The Prolotherapy Technique

Prolotherapy is an alternative medicine technique used to treat pain. It involves injecting a fluid, commonly sugar water (but sometimes liquids as varied as cod liver oil and the anesthetic lidocaine), into tendons or ligaments. The word prolotherapy is short for proliferative injection therapy. There is conflicting evidence on whether the method is effective. It's considered experimental. Modern prolotherapy dates back to at least 1940.

Procedure

• The solution is injected into the place where the ligament or tendon meets the bone. This is called the fibro-osseous junction. A typical course of treatments consists of four to six sessions, given once every two to six weeks. Among the many muscoskeletal pain for which it is used are back pain, neck pain, arthritis, whiplash, carpal tunnel syndrome, herniated discs, fibromyalgia, and sports-related injuries. Usually patients feel a bit sore after a prolotherapy session, because the needle passes through muscle tissue to reach the tendons and ligaments. Such pain can generally be overcome with massage and hot compresses or with Tylenol.

Theory

• The notion behind prolotherapy is that sometimes when tendons and ligaments, which are made of collagen, are strained or otherwise injured, they don't heal well because their blood supply is relatively poor. The idea, then, is to inject them with a mild irritant that will kick the immune system into gear in that area. The local inflammation process caused by the liquid irritant is the key, which signals the immune system. New collagen is formed in the affected area. You're left with tissue that is---quite literally, according to some practitioners of the technique---better and stronger than new.

Support

• The hope of doctors who practice prolotherapy is to help patients avoid surgery when possible. However, the majority of doctors do not support or use prolotherapy, nor are they trained in it. Nonetheless, the concept got a big boost in April 2005. That's the month the Mayo Clinic reported in a newsletter that the therapy "may be helpful" when ongoing tendon or ligament pain doesn't respond to other, more traditional treatment, such as physical therapy.

Candidates

• Patients for whom prolotherapy may be suitable are those who have pain that originates from a tendon or ligament, who have a willingness to make the required follow-up visits, who have a healthy diet and a positive frame of mind, and who have a strong immune system. The treatment is not recommended for those with depressed immune systems, with nutritional or hormonal deficiencies or, of course, with pain not caused by ligaments or tendons.