What is Prolotherapy?

Ligaments are the structural “rubber bands” that hold bones to bones in joints. Ligaments can become weakened or stretched with injury and may not heal back to their original strength or endurance. Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons also may become injured and cause pain. Healing from this type of injury is frequently slow and incomplete. This is largely because the blood supply to ligaments is limited. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose. Because of the weakness in the ligaments/ tendons, sometimes there may be alot of muscle shortening, tension and pain as a result; because the body is working overtime to keep that stability that has been lost. Simply injecting a solution of procaine and dextrose into the ligament or tendon where it attached to the bone the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak. The injected solution causes a localized inflammation in these weak areas which then increases the blood supply and the flow of nutrients which stimulates the tissue to repair itself.

Notable research

Historical research abstracts:

  • In a review article written by John R. Merriman, M.D In 1964, he estimated that prolotherapy was successful in roughly 80% to 90% of the 15,000 patients he treated with a diagnosis of tendon and ligament relaxation.
  • George S. Hackett, MD postulated in 1939 that the major cause of back pain was tendon and ligament relaxation. In his initial animal experiments he demonstrated a 30-40% increase in tendon size after prolotherapy injections in animal subjects.
  • During 19 years of practice, Dr. Hackett treated 656 patients with prolotherapy, ranging in age from 15 to 88 years old and delivering a total of 18,000 prolotherapy injections. At follow up, he noted an incredible 82% of the patients had no reportable pain in the treated areas.
  • In another large-scale, whole-practice study, Dr. Gustav A. Hemwall treated 1,871 patients with 6,000 injections, 75.5% percent reported complete recovery from pain, 24% reported general improvement, and .02% reported no improvements at time of the follow up study in 1974.
  • In a clinical paper from 1937, Dr. Earl Gedney reported successful treatment of painful joint conditions by injecting ligaments around the knee, sacroiliac joint, shoulder and sternum. The Osteopathic Profession, 30-31, 1937, June.

Modern Research Abstracts:

  • “Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity ” CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1-year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritis severity. ACL laxity, when present in these osteoarthritic patients, improved. (Reeves KD, Hassanein KM. Altern Ther Health Med 2000 Mar;6(2):68-74, 77-80)
  • “Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity”. CONCLUSION: In patients with symptomatic anterior cruciate ligament laxity, intermittent dextrose injection resulted in clinically and statistically significant improvement in ACL laxity, pain, swelling, and knee range of motion. (Reeves KD, Hassanein KM. Altern Ther Health Med. 2003 May-Jun;9(3):58-62.)
  • “Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy” CONCLUSION: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints. (Reeves KD, Hassanein KM. J Altern Complement Med 2000 Aug;6(4):311-20)
  • “Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature” CONCLUSION: Prolotherapy describes a variety of treatment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions. Future research should focus on those solutions and protocols that are most commonly used in clinical practice and have been used in trials reporting effectiveness to help determine which patients, if any, are most likely to benefit from this treatment. (Dagenais S, Haldeman S, Wooley JR. Spine J. 2005 May-Jun;5(3):310-28.)
  • “Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain” CONCLUSIONS: Dextrose prolotherapy showed marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes. (Topol GA, Reeves KD, Hassanein KM. Arch Phys Med Rehabil. 2005 Apr;86(4):697-702.)
  • “Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial”CONCLUSIONS: In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises. (Spine. 2004 Jan 1;29(1):9-16)
  • “Injection therapy for enthesopathies causing axial spine pain and the “failed back syndrome”: a single blinded, randomized and cross-over study.” RESULTS: By clinical assessment patients obtained excellent to good relief of pain and tenderness after 80% of prolotherapy injections, but only 47% after anesthetics alone. By questionnaire, 66% reported excellent to good relief after prolotherapy vs. 34% after anesthetics alone. Patients reported improvement in work capacity and social functioning following both types of injections, but a greater reduction in focal pain intensity following prolotherapy injections. In the crossover portion of the study, patients reported that prolotherapy injections following initial anesthetic-only injections provided much better relief than that achieved after their anesthetic-only injections, and that anesthetic-only injections following initial prolotherapy injections failed to provide relief as good as that achieved after their prolotherapy. Subsequent to this study, only four of 35 patients required additional spine surgery, but 29 of the 35 patients requested additional injections. CONCLUSIONS : Injection therapy of painful enthesopathies can provide significant relief of axial pain and tenderness combined with functional improvement, even in “failed back syndrome” patients. Phenol-glycerol prolotherapy provides better and longer lasting relief than injection with anesthetics alone. However, most patients described good to excellent relief, felt that the injections had been beneficial, and requested additional injections for recurrent or residual focal pain. (Wilkinson HA. Pain Physician. 2005 Apr;8(2):167-73.)