Prolotherapy

Overview

A natural irritant is injected into the soft tissue of a damaged joint during prolotherapy. The irritation initiates the healing response in the body.

Prolotherapy isn't a surgical procedure. As a result, it's often referred to as a regenerative joint injection or non-surgical ligament and tendon restoration.

Prolotherapy is mostly used by doctors to repair broken joints and ligaments. While prolotherapy is most typically utilized in the back, doctors may also use it in the following locations of the body: knees, hips, shoulders & other joints and ligament

In some cases, people with chronic conditions, such as degenerative disc disease or arthritis, may wish to use prolotherapy to help ease their pain.

Although prolotherapy has been around since the early 1900s, its overall efficacy is currently being challenged. Despite this scepticism, many doctors feel it is a safe alternative or supplementary treatment for back and joint pain.

 

What is Prolotherapy?

Prolotherapy is a pain-relieving injectable procedure. A little amount of an irritant will be injected into your body by your healthcare practitioner. The most typically injected irritant is dextrose (sugar) solution.

Proponents of prolotherapy believe it improves pain by reactivating your body's natural healing mechanisms. Prolotherapy is used to treat musculoskeletal disorders in individuals (issues with your bones, muscles, tendons, ligaments and soft tissues).

Prolotherapy is an alternative treatment, which means it is not regulated by the Food and Drug Administration in the United States (FDA). Experts have discovered that it can aid certain people in specific conditions, but it is still not commonly acknowledged due to inconclusive study results.

Prolotherapy has been shown in several trials to relieve pain. Others say that any advantages are most likely a placebo effect, which means that individuals believe it will assist them.

If you decide to utilize prolotherapy, be sure treatment is done by a respected clinic and provider. Before incorporating any new pain-management therapies into your regimen, consult with your doctor.

 

Is Prolotherapy Like Cortisone?

The difference between Prolotherapy and Cortisone is extensive.

• Cortisone injections into the joint can effectively mask discomfort. Many people have had extremely successful Cortisone treatments. We often meet individuals who have a long history of Cortisone injections that are no longer effective.
• Many studies have demonstrated that cortisol accelerates degenerative osteoarthritis by causing cartilage degradation.
• Unfortunately, for many people, high cortisol therapies increase chronic pain. Again, while cortisone may aid some people in the short term, the research suggests that it causes more issues than it solves.

Prolotherapy is a regenerative injection treatment used to treat joint and spine pain by repairing damaged and weakened ligaments and tendons.

• Prolotherapy is considered a viable alternative to surgery, and as an option to pain medications, cortisone and other steroidal injections.
• The Prolotherapy procedure is considered a safe, affordable option that allows the patient to keep working and/or training during treatment.
• H3 Prolotherapy difference: It is typically best to treat all or most of the ligaments of an unstable joint if that joint or its surrounding structures are painful. Multiple joints and structures can be treated with each visit.

 

Who Needs a Prolotherapy?

1. Helps Repair Tendons Injuries

Prolotherapy can boost platelet-derived growth factor expression, which kickstarts the regeneration of injured tendons. A JAMA research published in 2010 examined two types of prolotherapy (saline and PRP) for healing tendon injuries and discovered they had equivalent results. Both therapies assisted in the treatment of chronic Achilles tendinopathy, while others suggest that PRP may be more suited for this kind of injury.

2. Helps Treat Chronic Back & Neck Pain

Prolotherapy, according to Spine Health, can help heal small tears and weakened tissue in the back that lead to inflammation, decreased function, bulging discs, and back discomfort. The method by which stem cell therapy aids in the treatment of back pain is by inhibiting "ligamentous laxity," or the activation of pain receptors in tendon or ligament tissues that convey painful nerve signals up the back.

Damaged tissue in tendons or ligaments is susceptible to stretching, compressing, and other types of pressure, therefore prolotherapy helps to reduce the source of pain by minimizing these tears.

Prolotherapy has successfully been used in pain management for common conditions that affect the back including:

• Neck pain due to spine related conditions.
• Sciatica/sciatic nerve pain.
• Bulging or herniated discs.
• Degenerative disc disease.
• Sacroiliac problems.
• Rotator cuff injuries extending to the upper back.
• Whiplash.

3. Resolves Shoulder Injuries & Pain

Prolotherapy have been shown to be effective in the treatment of shoulder injuries and pain, which are often a result of the rotator cuff being overworked (sometimes from not resting enough between workouts). The shoulder is one of the body parts exposed to the most repetitive use, repeated traumas and degeneration, so athletes, laborers and aging adults are most susceptible to shoulder injuries of all kinds.

A 2009 Journal of Prolotherapy study reported that up to 82 percent of patients treated for chronic shoulder pain (also called frozen shoulder) experienced improvements in sleep, exercise ability, anxiety, depression and overall disability. And 39 percent of these patients were told by their medical doctors that there were no other treatment options available for their pain.

4. Treats Elbow & Wrist Tendonitis

According to a 2008 study published in Practical Pain Management, persons who often play golf or tennis are more prone to elbow injuries. Prolotherapy is widely recognized as a non-surgical treatment alternative for sports injuries. Not only can lateral and medial epicondylitis impact the elbow, but they can also cause discomfort in the lower back, wrist ligaments, or shoulders, as well as sprained ankles and other musculoskeletal problems caused by repetitive usage and joint degeneration.

5. Treats Injuries to the Hands & Feet

Prolotherapy is now being used to alleviate pain associated with common hand injuries experienced by younger and middle-aged adults, such as carpal tunnel syndrome, Skier's or "Gamekeeper's" thumb, and "Texting thumb," which are caused by repetitive use and damage to the ulnar collateral ligament.

Thumbs, fingers, hands, and feet are also prone to osteoarthritis and aging-related discomfort. Prolotherapy treatments were reported to effectively alleviate ankle and foot pain associated with arthritis, tendon ruptures, plantar fasciitis, misalignments, fractures, and ligament injuries in one research including over 600 patients with ankle and foot pain published in Operative Techniques of Sports.

6. Treats TMJ (Jaw Pain and Dysfunction)

A May, 2019 randomized controlled trial found that the use of prolotherapy injections administered over several months helped to significantly relieve TMJ (temporomandibular dysfunction) jaw pain and improve function of the mouth when compared to control injections.

Participants in the prolotherapy group received injections with 20% dextrose/0.2% lidocaine (an analgesic), while the control group received injections with only 0.2% lidocaine.  Symptom relief was seen 3 months after prolotherapy injections started and clinical improvements lasted to 12 months. Overall, “satisfaction was high” among the group receiving prolotherapy treatments. Participants who had mouth opening abilities that were initially restricted gained significant range of motion in their mouths/jaws. Pain and dysfunction improved by at least 50 percent in 38 of 54 participants (70 percent of all participants).

Researchers involved in the study state that dextrose prolotherapy injections are believed to work for TMJ because this treatment has a “multifactorial effect”: it’s been shown to initiate fibroblast proliferation which produces stronger, thicker, and more organized connective tissue, and to reduce nerve swelling and compression in the jaw.

 

Benefits of the Prolotherapy

1. Nonsurgical treatment:

Prolotherapy injections cure your connective tissues without the need for surgery. That means no incisions, no recuperation time, and maybe faster results. Prolotherapy can help your knees, hips, shoulders, and other joints function better. The only negative effect you may experience is transient soreness and swelling around the injection site.

2. Natural healing:

Prolotherapy employs an injectable solution to provide an intentional, controlled irritation in the tissue at the injection site, so triggering your body's inherent healing and regeneration capacities. Instead than depending on drugs or surgery to treat joint pain, prolotherapy encourages your body to heal itself.

3. Heal and regrow new tissue:

Your body undergoes an inflammatory reaction following your prolotherapy treatment, which only takes approximately 30 minutes to complete, boosting blood flow and encouraging the creation of new tissue. Your body repairs and replaces damaged regions in joints or surrounding ligaments in the days and weeks that follow.

Prolotherapy can be used to treat an injured region, including ligament and tendon problems. Alternatively, prolotherapy may be able to give comfort and regeneration for worn-down joints, restoring function and putting an end to the grind of chronic joint pain caused by degenerative disorders such as arthritis.

4. Strengthen and thicken your tendons and ligaments:

Following prolotherapy injections, the tendons and ligaments that support your joints grow thicker and stronger. That means pressure taken off the bones of your joint, and improvements in joint functioning, in addition to a reduction of your joint, ligament, or tendon pain symptoms. When you have strong joints, you’re at lower risk for falls and injuries.

5. High success rates:

Prolotherapy shows significant promise as a treatment for chronic joint pain and tendon and ligament damage. You may need several injections to fully treat an injury or weak area in your body. Our team may recommend between 4-15 shots per session, with multiple sessions over the course of 3-6 months.

 

Precautions Regarding Prolotherapy

There are currently no precise treatment standards or protocol rules in place for physicians who employ prolotherapy. Prolotherapy is frequently used in conjunction with other methods of lowering pain and mending injuries, such as physical therapy, stretching, myofascial release for sports, massage treatment, chiropractic adjustments, and, in rare cases, the use of anti-inflammatory or steroid medications.

Prolotherapy is used as a first-line therapy by certain doctors, however it is uncommon. Many people consider seeing a physical therapist following prolotherapy injections for additional assistance and evaluation.

Prolotherapy is not for everyone, including individuals who have not been diagnosed with an injury or the source of their pain. To inject and cure an injury (such as sprains, strains, and weakened ligaments), the affected tissue must first be detected utilizing diagnostic imaging investigations so that doctors know where to inject.

Although prolotherapy is thought to be relatively safe, some experts are concerned that a lack of expertise on how to give prolotherapy injections appropriately may result in negative effects in certain circumstances. Always go to a skilled specialist who has the necessary certifications and expertise with stem cell injections.

Side effects of treatments usually go away within several days, can if they become painful symptoms can be reduced through taking an over-the-counter pain killer temporarily (like ibuprofen).

Prolotherapy side effects can sometimes include:

• Swelling at the injection site.
• Increased pain and stiffness.
• Headaches.
• Signs of an allergic reaction.
• Although very rarely, cases of spinal fluid leaks and permanent nerve damage have also been reported.

 

How Does Prolotherapy Stimulate Healing?

Prolotherapy works by inducing a targeted, moderate inflammatory reaction near injured tissue, which promotes the growth of new fibers. While "inflammation" is typically regarded to be a harmful (and sometimes unpleasant) phenomenon, it also offers essential advantages for encouraging repair and repairing damaged tissue fibers.

Prolotherapy College describes this process as follows:

When ligaments or tendons (connective tissue) are strained or ripped, the joint they support becomes unstable and painful. With its unique capacity to directly target the root of the instability, prolotherapy can heal the damaged regions and manufacture new collagen tissue, resulting in permanent joint stabilization.

Prolotherapy works by tricking the body into mending an area by conducting a very targeted injection to an injured location. Prolotherapy injections used to contain a combination of drugs that served to numb pain and create a moderate inflammatory reaction, such as dextrose, saline, sarapin, and procaine.

Recently, platelet-rich plasma (PRP) procedures have been developed that use adult stem cells (from the person being treated) that are removed from the bone marrow or adipose (fat) tissue. These stem cells have the remarkable ability to transform themselves, making them highly valuable for treating many conditions.

Prolotherapy can work as follows:

• When stem cells are injected into soft tissue that is tearing, "natural healing" occurs at the injection site, which means that new blood vessels and fibers grow, helping to tighten, mend, and reinforce the injured joint or tissue.
• A series of injections are used in prolotherapy treatment. Depending on the degree of their injuries, patients may have 3-30 injections. Most individuals require 4-10 doses to see effects.
• Over the course of several months, injections are given every 2-3 weeks (usually 3 to 6 months).
• "Natural irritating agents" are among the substances used in "Dextrose Prolotherapy" injections (such as dextrose or glucose, which are types of sugar molecules, or glycerin and phenol).
• Irritants are often used with a local anesthetic (lidocaine, procaine or marcaine) to help numb the affected area and injection site. Sometimes other substances such as cod liver oil (sodium morrhuate) are also used to regulate inflammation and healing.
• There are certain differences between standard prolotherapy injections (using dextrose for example) and PRP injections.
• PRP Prolotherapy utilizes substances taken directly from the patient’s own body. PRP (or “platelet-rich plasma”) is defined as “autologous blood with concentrations of platelets above baseline levels, which contains at least seven growth factors.” Platelets contain a number of proteins, cytokines and other bioactive factors that initiate and regulate basic aspects of natural wound healing.

 

Before Starting Prolotherapy

Talk to your healthcare provider before starting prolotherapy. They’ll tell you if any medications you’re on or other pain-management techniques you’re using could cause complications during or after prolotherapy injections.

 

What Happens During Prolotherapy?

Your therapist will inject dextrose (or another solution) into any painful joints, tendons, or ligaments during a prolotherapy session. Your practitioner may use imaging technologies such as ultrasonography to guide the injections.

You will need several injection sessions. People commonly receive three to six injections throughout their prolotherapy sessions. The number of injections you'll need — and how frequently you'll need them — is dictated by where you're receiving treatment and what your clinician recommends. 

 

What is the Recovery Time After Prolotherapy?

Prolotherapy treatments need little to no recovery time. You should be able to resume all of your normal activities immediately. Although you may have a sore at the injection site, you should be able to continue all of your routine activities without interruption.

Before resuming intensive physical activity such as hard exercises or sports following an injection, consult with your physician.

If you require more prolotherapy injections, your physician will schedule them for you.

 

Cost

Prolotherapy can be quite costly for an individual. Many insurance companies will not cover prolotherapy, so individuals have to pay for their treatment.

Costs seem to range from around $250 to $600 for the procedure. The exact cost depends on the site of the injections, who does it, and if any additional treatment is required.

 

Conclusion

Prolotherapy, also known as proliferation therapy, is a complementary medicine treatment for musculoskeletal diseases. Prolotherapy has been used to treat arthritic symptoms, low back pain, and joint laxity in those suffering from chronic pain since the 1950s. 

Prolotherapy providers strive to provide non-surgical treatment for inflamed and injured joints by injecting a solution of dextrose (a natural sugar chemically equivalent to the body's own glucose).