What is Prolotherapy?
How Does Prolotherapy Work?
Prolotherapy works by triggering the body's wound healing mechanism. The solution that is injected causes the body to release a multitude of substances called growth factors and inflammatory mediators. This results in the migration of certain cells into the area injected, which then lay down collagen. The collagen will strengthen the ligament or muscle attachment to the bone. As the ligament strengthens and tightens with time, the joint will stabilize and very often the pain will subside and function will increase. As the joint stabilizes, the muscles that have been in spasm trying to protect the joint and compensate for the weak ligament start to relax and range of motion will increase. The stronger ligament will look like a normal ligament under a microscope. Prolotherapy does not work by simply producing a disorderly scar. It tricks the body into thinking that it has been injured, and induces the body's own natural healing mechanism to strengthen the ligament.
What is Injected?
There are a variety of solutions used. The most common contains dextrose (sugar water) combined with a local anesthetic such as lidocaine. The strength of the solution can be augmented with Sodium Chloride. We do not use P2G, which contains the chemical toxin called phenol. P2G has been known to cause accidental permanent nerve damage. We consider this to be an unacceptable risk.
What Types of Conditions Are Treated?
Prolotherapy can be beneficial in a wide variety of conditions. It can help many chronic pain conditions that are not caused by nerve injury. This includes chronic back and neck pain, even if pain radiates down the leg or arm. It also includes upper back pain, shoulder, elbow, wrist, hip, knee, and ankle pain. It is especially useful for persistent pain after a car accident, fall or injury. Many cases of longstanding back pain are not due to disc problems, but rather are due to ligament weakness in the low back, especially of the sacroiliac and iliolumbar ligaments. Chronically unstable joints can be treated and stabilized.
What Are the Risks and Side Effects?
Prolotherapy is very safe provided it is performed by a physician or physiotherapist well-trained in the technique. There is the risk of infection or nerve damage, both extremely rare. It is possible to get some numbness of the skin over the lower back and buttocks. If this happens, it can last from several days to several months. If injections are done on the chest or lower neck, it is possible to collapse the lung, which is called a pneumothorax. If this happens, a chest tube will have to be placed to re-expand the lung. The chance of this happening is very low. Injections near the spine can cause a leak of spinal fluid, which results in a spinal headache, this complication rarely needs treatment.
If prolotherapy does not work, it should cause no long term damage. However, with some injections such as the shoulder joint, it is important to work actively to increase the range of motion and strength, or weakness and/or decreased range of motion may result. You may get itchy if the skin overlies the area injected. If this happens, this will subside in a few weeks. It is common to experience a temporary increase in pain after the injections. This varies with different areas of the body and also with individual patients. The amount of pain is often proportional to the underlying problem and the disability of the patient, and can be more severe with more serious problems. This may last for a day or a few weeks, then the pain of the injections will subside, and you should notice a gradual improvement in your condition. No medical procedure is free of risk and even the simplest injection can result in serious problems.
How Many Injections Will I Need?
In each prolotherapy session, multiple injections are performed to treat all the important ligaments or tendons in the injured area. It is a long-term treatment and not a quick fix for most people. You may require repeat injections once a month for a total of three to nine sessions.
What is the Success Rate of Prolotherapy?
If the diagnosis is correct and the injections target the important ligaments or tendons involved, the success rate has been reported to be as high as 80%. In chronic pain problems, it is sometimes difficult to accurately diagnose the cause of the problem. For instance, neck pain may be caused by a shoulder injury. If the neck is treated, the patient may not improve until it is determined that the shoulder problem is causing the neck pain, and the shoulder is treated. It is also important to understand that solving a pain problem may require several different therapies. For example, in treating neck pain, in addition to prolotherapy it is important to correct the posture and position of the head and to reduce the stress and tension carried in the neck, or long term benefits will not be obtained. Prolotherapy also does not work well in patients on disability who have no desire to return to work. Therefore, in a small percentage of people, prolotherapy will not work. It is important to have prolotherapy performed by a physician or physiotherapist who is well-trained in this technique. The treatment also depends on the body's ability to heal itself, and patients who are smokers, have diabetes, have hormonal imbalances or nutritional disturbance, may not respond well to the treatment. No responsible physician would guarantee the success of prolotherapy.