Prolotherapy is a treatment technique used for chronic myofascial pain, back pain, osteoarthritis, or sports injury. Dr. George Hackett wrote in 1956 to describe prolotherapy:
“Within the attachment of weakened ligaments and tendons to bone, the sensory nerves become overstimulated by abnormal tension to become not only the origin of specific local pain, but also definite areas of referred pain throughout the body to as far as the head, fingers and toes from specific relaxed ligaments and tendons.”
The word prolotherapy came from Latin “proli” which means ‘to rebuild’ or ‘to regenerate’. Because the treatment results in growth and formation of new tissues where they have weakened, it is called prolotherapy. Prolotherapy, also known as proliferative therapy, is one of the effective pain management procedures we offer that repairs or strengthens wounded joints or connective tissues by stimulating the body’s healing process. When tendons or ligaments are torn or stretched, the joints destabilize and cause chronic pain. Prolotherapy works by addressing this injury. It can repair the areas where tissues are damaged and therefore, produce new collagen tissues to stabilize the joint. Once the joint is in its original stabilized form, the pain goes away. Originally, prolotherapy was known as “sclerotherapy”, it was called so in 1930, when the therapy was first applied, consisting both vein and joint injections. Nowadays, the term ‘prolotherapy’ is more accepted as it is used to treat tendon, joint and ligament injuries.
In human body, ligaments play the role of shock absorbers due to its “rubber band” characteristic in holding bones to bones in joints. Sometimes ligaments can be injured or weakened and may not get back their endurance and strength. Sometimes after the injury ligaments do not restore their primary length on their own. Blood supply of ligaments is generally less compared to that of muscle and other tissues. Therefore the injured area in ligaments heals slowly or sometimes incompletely. Ligaments contain numerous nerve endings, which intensified the situation even more, causing severe pain in the areas where the ligaments are damaged.
A sugar-based solution is used in prolotherapy, which is injected into the tendon or ligament in the areas where it is attached with the bone. A localized inflammation then takes place in the previously injured areas. This stimulates the supply of blood and other nutrients to the damaged areas to tighten and strengthen the connecting tissues. As a result, the areas concerned go through a rapid regeneration and stabilization process.
Generally up to 15% sugar (dextrose) mixed with a local anesthetic and Lidocaine are used as injectate solution. The inflammation caused by the solution initiates the body’s regenerative response by re-organizing collagens which in turn grow new tendon or ligament tissues. The procedure is made painless by using local anesthetic to numb the area to reduce discomfort. The patient might feel a little soreness for few days but it would go away. The whole process of injecting the solution is repeated for 2 to 3 weeks. No changes should be expected at least before six weeks. After that, the patient will feel a gradual improvement in the intensity of pain. The effect of prolotherapy is permanent. However, you may have to have booster injections each year after the first series. Based on appropriate patient evaluation and selection, if administered properly by a specialist, in almost 75% cases the pain will go away completely, or the amount of pain will reduce significantly.
In the traditional prolotherapy, repeated injections of dextrose solution are injected into the joint, tendon, or painful tissue in order to provoke a regenerative tissue response. As regenerative medicine rapidly advances, platelet rich plasma (PRP) and stem cell extract have been used in combination with traditional prolotherapy to achive more effective pain management by utilizing one’s own blood product and stem cells for their highly regenerative capacity.
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