Prolotherapy introduction
Prolotherapy is a non-surgical injection procedure used to treat connective tissue injuries of the musculoskeletal system that have not healed by either rest or conservative therapy in order to relieve back pain. The injections promote a healing response in small tears and weakened tissue, with the goal of alleviating back pain and improving function. Prolotherapy is also referred to as sclerosant therapy, sclerotherapy, regenerative injection therapy, “proliferative” injection therapy and nonsurgical ligament reconstruction.

Prolotherapy has been used in pain management and treatment of numerous conditions, including back pain and neck pain due to spine related conditions such as:

  • Degenerative disc disease
  • Sacroiliac problems
  • Sciatica
  • Whiplash

A theory behind prolotherapy is that back pain is related to activation of pain receptors in tendon or ligament tissues, which are sensitive to stretching, pressure, etc. It is thought that the cause of back pain is from ligamentous laxity.

With the prolotherapy procedure, the substance injected into the soft tissue causes an inflammatory response at the site, which in turn causes natural healing to take place (formation or “proliferation” of new blood vessels), with the goal of strengthening the torn or injured soft tissue and reducing the back pain.

While a history of the prolotherapy treatment approach has been traced back to ancient times, it is not yet widely practiced in the United States and many practitioners consider it an alternative therapy. Prolotherapy as a means of pain management is not taught in medical school or residency training programs.

There currently are few studies that show the effectiveness of the prolotherapy procedure for allieviating back pain. Patients considering prolotherapy for back pain should ask their physician if he or she is trained and experienced in the procedure.

If you suffer from back pain, sciatica, unresolved whiplash, a nagging sports injury, or any type of joint pain, you may be a candidate for prolotherapy (also called sclerotherapy).

Prolotherapy relieves musculoskeletal pain by strengthening ligaments and tendons. Ligaments and tendons are tough, fibrous bands of tissue that connect bone to bone, or bone to muscle. They are the stabilizers of the musculoskeletal system. As long as they are strong and taut, they keep bones, joints, and muscles in place, allowing for pain-free movement.

However, when the ligaments and tendons become injured, weak, or lax, these other structures become unstable and move out of position. The resulting misalignment impinges on nerves and blood vessels, thus damaging tissues and causing pain. Restoration of proper alignment and removal of pressure on sensitive tissues provides lasting pain relief.

How Does Prolotherapy Work?

Prolotherapy consists of injections of a mildly irritating solution into the painful area. The irritant, usually a dextrose-based solution, triggers the body’s natural healing response and causes the proliferation of new collagen fibers, which are the building blocks of ligaments and tendons. As tissues re-grow, ligaments and tendons become thicker and stronger, regaining their ability to stabilize the joint and take the pressure off sensitive nerve endings. Pain subsides, range of motion returns, and cartilage degeneration slows down.

One treatment is occasionally enough to achieve complete pain relief, but usually several treatments are required. The injections are administered a few weeks apart to produce continued collagen growth for sustained pain relief.

What Conditions Can Be Treated with Prolotherapy?

Prolotherapy helps a wide range of musculoskeletal conditions:

* Arthritis
* Back pain
* Fibromyalgia
* Headaches
* Knee pain
* Neck pain
* Sciatica



* Ligament sprains
* Shoulder pain
* Sports injuries
* Tendonitis
* Carpal tunnel syndrome
* Unresolved whiplash injury

How Does Prolotherapy Compare to Drugs?

Drugs used most commonly for musculoskeletal pain are nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs relieve joint pain by countering inflammation. However, because inflammation is the first stage of your body’s healing process, these drugs may hinder recovery. NSAIDs are also well known for their gastrointestinal side effects and actually end up damaging cartilage, the cushioning material that protects joints. Moreover, NSAIDs do nothing to address the underlying laxity of ligaments and tendons that is a contributing source of chronic pain.

For more severe or chronic musculoskeletal pain, doctors sometimes prescribe corticosteroids. Like NSAIDs, corticosteroids work by suppressing inflammation. However, they also suppress immune function, which increases your susceptibility to infection and intereferes with healing. Long-term use of these drugs is associated with an increased risk of high blood pressure, osteoporosis, and vision trouble.

Unlike anti-inflammatory drugs, prolotherapy does not mask pain. The goal of prolotherapy is to remove the source of the pain. It is a safe therapy has none of the risks of NSAIDs and corticosteroids. The only side effect of prolotherapy is mild discomfort during the first few days of healing.

Is Prolotherapy a Proven Treatment?

In a study published in the Lancet medical journal, 81 patients with chronic low back pain were randomly assigned to receive either prolotherapy injections or injections of saline a placebo. Six months after treatment, 87.5% of those who had received prolotherapy were rated as being more than 50% improved, compared to only 39% of those in the placebo group. In addition, almost four times as many patients in the prolotherapy group were completely free of disability as compared to the placebo group. Lancet, 1987; 2(8551):143-6.

George Hackett, MD, published a study of 656 chronic low back pain patients who were treated with prolotherapy. The average duration of pain prior to treatment was 4.5 years, although some had been suffering for as long as 65 years. About half of the patients had already undergone back surgery without success. Twelve years after treatment with prolotherapy, 82% of Dr. Hackett’s patients considered themselves cured. In other words, their pain had gone away and not returned. Hackett, G. Ligament and Tendon Relaxation Treated by Prolotherapy, 3rd edition. Springfield, IL: Charles C. Thomas, 1958.