|What is prolotherapy?
Prolotherapy is a form of injection treatment for pain caused by weakened ligaments and tendons.
“Prolo” is short for proliferation. The treatment causes the proliferation (growth/formation) of new ligament or tendon in areas where it has become weak or injured.
Ligaments are the structures that connect bones to bones and support joints. Tendons are the structures that connect muscles to bones and move joints.
Prolotherapy is often used to treat:
- Rotator cuff injuries
- Tennis elbow
- Low back pain
- Chronic knee pain
- Foot and ankle pain
When ligaments or tendons are injured, they don’t always heal to their original strength or endurance due to limited blood supply where they attach to the bone. These attachments have many small nerve endings and will cause pain when they are injured.
Prolotherapy involves injection of a solution (proliferant) into the area that the ligament or tendon attaches to the bone. This causes localized inflammation in the injured area. Inflammation increases the blood supply and flow of nutrients to the area, stimulating the body to repair itself. The result is a stronger bond between the ligament or tendon and the bone.
Prolotherapy is not a new technique. In ancient times, Hippocrates first used a version of this technique on soldiers and Olympic javelin throwers who often dislocated their shoulders.
In the past 60 years, research has helped doctors (MDs and DOs) improve injection techniques to successfully treat pain caused by instability.
How does instability cause pain?
A weak ligament causes the joint it supports to become loose or unstable. When this happens, the muscles around the joint will try to support it. This leads to spasm and early fatigue due to overwork of the muscle. Eventually, the tendons will weaken and other muscles will be recruited to help support the joint, causing widespread pain and spasm.
What is injected?
Many different proliferant solutions are available. Each stimulates the body’s healing response in a different way. A solution will be selected based on the type of injury or the area being treated.
Glucose (sugar water) combined with phenol and glycerin (irritants) is the most common solution.
A local anesthetic such as a procaine is usually added to decrease the pain during injection.
Will the injections hurt?
There is a wide variation in the discomfort level experienced by patients receiving prolotherapy. The needles used are very thin and tend to not cause much pain. Most of the discomfort is felt when the solution is injected and it is usually described as a “pressure sensation” rather than a true pain.
If you are interested in having prolotherapy but are very nervous or concerned about the pain, medications can be prescribed that can be taken before your appointment to help ease some of the discomfort and anxiety.
Are there any risks involved?
All procedures have possible risks. The type of risk often depends on the location of the body part that is being treated.
The most common risks include: no improvement, bleeding under the skin, infection, increased pain or swelling at the injection site and temporary or premature nerve damage.
The most serious risk of treatment in the upper back and chest is a pneumothorax (collapsed lung), which could lead to hospitalization and need for further treatment.
Great care is taken so that these do not happen, and in fact the more serious risks are very rare. However, it’s important for you to be aware of these risks. If you don’t feel that the possible benefits of this treatment are worth the risks, then prolotherapy might not be right for you.
How long will it take to complete a course of treatments?
The response to treatment varies from person to person, and depends upon one’s own healing ability. Some people may only need a few treatments, while others may need as many as 10 or more. The average number of treatments is 4 to 6 for an area treated. The usual time between treatments is 3 or 4 weeks. This is the time needed for the body to repair the area after the injection stimulates the healing response.
A typical course of injection treatment will take 3-6 months. Rehabilitation exercises may be recommended to continue even after injections are finished.
What can I expect after injection?
Pain and swelling at the injection site are normal for about 3-4 days after a treatment. The amount of pain experienced may vary with each injection or use of different proliferant solutions. The swelling is a result of the increased blood supply to the area and the body’s healing process at work. Pain medication will usually be prescribed for the first few days.
Do not take any anti-inflammatory medications (ibuprofen, aspirin or arthritis medications), since they will make the treatment less effective.
What else can I do to get better?
Exercise, physical therapy and postural retraining will usually be prescribed during and after a course of injections. It is critical to retrain muscles that have been weakened and injured so they can return to the job of moving joints during normal activities.
Ergonomic evaluation and workstation changes may be necessary to help avoid further repetitive motion injuries.
Supplementation recommendations or dietary changes may be made to help support healing ligaments, tendons and joints.
Nicotine use may slow the normal healing process. Prolotherapy will work better if you stop smoking or using tobacco products.
Is Prolotherapy right for me?
Prolotherapy is not for everyone. Dr. Pasquarello can answer questions you may have about prolotherapy treatment for chronic pain. Some of the common conditions that may benefit from prolotherapy are: rotator cuff injuries, tennis elbow, wrist pain from repetitive motions, degenerative arthritis related to instability, partial torn tendons and ligaments, low back pain, sciatica, chronic knee pain, foot and ankle pain.
George Pasquarello, DO, FAAO
Osteopathic Manipulative Medicine
Dr. Pasquarello has been teaching prolotherapy nationally since 1999. He has lectured, authored several articles and coauthored a textbook on prolotherapy.
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