Prolotherapy - Straight to the point
Updated: Apr 7, 2019
Prolotherapy is a short-hand name for proliferative therapy, which is named for its ability to trigger healing and proliferation in damaged tissues. Prolotherapy has been used for roughly a hundred years, and was formally described and systematized by a surgeon in the 1950’s. Prolotherapy has been practiced and researched for many different health conditions and applications since this time. This article provides a brief outline of prolotherapy, its uses, and what to expect in a treatment.
Benefits and Uses of Prolotherapy
The primary benefit of prolotherapy is a decrease in joint pain, whether it be in the knee, hip, spine, sacroiliac joints, or numerous other joints. There has also been success with treating pain in the wrist, hands, and fingers, ankles, and even the jaw. Newer research supports healing benefits with rotator cuff tears, plantar fasciitis, and some other conditions. On top of the pain relieving qualities, specific applications can also increase joint stability (such as with chronic ankle sprains), improve and boost the healing of chronic conditions, and improve joint motion and function.
Prolotherapy Solution and Mechanism
The active ingredient in prolotherapy is dextrose, which is a simple sugar commonly found in the human body. In a prolotherapy treatment, dextrose is injected directly into the bony attachment site of either a tendon or a ligament, or it can be injected directly into a joint space. The injected solution causes a localized inflammatory reaction that triggers the release of growth factors, which are necessary for healing, repair, and growth. Prolotherapy is generally understood to tighten and thicken cartilaginous tissues such as tendons and ligaments, while new research is suggesting that the dextrose reaction causes pain-related nerves to actually withdraw from the cartilaginous tissues and the joint spaces, which leads to decreased pain signals from these tissues. Despite minor differences in understanding the specific mechanism of benefits, the literature clearly points out that prolotherapy works, and can significantly decrease pain and dysfunction in a great many people, with minimal associated risk.
I believe prolotherapy is a very valuable therapy that should be offered to many more patients, and by many more qualified healthcare providers. The last training seminar I attended had both naturopathic and medical doctors who were excited to advance their own skillset and treatment options, in order to provide better patient care. While I am glad to see our professions growing in this together, there is still significant room for improvement regarding awareness and utilization of this powerful tool.
Prolotherapy Treatment: What to Expect
A prolotherapy appointment generally includes a physical exam to add to the info already acquired through the initial intake, an assessment of the involved tissues and structures, and finally the actual injection of the prolotherapy solution. To minimize the discomfort of the procedure, the dextrose solution is generally supplemented with a local anesthetic, which adds a short-term numbing effect to the treatment area.
The entire visit is generally 30-60 minutes, with the actual prolotherapy injection typically taking 5-10 minutes. I generally also include myofascial injections into local muscles to decrease tension on the tissues to be treated, and to further decrease local pain. Finally, I offer a set of movement exercises including stretching and strengthening to help with the rehabilitation process, and ensure you are getting the most out of this therapy.
To achieve maximum benefit, the body is nutritionally and metabolically prepared before the procedure occurs, which I believe bolsters the positive effects beyond what is otherwise possible. Each of these steps adds to the pain relief and healing potential of prolotherapy, which is why it is all included as part of the prolotherapy package I offer. I focus on getting good results, thus I aim to offer the complete combination of therapies as a whole.
Prolotherapy: What to Expect After Treatment
Immediately following treatment the treated area generally feels heavy, and any pain that was felt before treatment is generally decreased from the local anesthetic. After about 1-2 hours, the treated area feels similar to pre-treatment levels, and gradually worsens for up to a day. The discomfort is usually quite manageable without painkillers of any kind, though acetaminophen (Tylenol) can be used if needed without impairing the treatment. One to three days after treatment the localized inflammation wears off, which brings the discomfort back to the patient’s normal. Note that during the first 3 days after treatment you must avoid hot tubs and swimming pools to minimize the risk of infection, and you must avoid strenuous exercise of any kind.
Relief from pain and dysfunction occurs at different rates depending on the individual and the condition treated, but most will experience a noticeable decrease in 1 – 2 weeks, followed by a progressive improvement over 6 or more weeks. If another treatment is necessary, it may be repeated after reassessment in 4 – 6 weeks or earlier depending on your case. Prolotherapy usually requires between 1 and 4 treatments for maximum benefit, though more may be necessary after re-injury or with unusually complex cases.
For more information and research on regenerative therapies including prolotherapy and platelet rich plasma (PRP), here is a link to an article I wrote previously:
For info on pain solutions and case-based approaches, see another of my previous articles: