Prolotherapy is a regenerative injection therapy that stimulates the healing and strengthening of connective tissue within damaged and painful ligaments, tendons and joints. It is a non-surgical approach to managing musculoskeletal pain and injuries by stimulating the body to heal itself.
Prolotherapy is a safe and effective regenerative injection treatment that increases strength and stability in ligaments, tendons and joints. These injections aim to treat the cause of the pain and have the potential to offer longer lasting relief than some other treatments. It may be an alternative to surgery, long term pain medication use and steroid injections (such as cortisone). Weakened ligaments and tendons are a common cause of musculoskeletal pain, joint pain and instability.
Prolotherapy injections contain 15-25% glucose and a small amount of local anaesthetic (lignocaine). The concentrated glucose and the mild traumafrom the needle causes some mild tissue damage and inflammation which then triggers the immune system to restart the healing and repairing process. Over time new, stronger collagen fibres are formed, strengthening weakened ligaments and tendons and reducing pain and disability.
Before treatment is commenced, an initial assessment is done by your doctor to decide if prolotherapy is suitable for you. This involves giving a history and undergoing a physical examination, and sometimes having imaging (such as xrays, ultrasound or CT scans) and/or blood tests. Prolotherapy is a regenerative therapy which will require several treatments before ligament strengthening occurs and improvement is noted. To achieve lasting results, a series of injections is needed, spaced approximately 2-4 weeks apart. Typically, 3-6 treatments are needed but the number could be more or less depending on your response. Because the response to treatment depends on you own bodies healing, other factors (such as immunosuppressive medications, smoking, nutritional status, past trauma to the area) can impact how much improvement one person has with treatment. After a series of treatments, the cells in the tissues that build the collagen can continue working away for weeks to months to keep strengthening the tissue over time.
Multiple different areas can be treated during the same visit if needed. No injection treatment is totally pain free. We expect some pain from the injections and a tolerable flare of pain for the first couple of days after the procedure which is a result of the intentional tissue damage and inflammation. If needed, you can take painkillers, such as paracetamol or codeine/tramadol etc ½ hour prior to and after the treatment if required. Its best to try to avoid anti-inflammatory tablets, such as aspirin, ibuprofen and diclofenac, for 7-10 days prior to your treatment and afterward but these can be used if the pain is too severe.
Many clinical trials assessing the efficacy of prolotherapy have been performed. A good example was from an Australian trial was completed at a clinic in Queensland. 110 patients with chronic low back pain were treated.
• At 6 months, 50% had less than half their original pain
• At 12 months, 40% had less than half their original pain, and pain was reduced by 75%
• At 12 months, the average reduction in pain was 40%
Disability reductions were similar.
Prolotherapy can be used to treat a wide variety of musculoskeletal conditions, including osteoarthritis, low back pain, shoulder pain and rotator cuff injuries, tennis elbow, Achilles tendinopathy, hip pain and much more.
Yelland MJ et al(2004) Prolotherapy Injections, Saline Injections, and Exercises for Chronic Low-Back Pain: A Randomized Trial. Australasian Musculoskeletal Medicine,9(2):80-87
Healing of ligaments and tendons is primarily due to rebuilding of damaged collagen fibres. Vitamin C, Zinc and manganese are building blocks for collagen. In addition to a healthy diet, with plenty of protein and vegetables, taking these nutrients in the form of supplements seems to improve the efficacy of prolotherapy.
Vitamin C 1-2g per day
Zinc 15-30mg per day
Manganese 5-20mg per day
Your doctor may also recommend magnesium 300mg per day to help reduce muscle tightness.
If needed, the overlying skin can be numbed with an injection of local anaesthetic. Local anaesthetic is also included in the injections to reduce injection pain and may also allow your nervous system to reset itself to a level that tolerates pain better. Prolotherapy solution is injected into several tender, weak areas where the ligament or tendon attaches onto the bone. Glucose injected into joints may encourage regeneration of worn cartilage. Prolotherapy injections can also be used to relieve and treat muscle trigger points (persistent painful muscle knots).
Side effects are minimised by using careful injection techniques, however minor side effects can still occur. The main side effects of prolotherapy injections are a mild to moderate flare in the pain (a deep, dull ache) and stiffness. This usually occurs during the first 48 hours after treatment but could last just a few hours or up to seven days after the injections. It is temporary and usually well controlled with simple pain relief medication such as paracetamol, heat packs and gentle walking/movement. Please avoid anti-inflammatory medications like aspirin, ibuprofen or diclofenac.
The post-treatment discomfort is due to the inflammation caused by the injections to help stimulate the healing process. It is less severe later in the series of injections and is very rarely bad enough for patients to want to stop treatment. The glucose solution can be diluted for those patients who are particularly sensitive. There may also be bruising at the site of injections. The skin is cleaned with antiseptic before treatment to reduce the risk of infection. Please avoid pools and spas for 24 hours to prevent infections. Complications from the injections are rare but can occur. Your doctor will discuss these with you before starting treatment. Occasionally the vitamin and mineral supplements can cause gut upset, which is improved by taking them with food (recommended), lowering the dose or stopping them.
Prolotherapy is ideally part of a whole treatment plan. You can continue your general exercises, strengthening and rehabilitation, and continue massage, acupuncture, mobilisation and manipulation treatment if required, but please talk to your prolotherapy doctor to discuss any modifications that may be required. Behavioural and psychological therapies can be useful to help you cope with pain and loss of function. Medications such as antidepressants, PEA, fish oil and glucosamine can be taken. Your doctor may provide prolotherapy in conjunction with other regenerative treatments such as PRP (Platelet Rich Plasma) or perineural injection treatment.