What is Prolotherapy and how does it work?
It is a technique consisting of injecting tissue irritating substances, such as hypertonic glucose (sugar water), among others, into the tissues. These tissue irritating substances called prolifereants stimulate healing, tissue regeneration, and repair when injected into precise points called the enthesis. Basically, the enthesis is the point where tendons and ligaments attach to the bone. The prolifereant, when injected into these very precise points, stimulate tissues to proliferate (therefore the name Prolotherapy) and heal. When injuries occur, the area may not heal completely due to lack of proper treatment or poor blood supply. For this reason, ligaments, joints, and tendons heal very slowly and poorly. If left untreated or not treated correctly, damaged ligaments become loose, allowing bones in the joint to shift with excessive movements, causing pain, muscle spasms, and eventually arthritis. Aging can have the same effect. Arthritis occurs in the joints and spine as a result of instability in the structures supporting them. Prolotherapy can intervene by stabilizing the structures and decreasing the progression of pain, degeneration, and aging. When stretched, small nerve fibers in the damaged ligaments transmit pain impulses to the brain. Through a subconscious reflex, the surrounding muscles go into painful spasms in an attempt to stabilize the joint. This causes the region to feel tight, stiff, achy, burning, tingling, numb, fatigued and painful. The individual often notices painful knots in the surrounding muscles. These muscles become tight and painful as they try to compensate for the weak and damaged underlying structures. Spasms in the muscles decrease blood flow and nutrient delivery to the tissue, further contributing to the breakdown. Also, the chronic tension from the muscle in spasm leads to deterioration of the tendon attachments, leading to tendinosis (degeneration without inflammation). Not only is pain felt locally, but also it is referred to other areas. Injecting a stimulating solution the sites of the tissue breakdown stimulates the body’s own healing mechanism to repair and rebuild. This regenerative process leads to a stronger and more supportive structure.
Differences Between Prolotherapy and Cortisone Shots!
Cortisone shots can permanently damage bones, ligaments, muscles, cartilage, and tendons, resulting in a weakening of the joint and resultant degenerative joint disease (DJD), or osteoarthritis, osteoporosis, fractures, and muscle weakness. This structurally weakens the joint, increasing the production of more pain, which leads to more cortisone shots and eventually surgery.
Facts about Prolotherapy for the treatment of Chronic Musculoskeletal Pain
As published in the Journal of American Family Physician. 1. Prolotherapy is an injection-based complementary therapy for common chronic musculoskeletal conditions including tendinopathy, knee osteoarthritis, and low back pain. 2. Patients with severe refractory lateral epicondylitis (Tennis elbow) treated with prolotherapy, reported approximately a 90 percent reduction in resting elbow pain on a 10-point visual analog scale compared with a 22 percent reduction in the control group. 3. Other overuse injuries including Achilles tendinopathy, Abductor tendinopathy, and Plantar fasciitis have responded well to prolotherapy. 4. Prolotherapy has also been used in multidisciplinary care plans. Participants in an Achilles tendinopathy study responded earlier and with less money spent on treatment when physical therapy and prolotherapy were combined compared with either treatment alone. 5. The largest and most methodologically rigorous study compared prolotherapy in 110 participants with an average of 14 years of nonsurgical low back pain. Participants reported substantial and sustained reductions in pain (26 to 44 percent) and disability (30 to 44 percent) at 12 months. 6. Positive outcomes have been reported in prospective studies assessing prolotherapy for the following conditions: refractory coccygodynia, sacroiliac joint dysfunction, and leg pain caused by moderate to severe degenerative disk disease. 7. Prolotherapy performed by an experienced injector appears safe; no clinical trials report significant adverse events. Current data suggest that prolotherapy has a positive effect compared with baseline status, and in some cases compared with control therapy, in carefully selected patients for several indications including Achillis tendinopathy, Coccydynia (tailbone pain), knee osteoarthritis, lateral epicondylitis, degenerative disk disease, nonspecific low back pain, plantar fasciitis, and sacroiliac joint dysfunction.