Prolotherapy & How to Inject It

Prolotherapy is a non-surgical technique that injects solutions into damaged connective tissue in order to irritate the inflamed and damaged area and encourage the body to repair it naturally. It was first developed in the 1940's by George S. Hackett, and applied systematically to over 10,000 cases by Hackett and Gustav Hemwall. In 2005, the Mayo Clinic gave prolotherapy an endorsement over surgery for treatment of connective tissue damage where conservative methods of physical therapy had proved unsuccessful.

What Is Prolotherapy?

• Prolotherapy is a non-surgical technique designed to repair damaged connective tissues (ligaments and tendons) and used to treat a variety of ailments that result from tears and degeneration in the connective tissue of joints (including tennis elbow and patellar tendinitis).

  Conditions like patellar tendinitis are both chronic and degenerative. While many patients respond well to traditional methods of healing (like the RICE method and strengthening exercises), some tissues continue to degrade. Prolotherapy acts by stimulating the body's own natural mechanisms to encourage it to repair damaged tissue.

  A doctor performing prolotherapy will inject the aggravated area (the knee, in the case of patellar tendinitis) with an irritant, such as a concentrated sugar solution. This will further inflame the damaged area, and provoke the body to produce tissue-healing growth factors. The body often fails to do this upon injury to tendons, ligaments, and cartilage, because these tissues are not well-served by the body's circulatory system.

  Some treatment also involves the injection of platelet rich plasma (PRP). This substance consists of concentrated platelets, drawn from the patient's own blood. It contains growth factors that accelerate the repair and regeneration of damaged tissues. Patients undergoing this procedure would have it done concurrently with their prolotherapy and on the same schedule and time frame.

  Results from a number of studies have shown that the new tissue that is developed strengthens these once unstable connective tissues, and has shown promise for the regeneration of cartilage, which normally does not repair itself.

What to Use?

• Qualified practitioners (using doctors of osteopathy and physical therapists) can perform prolotherapy injections with a number of different substances designed to promote the formation of collagen in connective tissues. Connective tissues are comprised of collagen, a protein that occurs naturally in the human body.

  The most commonly used irritant are solutions called osmotic proliferants, which consist of dextrose and glycerin suspended in water. Other proliferants include zinc, calcium, or manganese.

  Those performing prolotherapy can also use irritants that alter the surface proteins of cells. These include dextrose, phenol, guaiacol, tannic acid, and plasma QU (quinine plus urea).

  Injecting particulates, such as pumice flour, will encourage molecules called macrophages to enter the injured tissue. Macrophages will eat the pumice molecules and begin to secrete growth factors that promote collagen tissue growth.

  Finally, practitioners of prolotherapy can inject chemotactics, such as sodium morrhuate, that draws immune cells into the injured area.

How Often?

• Doctors report that most the pain of chronic connective tissue problems stops after three to six prolotherapy sessions, which may involve multiple injections. Each session is spread out at four to six week intervals. The standard protocol involves 10 to 20 total injections for the knee, ankle or shoulder, and a range of 30 to 60 for connective tissue injuries of the neck, back, or spine.

  Users are encouraged to continue with conservative methods of treatment such as physical therapy. Those who do not respond well to prolotherapy are often examined to determine if the joint pain is caused by something else, like bacterial or viral infections or allergies.