMP treatment in terms of pain levels at rest, performing activities of daily living, and during exercise (Visual Analog Pain Scale), as well as their degree of stiffness, range of motion, and level of crepitus. Changes in the self-reported scores of these variables for each patient were analyzed to determine the effectiveness of BMP treatment. Data were obtained by comparing the differences between baseline and post-treatment scores and analyzed utilizing a two-tailed paired t test.
Results: Patient-reported improvements in pain relief and joint function were statistically significant (P < .001), as were gains in activities of daily living, exercise ability, and range of motion and losses in stiffness and crepitus. No adverse events occurred.Conclusion: Our survey of patient-reported outcomes supports the use of BMP as an effective therapy for treating osteoarthritis and suggests that BMP has potential for enhancing the quality of life of individuals with the disease.Read full Article
Bone Marrow Prolotherapy for Degenerative Joint Disease
Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series
Hauser R, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2013;6:65-72.
Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as Prolotherapy hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. 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. These preliminary findings suggest that OA treatment with WBM injection merits further investigation…Read full Article
More studies and outcome studies
Stem cells bone regeneration | Repairing bone damage from osteoarthritis
In this article we will examine the medical research concerning the effectiveness of stem cell therapy and bone repair in joint osteoarthritis. Stem cell therapy is part of our comprehensive Prolotherapy treatment program on stimulating bone repair in patients with knee osteoarthritis.
Prolotherapy and knee instability
The primary cause of knee pain is knee joint instability. This can be due to a number of ligaments and tendons attachments becoming torn or degenerated, as well as damaged or removed cartilage and meniscal tissue. It is also important to understand the referral patterns of knee ligaments that can trigger pain sensations further down the leg and into the foot. The medial collateral ligament refers pain down the leg to the big toe and the lateral collateral ligament refers pain to the lateral foot.
The ligaments inside the knee are called the anterior and posterior cruciate ligaments. These ligaments help stabilize the knee, preventing excessive forward and backward movement. If these ligaments are loose, even in a young person, degenerative arthritis begins to form.
The issues of knee instability are key to our work with Prolotherapy, the following articles on our website presents hundreds of medical citations and patient outcomes. These links will take you to specific ligament problems including that of the ACL.
Now let’s explore the research of knee instability.
Prolotherapy knee osteoarthritis injections | Whole knee treatment
We have published a very detailed article on the benefits of Prolotherapy for knee osteoarthritis with numerous references to the latest in prolotherapy knee osteoarthritis research.
This article is summarized and highlighted here:
- Prolotherapy research shows significant improvement in selected patients with knee osteoarthritis.
- Treating the whole knee as opposed to selective parts of the knee is more effective.
In the latest research from June 2017, doctors publishing in the British Medical Bulletin reviewed and evaluated Prolotherapy findings and determined Prolotherapy treatments for patients with knee osteoarthritis showed significant improvement in scores for pain, function and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%) (6)
Recent independent research published in the doctors writing in the journal Therapeutic advances in musculoskeletal disease, says that Prolotherapy treatments in female patients with knee osteoarthritis resulted in significant improvement in pain, function, and range-of-motion scores.(7)
In research, doctors from the University of Wisconsin School of Medicine and Public Health write: Systematic review, including meta-analysis, and randomized controlled trials suggest that Prolotherapy may be associated with symptom improvement in mild to moderate symptomatic knee osteoarthritis and Prolotherapy was effective in overuse tendinopathy.(8)
In 2016 this research team reported in the Journal of alternative and complementary medicine substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living.(9) In another study lead by David Rabago, MD
Doctors from the University of Wisconsin continued their research into Prolotherapy. They found Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants and continued as such at follow up an average of 2.5 years after initial treatment, this study from 2105.(10)
This followed up on a 2013 study which appeared in the Archives of physical medicine and rehabilitation and suggested “Prolotherapy resulted in safe, substantial improvement in knee osteoarthritis-specific Quality of Life compared with control over 52 weeks. Among prolotherapy participants, but not controls, magnetic resonance imaging-assessed intra-articular cartilage volume change (intra-articular cartilage volume stability) predicted pain severity score change, suggesting that prolotherapy may have a pain-specific disease-modifying effect.”(11)
Prolotherapy and cartilage regeneration
Our Caring Medical and Rehabilitation Services (CMRS) Research
- In Caring Medical research appearing in the Journal of Prolotherapy, Ross Hauser, MD was able to document articular cartilage regeneration.(12)
Prolotherapy knee cartilage regeneration | Standard Clinical X-ray Studies Document Cartilage Regeneration in Five Degenerated Knees
Degenerative joint disease is the most common form of arthritis. The condition is marked by progressive destruction of the articular cartilage which is easily documented by standard X-ray studies. The regeneration of this articular cartilage in clinical practice has been difficult. Five knees with articular cartilage degeneration were treated with Prolotherapy in this report. Each of the five knees showed improvement of their standard clinical X-rays after the Prolotherapy, signifying articular cartilage repair with Prolotherapy. It is suggested that before and after X-ray studies can be used to document the response of degenerated joints to Prolotherapy. Read full article
Prolotherapy and cartilage regeneration supportive research
- In April 2016, A multinational team representing university researchers including Dr. Gastón Andrés Topol in Argentina, Dr. Dean Reeves from the University of Kansas Medical Center, Dr. J Johnson Michigan State University and Dr Rabago from the University of Wisconsin, School of Medicine and Public Health researchers confirmed that Prolotherapy could regrow articular cartilage in the knee in a study of patients with an average age of 71 seventy-one.(13)
- Published in the journal Scientific reports doctors in Hong Kong found that three to five sessions of Prolotherapy knee injections have a statistically significant and clinically relevant effect in the improvement of WOMAC composite score, (a scoring system of pain, function, and stiffness) at 12 to 16 weeks compared to formal at-home exercise. The benefits of the treatment were sustained up to 1 year. (14)
More research and clinical outcomes on cartilage regeneration can be found on these pages:
Knee articular cartilage surgery and non-surgical repair
In this article we will present the non-surgical stem cell – comprehensive Prolotherapy alternative to various surgical techniques that are designed to repair or regrow the articular cartilage of the knee.
Arthroscopic knee surgery for osteoarthritis and cartilage damage | Prolotherapy Alternatives and options
Doctors and researchers are confirming arthroscopic knee surgeries for meniscus and cartilage “repair” do not heal, do not repair, and accelerate knee instability and the degenerative collapse of the knee.
Our Caring Medical and Rehabilitation Services (CMRS) Research
In published research in the Journal of Prolotherapy, Ross Hauser MD investigated the outcomes of patients receiving Prolotherapy treatment for unresolved, difficult to treat knee pain at a charity clinic in Illinois.(15) A retrospective study on dextrose prolotherapy for unresolved knee pain at an outpatient charity clinic in rural Illinois
- 80 patients, representing a total of 119 knees, that were treated quarterly with Prolotherapy.
- The results of this study showed that patients had a 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.
A Retrospective Study on Dextrose Prolotherapy for Unresolved Knee Pain at an Outpatient Charity Clinic in Rural Illinois
Ross Hauser, MD, Hauser M. 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.
The optimal long-term, symptomatic therapy for unresolved knee pain has not been established. Accordingly, we investigated the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved knee pain at a charity clinic in rural Illinois. We studied a sample of 80 patients, representing a total of 119 knees, that 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 a 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. Conclusion: In this study, patients with unresolved knee pain, treated with dextrose Prolotherapy, showed improvements in many clinically relevant parameters and overall quality of life.
Prolotherapy is becoming a widespread form of pain management in both complementary and allopathic medicine. Its primary use is in pain management associated with tendinopathies and ligament sprains in peripheral joints. Prolotherapy is also being used in the treatment of spine and joint degenerative arthritis.In double-blinded human studies, the evidence on the effectiveness of Prolotherapy . . .Read full Article
Our Caring Medical and Rehabilitation Services (CMRS) Research
Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function
Ross Hauser, MD, Sprague IS. Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2014;7:13-20.
We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18–82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella. Read full Article
Patellofemoral Pain Syndrome : More information
If you are experiencing severe knee pain centered around the patella, your pain may be worse than the damage. This may be especially true in runners. Researchers and our own clinical experience and outcome studies at Caring Medical explain how comprehensive Prolotherapy may handle the problem of Patellofemoral Pain Syndrome.
Surgery and non-surgical treatments for patellar instability
In this article we will examine surgical and non-surgical options for the patient with recurrent patellar instability.
Patellar Tendinopathy | Jumper’s Knee
In this article we will examine research and clinical observations of various treatments for “Jumper’s Knee,” medically referred to as patellar tendinopathy, a degeneration process of the knee cap tendon.
A common source of knee pain is chondromalacia patella. (Chondro means cartilage, malacia means breakdown, and patella means kneecap.) Thus, chondromalacia patella refers to cartilage breakdown underneath the kneecap. This article explores Prolotherapy as an option
Knee Tendinopathy | Tendinosis | Tendonitis
Tendonitis is the most common injury to the knee, although not the most well-known one. In general, it refers to an inflammation, irritation or tear of a tendon, the thick fibrous cords that attach muscles to bone.
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 cells. The stem cells and blood platelets are drawn from you the patient. In research, PRP by itself has been shown to be a remarkable treatment for knee osteoarthritis and meniscus degeneration.
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.
For a more detailed discussion on:
Our Caring Medical and Rehabilitation Services (CMRS) Research
Platelet Rich Plasma Prolotherapy as First-line Treatment for Meniscal Pathology
Ross Hauser, MD Phillips H, Maddela H. Platelet Rich Plasma Prolotherapy as first-line treatment for meniscal pathology. Practical Pain Management. 2010;July/August:53-64.
Meniscus injuries are a common cause of knee pain, accounting for one sixth of knee surgeries. Tears are the most common form of meniscal injuries, and have poor healing ability primarily because less than 25% of the menisci receive a direct blood supply.
While surgical treatments have ranged from total to partial meniscectomy, meniscal repair and even meniscus transplantation, all have a high long-term failure rate with the recurrence of symptoms including pain, instability, locking, and re-injury.
The most serious of the long-term consequences is an acceleration of joint degeneration. This poor healing potential of meniscus tears and degeneration has led to the investigation of methods to stimulate biological meniscal repair.
Research has shown that damaged menisci lack the growth factors to heal. In vitro studies have found that growth factors, including platelet derived growth factor (PDGF), transforming growth factor (TGF), and others, augment menisci cell proliferation and collagen growth manifold. Read full Article
More research and patient outcomes can be found here:
Prolotherapy for Meniscus Tears
One of the most common calls our office receives involves patients who have had part or all of their meniscus removed and are suffering with continued pain or arthritis that was accelerated due to the surgery. Meniscectomies worsen knee joint instability by negatively influencing other supporting knee structures, increasing contact stress, and leading to arthritis.
Platelet rich plasma injections for meniscus tears
In this article Ross Hauser, MD explores research on Platelet Rich Plasma therapy for meniscus injury. This article is for people exploring the possibility of meniscus arthroscopic surgery, meniscus arthroscopic surgery with PRP augmentation, or PRP injections for meniscus tears as an option.
Bucket handle meniscus tear repair and treatment options
In this article we present information on the bucket handle meniscus tear sometimes overlooked in the doctor-patient consultation. Not all bucket handle meniscus tears need to be operated on. The reasons are presented below.
Knee Surgery for Meniscus Tears | Complications and Outcomes
One of the most common calls our office receives involves patients who have had part or all of their meniscus removed and are suffering with continued pain or arthritis that was accelerated due to the surgery. Meniscectomies worsen knee joint instability by negatively influencing other supporting knee structures, increasing contact stress, and leading to arthritis.
Stem Cell Prolotherapy injections for knee meniscus tears and post-meniscectomy
With the rise of biologic technologies including stem cell technology and continued research calling arthroscopy surgery for meniscus tear in question, many patients are now exploring non-surgical meniscus regeneration with Stem Cell Prolotherapy.
The many types of meniscus tears
In this article we provide background information on the many types of meniscus tears and how they can be treated with a non-surgical Comprehensive Prolotherapy approach.
When is comes to the science of stem cells and the meniscus, patients are often confused by what types of treatments are available today and what type of treatments will be available in the future.
Caring Medical and Rehabilitation Research: Stem Cell Prolotherapy for knee pain
In a study published in the journal Clinical medicine insights. Arthritis and musculoskeletal disorders by our Caring Medical research team, our 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.
“We have explored whole bone marrow injection in combination with dextrose prolotherapy as a cost-effective approach with potentially broad application for osteoarthritis in non-specialized settings. Our initial experience has been encouraging, as all patients experienced significant gains in treatment periods of 2–12 months without adverse events.”(16)
Why stem cell therapy did not work for your knee pain
When a patient sends us an email or comes into our office seeking answers to why stem cell therapy did not work for their knee pain, we suggest that perhaps the answer was NOT:
- Because fat stems cells were used when bone marrow stem cells should have been used or vice versa.
- Because placenta or amniotic stem cells are not as superior to fat stem cells or vice versa,
- or even Because the number of stem cells were inadequate.
Bone Marrow Aspirate | Bone marrow stem cell therapy for knee pain
In this article we will present clinical research and case studies to support the use of Bone Marrow Aspirate for Knee Pain.
Stem cell therapy for cartilage regeneration
In this article we will examine the research and the clinical application of stem cell therapy for articular cartilage repair. Stem cell therapy will be explained in the various videos embedded in this article.
Stem cells bone regeneration | Repairing bone damage from osteoarthritis
In this article we will examine the medical research concerning the effectiveness of stem cell therapy and bone repair in joint osteoarthritis. Stem cell therapy is part of our comprehensive Prolotherapy treatment program on stimulating joint repair in patients with knee osteoarthritis.
Knee Ligament injury and Comprehensive Prolotherapy treatments
Medial Collateral Ligament Knee Injury
Your doctor or MRI tells you that you have a partial tear of the medial collateral ligament (MCL) of the knee. What are your treatment options?
ACL reconstruction surgery alternatives and treatment options
Is ACL reconstruction surgical repair the right option for every athlete? In this article Ross Hauser, MD reviews the latest medical research that can help the patient / athlete understand their ACL pre and post surgery challenges and how treatments that include Prolotherapy, PRP and stem cells may offer surgical options options and accelerated recovery.
After ACL Reconstruction | Complications and knee instability
In this article we will discuss problems of knee instability following anterior cruciate ligament reconstruction and review various non-surgical treatment suggestions including Prolotherapy.
Posterior Cruciate Ligament (PCL) Injury and Treatments
Isolated PCL injuries are already under scrutiny. Untreated knee instability from an undiagnosed PCL tear can lead to meniscal tears and osteochondral injuries which are relatively prevalent in isolated acute PCL injury of the knee.
LCL | Lateral Collateral Ligament Injury of the Knee
While we look at the LCL’s involvement in knee stabilization, no ligament or stabilizing structure in the knee should ever be considered an “island unto itself.” Each stabilizer interacts with other stabilizes to provide the highly active knee with support.
Posterolateral corner injuries of the knee
The knee is a complex joint of many parts. The posterolateral corner (PLC) of the knee is one such complex area. However a complex area can be described simply: (postero) back (lateral) outside – the back and outer side of the knee. It can also be treated in many cases more simply than with aggressive reconstructive surgery.
Caring Medical and Rehabilitation Services Information on Knee Replacement
Knee replacement complications and post-surgical pain | Post surgery treatment options
Can we help you with continued knee pain after knee replacement surgery? In this article we will address post-surgical problems that can be successfully treated with comprehensive Prolotherapy.
Pain treatments while waiting for knee replacement
Researchers have noted that patients on a waiting list for knee replacement surgery suffer from severe symptoms and the waiting list delay can be considered a major reason that patients seek alternative treatments
Research on Alternatives to Knee Replacement Surgery
Researchers say more patients, when given educational aids and time to think about the benefits and side effects and complications of knee replacement, opted out of getting the knee replacement
How fast can I return to work after knee replacement?
A great majority of patients are able to return to work following total knee replacement. For many, because of out of pocket expense, lost work time, especially among the self-employed with physically demanding jobs, the question they want to know is not IF they can return to work, simply because they have to and have no option, but WHEN?
Knee replacement complications in post-traumatic osteoarthritis patients
In a recent paper, doctors from NYU Langone Medical Center, Hospital for Joint Diseases suggest that total knee arthroplasty (replacement) is often the best answer for end-stage, post-traumatic osteoarthritis after intra-articular (inside) and periarticular (around) osteoarthritic fractures the knee.
Other knee research and observations
Hyaluronic Acid Injections for knee osteoarthritis | Options and alternatives
An examination of research making direct comparisons of Hyaluronic Acid Injections to alternatives which include stem cell therapy, PRP or Platelet Rich Plasma Therapy, and Prolotherapy will also be discussed.
Knee Synovitis | Synovial inflammation of the knee
In this article we will examine synovial inflammation of the knee as a result of knee instability and osteoarthritis and discuss treatment options.
Treating loose bodies in your knee
Loose bodies are free floating fragments of bone, cartilage, or collagen in the knee. When these fragments get trapped between the articular cartilage surfaces of the knee bones (like the femur and tibia), they can cause symptoms.
Knee pain – Baker’s cyst treatment
When you have instability of the knee, the knee compensates in many ways to keep itself functioning. One way the knee tries to stabilize itself is with the collection of fluid. The fluid acts as a brace to keep everything in place as best it can. In the case of a Baker’s cyst, the accumulation of fluid occurs in a sac behind the knee, causing discomfort and difficulty bending the knee.
Prolotherapy for back pain and spinal instability
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.
Prolotherapy for back pain
There is plenty of research to support the use of Prolotherapy for back pain (especially lumbar pain), here are some of the research summaries.
- University of Manitoba, Winnipeg, Manitoba, Canada. The journal of alternative and complementary medicine
- One hundred and ninety (190) patients were treated between, June 1999-May 2006.
- Both pain and Quality of Life scores were significantly improved at least 1 year after the last treatment.
- This study suggests that prolotherapy using a variety of proliferants can be an effective treatment for low back pain from presumed ligamentous dysfunction for some patients when performed by a skilled practitioner.7
- Harold Wilkinson MD, in the journal The Pain Physician
- Prolotherapy can provide significant relief of axial pain (soft tissue damage) and tenderness combined with functional improvement, even in “failed back syndrome” patients.8
Our Caring Medical and Rehabilitation Services (CMRS) Research
Citing our own Caring Medical and Rehabilitation Services published research in which we followed 145 patients who had suffered from back pain on average of nearly five years, we examined not only the physical aspect of Prolotherapy, but the mental aspect of treatment as well.
Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study
By Ross A. Hauser, MD & Marion A. Hauser, MS, RD
- In our study, 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option.
- In these 145 low backs,
- pain levels decreased from 5.6 to 2.7 after Prolotherapy;
- 89% experienced more than 50% pain relief with Prolotherapy;
- more than 80% showed improvements in walking and exercise ability, anxiety, depression and overall disability
- 75% percent were able to completely stop taking pain medications.9
Hauser RA, Hauser MA. Dextrose Prolotherapy for unresolved low back pain: a retrospective case series study. Journal of Prolotherapy. 2009;1:145-155. [JOP/CMRS]
If our study, mentioned above, was solely based on getting 75% of patients off their pain medications, that would be wildly successful in itself. But the fact that Prolotherapy was able to strengthen the patient’s spines and decrease overall disability and return these people to a normal lifestyle. That is not pain management, that is a pain cure.
More information can be found on these pages on our site Prolotherapy for Chronic Low Back Pain.
Prolotherapy and non-surgical treatment of lumbar radiculopathy
The best conventional medicine has to offer for lumbar disc herniation and associated lumbar radiculopathy are surgeries that do not work that well.
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). Prolotherapy, PRP, and Stem Cell Therapy have been used successfully in patients seeking alternatives to rotator cuff surgery. as well as patients with SLAP Lesions and Glenoid Labral Tears.
Doctors at The University of British Columbia, University of Kansas, and University of Missouri-Kansas City published joint research that found: In participants with painful rotator cuff tendinopathy who receive physical therapy and Prolotherapy, treatments resulted in superior long-term pain improvement and patient satisfaction. “Prolotherapy may improve on the standard care of painful rotator cuff tendinopathy for certain patients.”37
Prolotherapy research for hip pain
In the Journal of Prolotherapy we sought to show how Prolotherapy could provide high levels of patient outcome satisfaction while avoiding hip surgery. Here is what we reported:
- We examined Sixty-one patients, representing 94 hips, who had been in pain an average of 63 months We treated these patients quarterly with Hackett-Hemwall dextrose Prolotherapy.
- This included a subset of 20 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of eight patients who were told by their doctor(s) that surgery was their only option.
Patients were contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.
Results: In these 94 hips,
- pain levels decreased from 7.0 to 2.4 after Prolotherapy;
- 89% experienced more than 50% of pain relief with Prolotherapy;
- more than 84% showed improvements in walking and exercise ability, anxiety, depression and overall disability;
- 54% were able to completely stop taking pain medications.
The results confirm that Prolotherapy is a treatment that should be highly considered for people suffering with chronic hip pain.38
Published research on Prolotherapy:
Dr. Ross Hauser and our team have published a number of research papers, case studies, and scientific editorials in the Journal of Prolotherapy, including articles on Prolotherapy as an alternative to surgery; Prolotherapy for chronic back pain; cartilage regeneration in knees; Stem cell therapy for degenerative joint disease; Prolotherapy as for meniscus tears, and many, many more.
Our Prolotherapy research papers, case studies, & scientific editorials:
- Articular Cartilage Regeneration
- Avascular Necrosis Case Report
Cervical Instability as a Cause of Barré-Liéou Syndrome and Definitive Treatment with Prolotherapy: A Case Series
Hauser R, Steilen-Matias D, Sprague IS. Cervical instability as a cause of Barré-Liéou syndrome and definitive treatment with prolotherapy: a case series. European Journal of Preventive Medicine. 2015;3(5):155-166.
Barré-Liéou syndrome, or posterior cervical sympathetic syndrome, has symptomatology related to underlying cervical instability. While classified as a rare disease, Barré-Liéou syndrome is likely underdiagnosed. Vertebral instability, occurring after neck ligament injury, affects the function of cervical sympathetic ganglia (located anterior to vertebral bodies). Symptomatology includes neck pain, migraines/headache, vertigo, tinnitus, dizziness, visual/auditory disturbances, and other symptoms of the head/neck region. Treatment for Barré-Liéou syndrome is suboptimal and often involves long-term use of pain medications, chiropractic care, or surgical fusion. Prolotherapy offers a noninvasive treatment option to ameliorate symptoms while treating the underlying cause of the disorder—cervical instability. In this case series, the results of eight patients from 2011 to 2013 who received prolotherapy for Barré-Liéou syndrome following longstanding symptoms after trauma are reported. All patients reported improvement of neck pain and associated symptoms and increased physical activity. Prolotherapy should be considered as treatment for Barré-Liéou syndrome…
Dextrose Prolotherapy with Human Growth Hormone to Treat Chronic First Metatarsophalangeal Joint Pain
Hauser R, Feister W. Dextrose prolotherapy with human growth hormone to treat chronic first metatarsophalangeal joint pain. The Foot and Ankle Online Journal. 5(9):1.doi: 10.3827/faoj.2012.0509.0001
The metatarsophalangeal joint (MTPJ), formed by the metatarsal and phalangeal bones of the toes, is the location of common foot pathologies. The two most prevalent sources of pain in the MTP joint are the conditions of hallux valgus, a precursor to bunions, and hallux rigidus, stiffness in the big toe.
A well-researched etiology (cause) for these conditions is ligament laxity. In this study, twelve patients were treated with a series of Dextrose Prolotherapy injections to stimulate the regeneration of tendons and ligaments and to promote the repair of articular cartilage. Upon completion of three-to-six therapy sessions, eleven of twelve patients had a favorable outcome—the relief of symptoms—with an average of four treatments. Based on such positive, verifiable results, Hackett-Hemwall Dextrose Prolotherapy can be viewed as a promising alternative to steroid injection, surgical repositioning (e.g., chevron osteotomy), or joint replacement.
Chronic foot pain has reached epidemic proportions in the United States with over 40 million people reporting problems in their feet. A typical cause of foot pain is deformity in the first metatarsophalangeal (MTP) joint, commonly called a bunion. The American Academy of Orthopaedic Surgeons reports, “more than half of the women in America have bunions, a common deformity…” and “nine out of ten bunions happen to women.” According to the AAOS, bunions are one of the most widespread, chronic foot complaints addressed by foot and ankle specialists.
Surgical reconstruction of this joint, therefore, is one of the most prevalent joint surgeries performed on the foot. The two most prevalent causes of pain in the MTP joint are the conditions of hallux valgus and hallux rigidus, with hallux valgus being more and hallux rigidus less frequent.[3, 4] Hallux valgus, specifically, is a deformity that occurs when the big toe angles toward the other toes
Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability
Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The Open Orthopaedics Journal. 2014;8:326-345.
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain.
The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.
When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.
Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability…
Cartilage Degeneration with NSAIDs
Hauser R. The acceleration of articular cartilage degeneration in osteoarthritis by nonsteroidal anti-inflammatory drugs. Journal of Prolotherapy. 2010;(2)1:305-322.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs in the world for the treatment of osteoarthritis (OA) symptoms, and are taken by 20-30% of elderly people in developed countries. Because of the potential for significant side effects of these medications on the liver, stomach, gastrointestinal tract and heart, including death, treatment guidelines advise against their long term use to treat OA. One of the best documented but lesser known long-term side effects of NSAIDs is their negative impact on articular cartilage.
In the normal joint, there is a balance between the continuous process of cartilage matrix degradation and repair. In OA, there is a disruption of the homeostatic state and the catabolic (breakdown) processes of chondrocytes. It is clear from the scientific literature that NSAIDs from in vitro and in vivo studies in both animals and humans have a significantly negative effect on cartilage matrix which causes an acceleration of the deterioration of articular cartilage in osteoarthritic joints. The preponderance of evidence shows that NSAIDs have no beneficial effect on articular cartilage in OA and accelerate the very disease for which they are most often used and prescribed. Some of the effects of NSAIDs on the articular cartilage in OA include inhibition of chondrocyte proliferation, synthesis of cellular matrix components, glycosaminoglycan synthesis, collagen synthesis and proteoglycan synthesis. The net effect of all or some of the above is an acceleration of articular cartilage breakdown.
In human studies, NSAIDs have been shown to accelerate the radiographic progression of OA of the knee and hip. For those using NSAIDs compared to the patients who do not use them, joint replacements occur earlier and more quickly and frequently. The author notes that massive NSAID use in osteoarthritic patients since their introduction over the past forty years is one of the main causes of the rapid rise in the need for hip and knee replacements, both now and in the future.
While it is admirable for the various consensus and rheumatology organizations to educate doctors and the lay public about the necessity to limit NSAID use in OA, the author recommends that the following warning label be on each NSAID bottle:
The use of this nonsteroidal anti-inflammatory medication has been shown in scientific studies to accelerate the articular cartilage breakdown in osteoarthritis. Use of this product poses a significant risk in accelerating osteoarthritis joint breakdown. Anyone using this product for the pain of osteoarthritis should be under a doctor’s care and the use of this product should be with the very lowest dosage and for the shortest duration of time.
If NSAID use continues, then most likely the exponential rise in degenerative arthritis and subsequent musculoskeletal surgeries, including knee and hip replacements as well as spine surgeries, will continue to rise as well.
Non-Operative Treatment of Cervical Radiculopathy: A Three Part Article from the Approach of a Physiatrist, Chiropractor, and Physical Therapists
Ross Hauser, MD, Batson G, Ferrigno C. Non-operative treatment of cervical radiculopathy: a three part article from the approach of a physiatrist, chiropractor, and physical therapists. Journal of Prolotherapy. 2009;1(4):217-231.
The painful condition resulting from soft tissue damage and degenerative disc changes causing pressure on a cervical nerve root is called cervical radiculopathy. It often produces agonizing neck pain, a burning sensation, along with numbness radiating down the arms, shoulder blades, and back, or up into the head. Authors discuss cervical radiculopathy from the position of a Physiatrist (R.H.), chiropractor (G.B.), and physical therapist (C.F.). Each author reviews case studies and techniques utilized in order to successfully treat patients presenting with cervical radiculopathy.
Cervical radiculopathy refers to a pinching or inflammation of a cervical nerve at its exit point in the spine, called the neuroforamen. It is caused by lesions that narrow the space in the neuroforamen, including cervical disk herniations, but more commonly occurs with cervical spondylosis.1,2 This latter condition refers to a gradual wear and tear or age-related degenerative changes.3 Many of these changes can be diagnosed or identified on conventional X-rays and MRI’s and may include narrowing of the disc space, bulging of the contour of the disc, herniation of the disc, calcification of the disc, and vertebral margins that result in spurs. When the spurring significantly narrows around the nerve root exit passage or foramen it is referred to as neuroforaminal stenosis. These degenerative changes can lead to constant or episodic waves of pain. The symptoms of cervical radiculopathy typically include severe neck pain with radiation of the pain to the back of shoulder blade, shoulders, arm, or hand. Numbness or weakness in the arm can also be present.
The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study
Ross Hauser, MD, Steilen-Matias D, Gordin K. The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study. European Journal of Preventive Medicine. 2015;3(4):85-102.
Background: In an effort to facilitate the diagnosis and treatment of clinical cervical spine instability (CCSI) and chronic neck pain, we investigated the role of proliferative injection Prolotherapy in the reduction of pain and recovery of constitutional and neurological symptoms associated with increased intervertebral motion, structural deformity and irritation of nerve roots.
Methods: For this retrospective case series, 21 study participants were selected from patients seen for the primary complaint of cervicalgia. Following a series of proliferative injections, performed in a private sub-specialty pain clinic, patient- reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (mean = 24 months). All patients signed a consent form prior to treatment.
Results: 95 percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality. Significant reductions in pain at rest, during normal activity, and during exercise were reported. A mean of 86 percent of patients reported overall sustained improvement, while 33 percent reported complete functional recovery. 31 percent of patients reported complete relief of all recorded symptoms. No adverse events were reported.
Conclusion: The results of this study demonstrate statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability. Such clinical efficacy of this procedure warrants further investigation as a non- invasive treatment option.
Dextrose Prolotherapy Injections for Chronic Ankle Pain
Hauser R, Hauser M, Cukla J. Dextrose prolotherapy injections for chronic ankle pain. Practical Pain Management. 2010;Jan/Feb.
In this retrospective observational study of chronic unresolved ankle pain, Hackett-Hemwall dextrose prolotherapy helped promote a measurable decrease in the pain and stiffness of the treated joints and improvement in clinically-relevant parameters.
In this continuing series, Dr. Hauser reports on patients treated for unresolved ankle pain at a volunteer charity clinic having limited resources and personnel between 2000 to 2005. Treatment consisted of injecting a dextrose solution at specific ankle sites to stimulate healing of ligaments, tendons and joints. Patients—including those who were told by prior doctors that ‘nothing more could be done’ or that ‘surgery was the only option’—responded favorably to treatment as demonstrated by reports of reduced pain levels, increased range of motion, extended ability to exercise, reduced depression, reduced anxiety, and a reduction in medications needed.
A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an Outpatient Charity Clinic in Rural Illinois
Ross Hauser, MD, Hauser M. A retrospective study on Hackett-Hemwall dextrose prolotherapy for chronic hip pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;1(2):76-88.
Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for chronic hip pain.
Study Design: Sixty-one patients, representing 94 hips who had been in pain an average of 63 months, were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. This included a subset of 20 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of eight patients who were told by their doctor(s) that surgery was their only option. Patients were contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.
Results: In these 94 hips, pain levels decreased from 7.0 to 2.4 after Prolotherapy; 89% experienced more than 50% of pain relief with Prolotherapy; more than 84% showed improvements in walking and exercise ability, anxiety, depression and overall disability; 54% were able to completely stop taking pain medications. The decrease in pain reached statistical significance at the p
Conclusion: In this retrospective study on the use of Hackett-Hemwall dextrose Prolotherapy, patients who presented with over five years of unresolved hip pain were shown to improve their pain, stiffness, range of motion, and quality of life measures even 19 months subsequent to their last Prolotherapy session. This pilot study shows that Prolotherapy is a treatment that should be considered and further studied for people suffering with unresolved hip pain.
A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois
Hauser R, Hauser M. A retrospective study on Hackett-Hemwall dextrose prolotherapy for chronic shoulder pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2009;4:205-216.
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<.0000001 level with Prolotherapy, including the 39% of patients who were told by their medical doctors that there were no other treatment options for their pain and the twenty-one percent who were told that surgery was their only option. Over 82% of all patients experienced improvements in sleep, exercise ability, anxiety, depression, and overall disability with Prolotherapy. Ninety-seven percent of patients received pain relief with Prolotherapy.
Conclusion: In this study, patients with chronic shoulder pain reported significant improvements in many clinically relevant parameters and overall quality of life after receiving Hackett-Hemwall dextrose Prolotherapy.
The Theoretical Basis for and Treatment of Complex Regional Pain Syndrome with Prolotherapy
Ross Hauser, MD, Brinker D. The theoretical basis for and treatment of complex regional pain syndrome with prolotherapy. Journal of Prolotherapy. 2010;2(2):356-370.
Complex regional pain syndrome (CRPS) typically refers to post-traumatic pain that spreads from the site of injury, exceeds in magnitude and duration the expected clinical course of the inciting event, and progresses variably over time. Burning pain is the primary symptom, but patients frequently report allodynia, changes in the color or temperature of the skin, and if the condition progresses, trophic changes of the skin, nails, and bone occur. The condition produces a high degree of suffering, lost productivity and cost of treatment. While there are many theories as to why CRPS occurs, success in treatment of CRPS with traditional medical therapies is dismal.
CRPS generally appears following a physical trauma, involving the bone and soft tissues which are treated with long periods of immobility. While this immobility itself may be needed to heal a bone injury such as a fracture, it encourages ligament injuries to not heal. Stress deprivation or immobility causes a protracted state of progressive atrophy and lack of mechanical strength in the injured ligaments. The high density of both myelinated and unmyelinated nociceptors in the non-healed ligaments then become sensitized to the point that even normal or less than normal activities activate them to fire causing severe burning pain. These activated nociceptors through local and feedback loops in the central nervous system, cause autonomic phenomenon in the extremity including referral pain, edema and temperature disturbances. Research by George S. Hackett, M.D., who coined the term Prolotherapy, found that ligament relaxation (his term for non-healed ligament injuries) caused bone dystrophy (osteopenia/osteoporosis), which is a common feature of CRPS. He also noted that ligament relaxation often activated the sympathetic nervous system and that when Prolotherapy was performed to the injured ligament(s), not only did the local pain remit, but so did the autonomic phenomenon. Since traditional treatments do not address non-healed ligament injuries, this entity could be the reason that so many cases of CRPS are never resolved. Since Prolotherapy causes ligament regeneration, it should be in the arsenal of any clinician treating patients with unresolved CRPS symptoms.
The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections
Ross Hauser, MD. The deterioration of articular cartilage in osteoarthritis by corticosteroid injections. Journal of Prolotherapy. 2009;1(2):107-123.
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage of joints such as the knee and hip. Both animal and human research has consistently shown that corticosteroid injections into normal and degenerated knees accelerate the arthritic process. A summary of the effects of the intraarticular corticosteroids on articular cartilage includes: a decrease of protein and matrix synthesis, matrix hyaline appearance becomes fibrotic, clumping of collagen, alteration in chondrocyte cell shape, chondrocyte cell proliferation inhibited, chondrocyte cytoxicity enhanced, loss of chondrocytes, surface deterioration including edema, pitting, shredding, ulceration and erosions, inhibition of articular cartilage metabolism, articular cartilage necrosis, thinning of articular cartilage, decrease in cartilage growth and repair, formation of articular cartilage cysts, and ultimately articular cartilage destruction.
When researchers microscopically and radiologically examine human joints after corticosteroid injections, the same results are found in humans as in animals. Intraarticular corticosteroid injections accelerate the osteoarthritic degenerative process. Because of this possibility, organizations such as the American College of Rheumatology acknowledge, “It is generally recommended, although not well supported by published data, that injection of corticosteroids in a given joint not be performed more than three to four times in a given year because of concern about the possible development of progressive cartilage damage through repeated injection in the weight-bearing joints.” It is this author’s opinion that there is no doubt that the rise of osteoarthritis, as well as the number of hip and knee replacements, is a direct result of the injection of corticosteroids into these joints.
Hackett-Hemwall Dextrose Prolotherapy for Unresolved Elbow Pain
Ross Hauser, MD, Hauser M, Hollan P. Hackett-Hemwall dextrose prolotherapy for unresolved elbow pain. Practical Pain Management. October 2009;14-26.
In this retrospective pilot study at an outpatient charity clinic in rural Illinois, Hackett-Hemwall dextrose prolotherapy helped reduce pain and stiffness and clinically improved the quality of life in people with unresolved elbow pain.
Chronic elbow pain is a common condition affecting 15% of the population at any one time.1 Lateral epicondylitis (tennis elbow) is the most common form of elbow pain and the most common reason patients with elbow pain come to a physician’s office.2 It is usually an overuse injury. Elbow injuries in sports with overhead or repetitive arm actions are frequent and often severe. Epicondylitis is an acute injury that results in inflammation and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon.3 Other diagnoses for elbow pain include olecranon bursitis, biceps tendinitis, ulna and radial collateral ligament sprain, and degenerative arthritis.
A Retrospective Observational Study on Hackett-Hemwall Dextrose Prolotherapy for Unresolved Foot and Toe Pain at an Outpatient Charity Clinic in Rural Illinois
Hauser R, Hauser M, Cukla J. A retrospective observational study on Hackett-Hemwall dextrose prolotherapy for unresolved foot and toe pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2011;3(1):543-551.
To study the efficacy of Hackett-Hemwall dextrose Prolotherapy for foot and toe pain, a retrospective observational study was commissioned using the data obtained at a charity health clinic in rural Illinois. Foot and toe pain is a common complaint affecting the lives of millions. Nearly 25% of the population suffers from foot and toe pain at any one time. The diagnoses given to these patients by their medical doctors and podiatrists are many and varied. Some of the most common are hallux rigidus and hallux malleus. Prolotherapy is an injection treatment used to initiate a healing response in injured connective tissues such as tendons and ligaments, common in painful foot and toe conditions. This retrospective study documents the improvements the subjects obtained after receiving Prolotherapy treatments, which included reduction of their pain and an increase in quality of life measures.
Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved foot and toe pain.
Design: Nineteen patients who had been in pain an average of 54 months were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. This included a subset of eight patients who were told by their medical doctor(s) that there were no other treatment options for their pain. Patients were contacted an average of 18 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
Results: In these 19 patients, all 100% had improvements of their pain and stiffness. Eighty-four percent experienced 50% or more pain relief. Dextrose Prolotherapy helped the patients make large improvements in walking and exercise ability, as well as produced decreased levels of anxiety and depression. One-hundred percent of patients said Prolotherapy changed their lives for the better.
Conclusion: In this retrospective observational study, Hackett-Hemwall dextrose Prolotherapy helped cause large decreases in pain and stiffness and improved clinically relevant quality of life parameters in people with unresolved foot and toe pain.
Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study
Ross Hauser, MD, Hauser M, Dolan E, Orlofsky A. Prolotherapy: a non-invasive approach to lesions of the glenoid labrum; a non-controlled questionnaire based study. The Open Rehabilitation Journal. 2013;6:69-76.
Lesions of the glenoid labrum are a common cause of shoulder instability and a frequent finding in patients with shoulder pain. Management of these patients typically involves an attempt to avoid surgery through conservative treatment. However, there is currently a dearth of conservative options that promote labral healing. Regenerative injection therapies, including prolotherapy, have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to glenoid labral tear. Here we review several important aspects of these lesions and present an initial case series of 33 patients with labral tear that were treated in our clinic with intra-articular injections of hypertonic dextrose. Patient-reported assessments were collected by questionnaire at a mean follow-up time of 16 months. Treated patients reported highly significant improvements with respect to pain, stiffness, range of motion, crunching, exercise and need for medication. All 31 patients who reported pain at baseline experienced pain relief, and all 31 who reported exercise impairment at baseline reported improved exercise capability. Patients reported complete relief of 69% of recorded symptoms. One patient reported worsening of some symptoms. Prolotherapy for glenoid labral tear appears to be a safe procedure that merits further investigation.
A Retrospective Observational Study on Hackett-Hemwall Dextrose Prolotherapy for Unresolved Hand and Finger Pain at an Outpatient Charity Clinic in Rural Illinois
Hauser R, Baird N, Cukla J. A retrospective observational study on Hackett-Hemwall dextrose prolotherapy for unresolved hand and finger pain at an outpatient charity clinic in rural Illinois. Journal of Prolotherapy. 2010;2(4):480-486.
Hand and finger pain and stiffness are common problems that can affect the productivity of those afflicted, especially in regard to their activities of daily living. Prolotherapy is an injection treatment used to initiate a healing response in injured connective tissues such as tendons and ligaments, tissues commonly involved with hand and finger injuries. A retrospective observational study on Prolotherapy for hand and finger pain was done at an outpatient charity clinic.
Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved hand and finger pain.
Design: Forty patients, who had been in pain an average of 55 months (4.6 years), were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. Patients were contacted an average of 18 months following their last Prolotherapy session and asked questions regarding their levels of pain and stiffness before and after their last Prolotherapy treatment.
Results: In these 40 patients, 98% had improvements in their pain. Eighty-two percent had 50% or more pain relief. Dextrose Prolotherapy caused a statistically significant decline in patients’ pain and stiffness. Prolotherapy helped all but one patient on pain medications reduce the amount of medications taken. All 40 patients have recommended Prolotherapy to someone.
Conclusion: In this retrospective observational study, Hackett- Hemwall dextrose Prolotherapy treatments helped reduce the pain and stiffness in patients with unresolved hand and finger pain.
Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study
Ross Hauser, MD, Orlofsky A. Regenerative injection therapy (prolotherapy) for hip labrum lesions: rationale and retrospective study. The Open Rehabilitation Journal. 2013;6:59-68.
Background: Acetabular labral tear is a debilitating condition for which there are few effective non-surgical treatment options. A number of studies in humans and in animal models suggest that the labrum may have a capacity for spontaneous healing, and that therapies that seek to exploit and facilitate this process may be beneficial. Regenerative injection therapies have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to labral tear.
Methods: We present an initial case series of 19 patients with labral tear that were treated in our clinic with intra-articular injections of hypertonic dextrose (Prolotherapy). Patient-reported assessments were collected by questionnaire between 1 and 60 months post-treatment (mean = 12 months).
Results: All patients reported improvements in pain relief and functionality. Patients reported complete relief of 54% of recorded symptoms. Improvements did not show dependence on the time between treatment and follow-up. No adverse events were reported.
Conclusions: Regenerative injection therapy (prolotherapy) for acetabular labral tear appears to be a safe and potentially efficacious procedure that merits further investigation as a nonsurgical option.
Treatment of Joint Hypermobility Syndrome, Including Ehlers-Danlos Syndrome, with Hackett-Hemwall Prolotherapy
Hauser R, Phillips H. Treatment of joint hypermobility syndrome, including Ehlers-Danlos syndrome, with Hackett-Hemwall prolotherapy. Journal of Prolotherapy. 2011;3(2):612-629.
Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are both heritable disorders of connective tissue (HDCT) characterized by joint laxity and hypermobility. The conditions are both genetic disorders of collagen synthesis, where the adverse effects of tissue laxity and fragility can give rise to clinical consequences that resonate far beyond the confines of the musculoskeletal system. Both conditions have as their hallmark generalized hypermobility which can affect almost every bodily system. The hypermobility can be documented by the Brighton criteria which involves the objective measurement of the hyperextensibility of various joints. While the major presenting complaint of JHS and EDS is arthralgia in multiple joints, if the hypermobility is left unchecked, joint dislocations and degeneration may prevail.
While traditional medical treatments including education and lifestyle advice, behavior modification, physiotherapy, taping and bracing, exercise prescription, functional rehabilitation and pain medications offer some symptomatic control, they do little in regard to curbing the progressive debilitating nature of the diseases. The excessive joint mobility with its subsequent joint degeneration and multiple joint dislocations, can then lead the individual to seek out surgical intervention, which has suboptimal results in the hypermobile patient population versus the normal population. As such, some patients with JHS and EHS are seeking alternative treatments for their pain, including Prolotherapy.
Prolotherapy offers great hope for those with symptoms from generalized hypermobility because it is designed to successfully treat the ligament and tissue laxity that accompanies JHS and EDS. Prolotherapy works by initiating a brief inflammatory response, which causes a reparative cascade to generate new collagen and extra cellular matrix giving connective their strength and ability to handle strain and force. Prolotherapy has a long history of success treating ligament injuries, including patients with joint hypermobility. Studies on Prolotherapy have shown that it eliminates chronic pain even in those patients who have been told by their medical doctor(s) that surgery was the only treatment option for their pain.
Some of the rationale for using Prolotherapy for patients with EDS and JHS include that it has a high safety record, is comprehensive (all or most joints can be treated at each visit), is an outpatient procedure, is cost effective (compared to surgery), pain relief is often quick, and it provides joint stabilization. Perhaps its greatest asset is the fact that this one treatment modality can handle most of the painful musculoskeletal conditions that occur in individuals with EDS and JHS.
Prolotherapy could contribute to the treatment of hypermobility disorders also by preventing the development of precocious osteoarthritis. It has long been known that individuals with JHS and EDS suffer with premature osteoarthritis in various joints and the amount of degeneration correlates with the extent of the individuals hypermobility. The combination of extreme hypermobility and repeated injury is presumed to be what leads to the early osteoarthritis. This is most likely the reason that the hypermobility type of Ehlers-Danlos Syndrome is the most debilitating form with respect to musculoskeletal function.
While the primary author has twenty years experience treating JHS and EDS musculoskeletal symptoms with Prolotherapy, future studies will need to be conducted to best document the exact role Prolotherapy has in the treatment of the musculoskeletal symptoms and hypermobility of JHS and EDS and if it can prevent future joint degeneration in these individuals.
- Ligament Injury and Healing
- Low Back Pain
- Morton’s Neuroma Pain
- Neck Pain
- Osteochondritis Dissecans
- Over-manipulation Syndrome
- PRP Injection Technique
- Thumb Arthritis
- TMJ Dysfunction Pain
- Upper Cervical Instability
- Wrist Pain
In research histologic studies of ligaments and tendons following Prolotherapy injections have shown an enhanced inflammatory healing reaction involving fibroblastic and capillary proliferation, along with growth factor stimulation.
This is a brief review on Prolotherapy’s ability to repair tendons
- In the Journal of back and musculoskeletal rehabilitation, doctors wrote that as a healing agent, sodium morrhuate appears to mimic the early stages of an injury-repair sequence when injected directly into intact tendons. (1)
- In his classic work of 1955 published in the American Journal of Surgery, George Hackett MD found joint stabilization with Prolotherapy injections into the ligaments.(2)
- In 2006, Korean medical researchers published their findings that supported Prolotherapy’s ability to enhance fibroblastic stimulation and elaboration of extracellular matrix. (3) In other words, rebuild the diseased joint by changing the the healing mechanisms on a cellular level. This fascinating subject is covered in our article Extracellular matrix in osteoarthritis and joint healing.
- In 2017, researchers in the United Kingdom wrote that Prolotherapy dextrose injections followed by a period of immobilization in an Aircast boot and a progressive rehabilitation program produced clinically significant improvements in patients with an intra-tendinous Achilles tear.(4)
- In February 2018 doctors writing in the Scandinavian journal of medicine & science in sports also found favorable results for prolotherapy on chronic painful Achilles tendinopathy.(5)
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