Prolotherapy: Answer to Pain & Injuries that Won’t Go Away?

Prolotherapy is a cutting-edge form of regenerative medicine that is leading the way in helping treat both acute and chronic injuries, as well as difficult-to-resolve joint pain. Studies suggest that you can benefit from prolotherapy if you have temporomandibular dysfunction of the jaw (TMJ), arthritis, a torn ligament, tendonitis, a bulging disc or pain in any susceptible area, such as your neck, lower back, knee or shoulder.

Prolotherapy uses your body’s own platelets (platelet-rich plasma, aka PRP) and growth factors to help repair damaged tissues naturally. Through utilizing glucose and increasing collagen production to re-create your body’s own natural healing process, prolotherapy is considered one of the most advanced forms of regenerative medicine available today for repairing damaged tissue fibers and joints.

What is really extraordinary about stem prolotherapy is this: When you remove your body’s own stem cells from one location and re-inject them into another damaged area, the stem cells automatically know how to transform into the type of cells your body needs in order to start the repair process. For example, if you partially tear the ACL in your knee, your stem cells adapt by turning into cells that form a strengthened, repaired ACL ligament.

Prolotherapy is one of the newer secrets from pro athletes, helping them bounce back from frequent injuries and ongoing wear and tear. Want to know how former NBA star Kobe Bryant came back from what should have been a career-ending Achilles tendon tear at 38 years old? He received prolotherapy treatments, as did Pro Football Hall of Fame quarterback Peyton Manning.

What is prolotherapy?

First, prolotherapy goes by many different names but isn’t the exact same therapy. These names include:

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• Proliferation injection therapy
• Platelet-rich plasma (PRP) therapy
• Regenerative injection therapy
• Sclerosant therapy or sclerotherapy
• And sometimes nonsurgical ligament reconstruction

Prolotherapy is an injection procedure that helps resolve tiny tears or injuries to connective tissue located throughout the musculoskeletal system (ligaments, tendons, muscle fibers, fascia and joint capsules). Often, connective tissue becomes injured when it is torn away from a nearby bone.

Prolotherapy is most often used in the case of injuries or conditions that cause chronic pain that don’t respond well to other natural therapies or medications (nonsurgical treatments).

Who can benefit from prolotherapy most?

Stem cell therapies are suited for people with:

• Chronic ligament and tendon injuries, pains, sprains or strains
• Chronic back pain or neck pain
• Joint pain caused by osteoarthritis (especially arthritis of the knee and back)
• Bursitis
• Weakness and instability that lasts for more than six weeks and is tied to muscle or joint pain
• Degenerative knee cartilage
• Frozen shoulder and rotator cuff injuries
• Chronic elbow tendonosis (tennis elbow)
• Plantar fasciitis
• People who take pain-reducing medications frequently (including Advil, aspirin, ibuprofen, oral steroids) but don’t feel their conditions are getting better
• Those who fail to feel better after having corrective surgery
• People who have tried physical therapy but still experience pain and stiffness
• Anyone having trouble exercising, sleeping or moving normally without experiencing joint pain and limitations

How does it work?

The way that prolotherapy works is by causing a purposeful, mild inflammation response near damaged tissue that helps new fibers grow. While usually “inflammation” is thought of as a bad (and sometimes painful) thing, it also has important benefits for stimulating repair work and healing damaged tissue fibers.

The American Osteopathic Association of Prolotherapy Regenerative Medicine describes this process as follows: “When ligaments or tendons (connective tissue) are stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new collagen tissue, resulting in permanent stabilization of the joint.”

Essentially through performing a very directed injection to an injury site, prolotherapy tricks the body into repairing an area. In the past, prolotherapy injections contained a mix of substances that helped dull pain and cause a mild inflammation response, including dextrose, saline, sarapin and procaine.

Recently, platelet-rich plasma (PRP) procedures have been developed that use adult stem cells (from the person being treated) that are removed from the bone marrow or adipose (fat) tissue. These stem cells have the remarkable ability to transform themselves, making them highly valuable for treating many conditions.

• When stem cells are injected into soft tissue that is experiencing tiny tears, “natural healing” takes place near the area of the injection, which really means that new blood vessels and fibers form, helping tighten, repair and strengthen the damaged joint or tissue.
• Prolotherapy treatment involves a series of injections. Patients receive anywhere from three to 30 injections depending on the severity of their injury. Most people need about four to 10 injections to experience results.
• Injections are administered every two to three weeks over the course of several months (usually three to six months).
• Substances used in “dextrose prolotherapy” injections include “natural irritant agents” (such as dextrose or glucose, which are types of sugar molecules, or glycerin and phenol).
• Irritants are often used with a local anesthetic (lidocaine, procaine or marcaine) to help numb the affected area and injection site. Sometimes other substances, such as cod liver oil (sodium morrhuate), are also used to regulate inflammation and healing.
• There are certain differences between standard prolotherapy injections (using dextrose, for example) and PRP injections.
• PRP prolotherapy utilizes substances taken directly from the patient’s own body. PRP is defined as “autologous blood with concentrations of platelets above baseline levels, which contains at least seven growth factors.” Platelets contain a number of proteins, cytokines and other bioactive factors that initiate and regulate basic aspects of natural wound healing.

Benefits

1. Helps repair tendon injuries

Prolotherapy can increase platelet-derived growth factor expressions that kick off repairment of damaged tendons.

A 2010 JAMA study compared two forms of prolotherapy (saline and PRP) for treating tendon injuries and found they had similar effects. Both treatments helped treat chronic Achilles tendinopathy, although some speculate that PRP might be best suited for this kind of injury. (5)

2. Helps treat chronic back and neck pain

According to research, prolotherapy can help repair small tears and weakened tissue in the back that contribute to inflammation, reduced functioning, bulging disc and back pain. The mechanism by which stem cell therapy helps treat back pain is by shutting down “ligamentous laxity,” which is the activation of pain receptors in tendon or ligament tissues that send painful nerve signals up the back.

Damaged tissue in tendons or ligaments are sensitive to stretching, compressing and other forms of pressure, so by reducing these tears, prolotherapy helps eliminate the root source of pain.

Prolotherapy has successfully been used in pain management for common conditions that affect the back, including:

• Neck pain due to spine-related conditions
• Sciatica/sciatic nerve pain
• Bulging or herniated discs
• Degenerative disc disease
• Sacroiliac problems
• Rotator cuff injuries extending to the upper back
• Whiplash

3. Aids recovery from shoulder injuries and pain

Prolotherapy has been shown to be effective in the treatment of shoulder injuries and pain, which are often a result of the rotator cuff being overworked (sometimes from not resting enough between workouts). The shoulder is one of the body parts exposed to the most repetitive use, repeated traumas and degeneration, so athletes, laborers and aging adults are most susceptible to shoulder injuries of all kinds.

A 2009 Journal of Prolotherapy study reported that up to 82 percent of patients treated for chronic shoulder pain (also called frozen shoulder) experienced improvements in sleep, exercise ability, anxiety, depression and overall disability. In addition, 39 percent of these patients were told by their medical doctors that there were no other treatment options available for their pain!

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4. Can help relieve elbow and wrist tendonitis symptoms

Adults who play golf or tennis frequently are some of the people more prone to elbow injuries. Prolotherapy is now considered an effective non-surgical treatment option for sport-related injuries, including those sustained playing golf and tennis.

It’s not only effective for injuries that affect the elbow (like lateral and medial epicondylitis) either, but also those causing subsequent pain in the lower back, wrist ligaments or shoulders, plus sprained ankles and other musculoskeletal damage caused by repetitive use and joint degeneration.

5. Helps treat injuries to hands and feet

Prolotherapy is now used to help lower pain associated with common hand injuries experienced by younger and middle-aged adults, such as carpal tunnel syndrome, skier’s or “gamekeeper’s thumb,” and “texting thumb,” which are caused by repetitive use and damage to the ulnar collateral ligament.

Doctors have seen a steady increase in injuries triggered from everyday activities like typing, computer mouse use or playing sports.

The thumbs, fingers, hands and feet are also prone to pain caused by osteoarthritis and aging. One study involving more than 60 patients with ankle and foot pain found that prolotherapy treatments helped reduce pain.

It’s also been found to help with ankle and foot pain associated with arthritis, tendon ruptures, plantar fasciitis, misalignments, fractures and ligament injuries.

6. May improve jaw pain and dysfunction

A May 2019 randomized, controlled trial published in the journal Mayo Clinic Proceedings found that the use of prolotherapy injections administered over several months helped significantly relieve TMJ jaw pain and improve function of the mouth when compared to control injections.

Participants in the prolotherapy group received injections with 20 percent dextrose/0.2 percent lidocaine (an analgesic), while the control group received injections with only 0.2 percent lidocaine. Symptom relief was seen three months after prolotherapy injections started, and clinical improvements lasted up to 12 months.

Overall, “satisfaction was high” among the group receiving prolotherapy treatments. Participants who had mouth-opening abilities that were initially restricted gained significant range of motion in their mouths/jaws. Pain and dysfunction improved by at least 50 percent in 38 of 54 participants (70 percent of all participants).

Researchers involved in the study stated that dextrose prolotherapy injections are believed to work for TMJ because this treatment has a “multifactorial effect.” It’s been shown to initiate fibroblast proliferation that produces stronger, thicker and more organized connective tissue, and to reduce nerve swelling and compression in the jaw.

History

Some sources have revealed that prolotherapy treatments have a very long history, dating all the way back to ancient times. In the fifth century B.C., Hippocrates supposedly treated shoulder injuries by cauterizing areas of the shoulder to promote scarring and healing, for instance.

How prolotherapy, PRP and stem cell treatment evolved

• In the field of modern Western medicine, prolotherapy is still only practiced by a small percentage of trained practitioners. Stem cell therapies came about around the 1930s after doctors realized that once a painful joint is stabilized, then pain and inflammation can usually resolve themselves. At the time stem cell therapy was referred to as “sclerotherapy,” which now has somewhat of a different meaning.
• Originally, stem cell treatments were referred to as sclerotherapy. Today, the term “prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for the treatment of varicose veins, spider veins, hemorrhoids and other vascular (blood vessel) abnormalities.
• Beginning in the early 1990s, physicians started to use prolotherapy-type injections in dental treatments, periodontal surgeries, cosmetic surgeries and skin-grafting treatments. The use of PRP prolotherapy expanded into orthopedic treatments around the early 2000s.

How to find a prolotherapist

• Physicians who treat patients using prolotherapy normally receive training by an institute associated with the American Osteopathic Association of Prolotherapy Regenerative Medicine. Several other authorized training groups now exist for physicians, as well as emerging postgraduate training programs for students.
• In most cases, a prerequisite before treating any patient is to be a licensed medical orthopedic physician. However, it’s up to individual patients to find a qualified practitioner as laws differ from state to state.
• Look for a physician with accreditation through the American Board of Prolotherapy, which has been certifying physicians in prolotherapy since 1989, or the American Osteopathic Association of Prolotherapy Regenerative Medicine.
• The Prolotherapy College website offers resources for locating trained physicians by state.

Risks and side effects

Currently there are no official treatment guidelines or protocol regulations in place for physicians regarding the use of prolotherapy. Most often, doctors use prolotherapy along with other means of reducing pain and treating injuries, including physical therapy, stretching, myofascial release for athletes, massage therapy, chiropractic adjustments, and sometimes the use of anti-inflammatory or steroid medications.

Some physicians do use prolotherapy as a first-line therapy, but this is rarer. Many also recommend visiting a physical therapist after prolotherapy injections for further help and an evaluation.

Prolotherapy is not intended for everyone, including those who have not yet been diagnosed with an injury or cause of their pain. In order to inject and treat an injury (sprains, strains and weakened ligaments, for example), the damaged tissue must first be identified using diagnostic imaging studies so the physicians know where to place the injection.

Although prolotherapy is considered to be very safe, some experts have concerns that a lack of training regarding how to correctly perform prolotherapy injections can lead to side effects in some cases. Always make sure to visit a trained professional who has proper credentials and experience with stem cell injections.

Side effects of treatments usually go away within several days. If they become painful, symptoms can be reduced through taking an over-the-counter painkiller temporarily (like ibuprofen).

Prolotherapy side effects can sometimes include:

• Swelling at the injection site
• Increased pain and stiffness
• Bleeding
• Occasional numbness
• Headaches
• Signs of an allergic reaction
• Although very rare, cases of spinal fluid leaks and permanent nerve damage have also been reported

Final thoughts

• Prolotherapy/PRP is a type of natural soft tissue/connective tissue treatment that promotes long-term healing without the use of surgery or prescription medications.
• It works by stimulating the body’s ability to repair itself through causing a mild inflammatory response in damaged tissue, which triggers the release of proteins and growth factors to strengthen the weakened area.
• Conditions that with prolotherapy or PRP can help with include sports injuries, tendonitis, back and neck pain, arthritis, whiplash, joint sprains, degenerative disc disease/osteoarthritis, and more.