Prolotherapy: How Do You Spell Relief?
Performed by Naturopathic Doctors – Patrick Bartoshyk, ND; Mélanie Robinson, ND
Prolotherapy also referred to as Regenerative Injection Therapy (RIT), is defined as both a “nonsurgical ligament reconstruction” therapy as well as a treatment for chronic musculoskeletal pain.
The word “Prolo” is short for proliferation as prolotherapy treatment enhances the growth and formation of new ligaments, tendons, and cartilage in areas where there is a weakness or excess scar tissue. Any joint in the body can be treated successfully with prolotherapy regardless of when the injury happened.
The treatment is also beneficial for most types of musculoskeletal pain. Prolotherapy incorporates the use of a specialized dextrose (sugar) solution, which is injected into a ligament or tendon where it attaches to the bone.
The initial reaction of the treatment is localized inflammation triggering a wound healing cascade leading to increased blood supply and flow of nutrients and growth factors. This stimulates the tissue to repair itself by deposition of new collagen, the material that ligaments and tendons are made of. The new collagen then shrinks as it matures leading to ligament/tendon tightening and increased strength.
What Are Ligaments?
Ligaments can be described as “rubber bands” that actually hold bone to bone and allow flexible movement of joints. Injury, overstretching and degeneration/weakness of ligaments can cause them to become weak and damaged to a state of disrepair.
The reason that ligaments don’t heal easily is largely due to the lack of blood supply to the area. As a result, healing is slow and not always complete. In addition, the nerve endings to ligaments can become impaired or damaged, so you may feel acute intense pain. This pain can then become chronic.
What Are Tendons?
Tendons are the name given to tissue which connects muscle to bone. Tendons may also be damaged in the same manner as ligaments which can result in pain and scar tissue development if not treated appropriately.
Why Is There Pain With The Treatments?
With Prolotherapy, an important concept to understand is that chronic pain leads to tissue destruction and acute pain leads to tissue regeneration. With this treatment, patients often say “I already have inflammation and you want to give me more?”
The idea behind this is that acute inflammation leads to healing. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue (up to 40% stronger in some cases).
The Injection Solution
The basic Prolotherapy solution is 12.5% to 20% dextrose with 1% procaine. The dextrose makes the solution more concentrated than blood, acting as a strong proliferant. Procaine is an anaesthetic that helps reinforce the diagnosis because the patient may experience immediate pain relief after the injection. The dextrose solution, in addition to being safe, will not affect a diabetic’s blood sugar level. Other injectables may be added such as hyaluronic acid or Vitamin B12 (methylcobalamin).
The hyaluronic acid would be added in cases of osteoarthritis where cartilage regeneration is the desired outcome and methylcobalamin is used in nerve regeneration. Homeopathic remedies may also be added to help speed the healing process; however, these will vary depending on the type of injury.
How Many Treatments Are Needed, And How Might You Respond?
It will often take a series of RIT treatments spaced at appropriate intervals to maximize the healing power of the body. Sometimes a patient’s body is incapable of generating an appropriate healing response because of other factors such as deficient nutritional support. These factors are addressed in conjunction with RIT treatment so that the maximum benefit can be made with each session.
The response to treatment varies with each individual and the extent of trauma to the ligament, tendon or cartilage, as well as individual rates of healing; results are not guaranteed. Some people require a few treatments (I.E. 3 to 6) while others may need 10 or more. Once you begin treatment, you will be able to assess how you are responding.
Wound strength studies show that it takes 6-12 months for maximum tensile strength to occur without prolotherapy and even then the resultant wound has approximately 60% of the original strength. With a treatment every 2 weeks, prolotherapy healing can occur in 1-2 months. Prolotherapy can be combined with Ultrasound, Acupuncture, Physiotherapy, Laser therapy, Chiropractic treatments, Homeopathy, and nutritional supplements to obtain the best results. To understand if prolotherapy could be helpful in your case, speak with your naturopathic doctor.
Exercise
In order to align the new collagen correctly with the existing ligament tissues, it is very important for the structure to heal in the presence of movement. As such, gentle walking is recommended after a treatment. This will protect the ligament from forming adhesions to neighbouring structures and increase the correct formation of the new collagen.
Pain From Injections
Not every patient experiences pain with the injection. Nevertheless, the injections may be more painful, particularly in the first two to three visits. After an injection there is usually a significant change in sensation with some contraction or release of muscles and changes in blood flow. For this reason, it may be helpful to have someone drive you home after the treatment so you can rest. After the second or third treatment, these functional changes are usually not so profound.
Secondary Effects
Soreness and bruising at the injection site and temporary muscle stiffness are normal and may last for 1-2 days. That said, the use of over the counter anti-inflammatories is discouraged as these will defeat the purpose of prolotherapy which is to temporarily increase inflammation.
You can apply alternating hot and cold compresses over the affected area. Traumeel cream or a “deep heat” like Tiger Balm can be used if some additional relief is needed.
Using MSM and glucosamine sulphate may also lessen the secondary pain reaction. Natural anti-inflammatories, such as bromelain, curcumin, proteolytic enzymes, fish oils etc., will help the healing response. If you are taking any of these, please stop taking them the day before, day of, and day after a prolotherapy treatment to allow the natural inflammatory response to occur.
Conditions Treated with Prolotherapy
Prolotherapy (RIT) has been found to be an effective treatment for:
- Joint pain (all locations)
- Torn ligaments, tendons and cartilage
- Herniated / Degenerated discs
- Post injury / Trauma pain
- Low Back Pain /Rib Pain
- Neck Pain /Headaches / TMJ
- Unstable shoulder joints (dislocations)
- Surgical scar reduction
- Yoga overstretch injuries
- Post fractures
- Pain conditions: Sciatica, Arthritis, etc.
- Frozen shoulder
- Whiplash injuries /Sports Injuries
- Fibromyalgia
- Tendonitis
Prolotherapy FAQs
You may be new to the world of Prolotherapy for chronic pain relief and have many questions. Here are general answers to some questions we are frequently asked:
Research
Modern medical research demands that therapies be proven by double-blind placebo controlled trials. For medications, the pills can easily be made to look alike and a sugar pill used as a placebo that is presumed to have no therapeutic value. For procedures like Prolotherapy and most surgeries, there is no adequate placebo. Cortisone cannot be used as a placebo because cortisone can only be injected 3 times a year; typically, Prolotherapy requires 4-6 treatments.
Health Canada wants more data to show the effectiveness of Prolotherapy. Drug companies pay for research when it is profitable. They are unlikely to pay for research on Prolotherapy because this would not be a profitable venture. In fact, drug companies and surgeons would profit less if Prolotherapy would be more widely used, since fewer people would need pain medication and they could avoid expensive surgeries or complications from surgeries.