Prolotherapy or proliferation therapy is an injection technique for chronic painful conditions of ligaments, tendons, tendon sheaths, joint capsules, muscles, and other soft tissues elements of the musculoskeletal system. It is based on the natural capacity of the human body to heal itself after an injury. Its main principle is that musculoskeletal chronic pain results from an incomplete healing process and that reactivation of the normal reparative healing process will help cure the pain.
Normally, after acute injury the body’s defense system responds by activating complex molecular and cellular mechanisms resulting in the appearance of repair cells at the site of the injury. These cells divide and multiply (proliferate), differentiate and organize themselves to fill the defect from the injury and heal the damaged area. In most cases, the result is complete healing and the pain subsides. In some cases and in particular with repetitive trauma to the same area, the reparative response described above tends to weaken with each additional assault and ultimately is not able to complete the repair. A condition of incomplete repair is established in which the defect is still present to some degree and the efforts to repair it on the part of the body’s defense system continue, although ineffectively. This ongoing process also known as chronic inflammation results in continuous irritation of the nerve endings present in these structures and, ultimately, in chronic pain.
Two major therapeutic approaches are being used to treat the chronic pain based on the above model. The first one is to block the inflammation since it is believed to be an incomplete and ineffective attempt on the part of the body’s defense system to repair the damage and at the same time causes pain. Anti-inflammation therapies can be systemic, in the form of an anti-inflammatory medicine like Celebrex, or local, like a steroid injection. An obvious downside of this approach is that these therapies block the inflammation, which is believed to be the cause for pain, but do not let the reparative process be completed. This leaves the injured area in a state of disrepair and if the anti-inflammatory therapy is stopped, the pain returns. This is why anti-inflammatory therapies are generally considered to be just symptomatic, but not curative.
A different approach is to attempt to reignite the body’s healing system and to allow it to complete the repair of the injured area as if this is a case of acute trauma. This is what prolotherapy attempts to do. By injecting solutions that contain some natural irritants, for example highly concentrated sucrose/sugar, the body’s repair systems are reactivated as in acute injury. This results in an initial increase of blood supply to the injured area, which is felt by the patient as a feeling of warmth and possibly mild swelling. The increased blood supply brings nutrients, defense molecules (cytokines) and repair cells called fibroblasts to the injured area. These repair cells proliferate (prolotherapy) and produce collagen in order to fill the defect caused by the injury. This mixture of fibroblasts and collagen becomes new ligament, fascia, tendon or capsular tissue. The end result is thickening and strengthening of the injured musculoskeletal elements and ultimately, a complete healing of the injured area with resolution of pain.
In our practice, prolotherapy usually entails 3-6 injections into the injured area done 1-2 weeks apart. We usually use a mixture of a numbing agent (Lidocaine or Marcaine) and 25% dextrose. Some mild exacerbation of symptoms, including redness, mild swelling, warmth, and, rarely, increased soreness in the injured area may be experienced for a couple of days. The concentrations of the injected ingredients are chosen so that these symptoms are mild, if any, and that the procedure is well tolerated.
Essentially, any chronic musculoskeletal injury with pain is a potential candidate for prolotherapy. This includes conditions such as chronic back or neck pain, sprains and strains, arthritis, tendonitis, bursitis, capsulitis, and others. If you suffer from a chronic musculoskeletal painful condition, you should try prolotherapy. It makes sense, it is safe, and it works!