Prolotherapy

Also called proliferation therapy, regenerative injection therapy or proliferative injection therapy. This procedure involves injecting an otherwise non-pharmacological irritant solution into the body to repair regions and to alleviate pain.

Prolotherapy is also known as “proliferative injection therapy”, “proliferation therapy” and “regenerative injection therapy”.

The definition of prolotherapy is as follows: the rehabilitation of an incompetent structure, such as a ligament or tendon, by the induced proliferation of new cells.

History of prolotherapy:

In the modern era, pro-therapy has been used clinical practice for more than 80 years.

This all began in the fifth century B.C.by Hippocrates, where he treated unstable joints by cauterising the ligaments with a hot metal rod. First century BC Celsus described the treatment of hydroceles around the testes with injection of a sclerosant solution. Fortunately over the years this treatment has been refined!

Prolotherapy comes from the word ‘proli’ (Latin) meaning offspring: ‘proliferate’-to produce new cells in rapid succession.

The term was coined by a trauma surgeon, George Hackett in 1939, where he described using a sclerosant for tendon pathology and ligament laxity in chronic musculoskeletal pain.

Increasing interest in prolotherapy, accompanied by increased number published treatment outcome studies confirm that pro-therapy is effective in treating the conditions with few adverse effects.

Types of prolotherapy:

If looking online or reading literature, this can be confusing as prolotherapy is a broad term with different meanings to different people.

There are many substances used depending on the practitioner and what it is that is trying to be achieved.

The term encompasses sclerosants, such as dextrose, as well as platelet rich plasma (PRP) and stem cell therapy.

In this practice prolotherapy is used to describe dextrose injection therapy.

Why would prolotherapy be indicated?

The goal of prolotherapy is the resolution of pain and return to function, allowing patients the ability to return to normal activities of daily living and exercise.

Some regions tend to respond well to this form of treatment such as sacroiliac joint, pubic symphysis and the plantar fascia.

Other conditions where pro-therapy can be utilised include: osteoarthritis, overviews tendinosis to

The best treatment option ion any particular patient relies on many factors including, but not limited to, exact location and nature of the injury, the length of time it has been present, imaging characteristics, patients age, previous therapy and other concomitant medical issues.

This usually involves the injection of the solution at points where tendons or ligaments attach to a bone to induce an inflammatory reaction. This inflammatory reaction initiates regeneration and repair of the injured tissues.

Method of action:

Hypotonic dextrose solution acts by dehydrating cells at the injection site, leading to local tissue trauma which in turn attracts granulocytes and macrophages, promoting healing.

This process takes about 6- 8 weeks to occur. This explains why it takes a while for patient’s symptoms to respond.

Therefore if repeat therapy is required we usually wait about 6-8 weeks between injections.

Articles:

  1. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Hauser R, Lackner J etal. Clinical medicine insights: Arthritis and Musculoskeletal Disorders  2016:9 139-159; Click Here to Read the Full Article
  1. Journal of Prolotherapy International Medical Editorial Board Consensus Statement on the Use of Prolotherapy for Musculoskeletal Pain: Hauser R, Maddela H et al. Journal of Prolotherapy volume 3, issue 4, December  2011, 744-764; Click Here to Read the Full Article
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Dr Berman is a dual specialist – Musculoskeletal Radiologist and Vein Specialist (Phlebologist)
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