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.
In our opinion, Comprehensive Prolotherapy is superior to many other treatments in curing chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle.
Before we continue, did you want to ask a question about our treatments?
The basic mechanism of Prolotherapy is simple.
- Prolotherapy solutions are injected into your painful areas to begin a reparative action.
- The injections create a localized inflammation triggering the immune system to create the building blocks of ligaments, tendons, cartilage and bone.
- Comprehensive Prolotherapy through a series of injections REBUILDS the joints from within.
Prolotherapy patient information in brief
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 (1025% 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 our clinic to thousands of patients, administering millions of injections over the years.
- 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 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.
- What is in Prolotherapy Injections?
- Prolotherapy Treatment Goals
- Questions about Prolotherapy injections at the time of treatment
- Prolotherapy Side effects and risks
- Prolotherapy for knee pain
- Prolotherapy for back pain
- Prolotherapy for hip pain
- Prolotherapy for shoulder pain
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]
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.4-6
Animal research has documented that Prolotherapy-injected ligaments have an increased ligament mass, extracellular matrix, thickness and junction strength with bone.7-11
Prolotherapy is given to the articular ligaments of the entire spine, pelvis and peripheral joints to tighten unstable joints. Case series have documented the efficacy of Prolotherapy for ligament injuries of the sacroiliac joint 12-14, low back 15-16, neck 17-18, shoulder 19, elbow 20, knee 21-22 temporomandibular joint 23,24 and other articulations 25.
A discussion of Prolotherapy as non-surgical option
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.
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
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.
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
- 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 an infection. Infection after Prolotherapy is the most serious risk that we have seen.
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.
Prolotherapy for knee pain
Research conducted by our team members at Caring Medical and independent investigators have found Prolotherapy to be an effective non-surgical treatment for various knee pathologies and degeneration.
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.
They concluded Prolotherapy may be an appropriate therapy for patients with unresponsive knee osteoarthritis. 26
Caring Medical doctors investigated Prolotherapy in patients with unresolved knee pain at a charity clinic in rural Illinois. Eighty patients, representing a total of 119 knees, were treated every three months with Prolotherapy. On average, 15 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment. The results of this study showed that patients had:
- Statistically significant decline in their level of pain, stiffness, crunching sensation, and improvement in their range of motion with Prolotherapy.
- More than 82% showed improvements in walking ability, medication usage, athletic ability, anxiety, depression, and overall disability with Prolotherapy.
- Ninety-six percent of patients felt Prolotherapy improved their life overall. 27
Other researchers have shown that Prolotherapy injections resulted in safe and substantial improvement in quality of life in knee osteoarthritis patients.28 Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.29 In other Caring Medical research, Dr. Hauser was able to document articular cartilage regeneration.30 In April 2016, researchers confirmed that Prolotherapy could regrow articular cartilage in the knee in a study of patients with an average age of 71 seventy-one.31
In patients with symptoms of anterior cruciate ligament laxity and weakness, intermittent Prolotherapy injections resulted in clinically and statistically significant improvement in pain, swelling, and knee range of motion.32
This was confirmed by September 2016 research from the Universities of Wisconsin, Chicago, and Minnesota which found “Most (Prolotherapy) participants reported substantially improved knee-specific effects, resulting in improved quality of life and activities of daily living.”36
More information can be found at these articles:
- Prolotherapy knee osteoarthritis injections | Whole knee treatment
- Comprehensive Prolotherapy | Knee Pain PRP and stem cells treatments
- See this page for articles for Prolotherapy addressing various disorders including knee ligament and tendon damage, knee cap problems, and sports related injuries.
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. However, other research points out that PRP’s effects may not be long lasting or beyond six months.33 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:
- Platelet Rich Plasma Therapy for Osteoarthritis of the knee and bone on bone on our website.
- Platelet Rich Plasma Therapy meniscus injections
Prolotherapy and Stem Cells for Knee Pain
Bone marrow derived stem cells
In this study, Caring Medical doctors examined the use of a simple, cost-effective regenerative treatment using direct injection of bone marrow stem cells into osteoarthritic joints in combination with dextrose Prolotherapy. Seven patients with hip, knee or ankle osteoarthritis received two to seven treatments over a period of two to twelve months. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise.34
For a more comprehensive article please see: The stem cell alternative to knee replacement
Prolotherapy for back pain
Caring Medical patients are often surprised to learn that Prolotherapy can heal most disc problems in neck and back. While we talk about Prolotherapy healing joint pain that results from ligament and tendon injuries, most people are unaware that disc problems results from ligament injuries or instability along the spine. Patients with degenerative disc disease,herniated discs, bulging discs, bone on bone, etc can all be healed with Prolotherapy.
Prolotherapy works to stabilize the ligaments of the spine allowing discs to get back into position and can even create space to a person who has lost space due to one or more degenerated disc. In Prolotherapy research from the doctors of Caring Medical, patients with more than four years of unresolved low back pain were shown to have had their pain improved, stiffness, range of motion, and quality of life measures even 12 months subsequent to their last Prolotherapy session.35 More information can be found on these pages on our site Prolotherapy for Chronic Low Back 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
- Barré-Liéou Syndrome
- Big Toe and Bunion Pain
- Bone Marrow Prolotherapy for Degenerative Joint Disease
- Capsular Ligament Laxity
- Cartilage Degeneration with NSAIDs
- Cartilage Regeneration in Knees
- Cervical Radiculopathy Treatment
- Cervical Spine Instability
- Chondromalacia Patella
- Chronic Ankle Pain
- Chronic Hip Pain
- Chronic Shoulder Pain
- Complex Regional Pain Syndrome
- Consensus Statement on Prolotherapy for Musculoskeletal Pain
- Corticosteroid Injections
- Dextrose Prolotherapy for Musculoskeletal Pain
- Prolotherapy for Headache and Migraine Pain
- Direct Bone Marrow Aspirate Therapy
- Elbow Pain
- Foot & Toe Pain
- Glenoid Labrum Tears
- Hand & Finger Pain
- Hip Labrum Lesions
- Joint Hypermobility Syndrome
- Joint Instability Treatment with Prolotherapy
- Knee Pain
- Ligament Injury and Healing
- Low Back Pain
- Meniscal Tears & Degeneration
- Morton’s Neuroma Pain
- Neck Pain
- Osteoarthritis Pain: Can Prolotherapy Help?
- Osteochondritis Dissecans
- Over-manipulation Syndrome
- PRP Injection Technique
- Prolotherapy as an Alternative to Surgery
- PRP Prolo for Meniscal Pathology
- Rationale for Direct Bone Marrow Aspirate
- Systematic Review of Dextrose Prolotherapy
- Thumb Arthritis
- TMJ Dysfunction Pain
- Upper Cervical Instability
- Wrist Pain
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