Prolotherapy – An underused but effective injectable treatment for musculoskeletal conditions

Today I will start by telling you about what prolotherapy is and its origin. After that I will talk about its uses, mode of action, procedure and whether prolotherapy is for you.

1 – What is Prolotherapy?

Firstly, the word Prolotherapy comes from ”Prolo”. Prolo is the short for “Proliferative” which in Ancient Greek means “Fruitful” (Polukarpos)

Prolotherapy is an injection-based therapy for chronic musculoskeletal pain conditions, for instance knee osteoarthritis, As a result Prolotherapy helps to repair damaged cells or tissue in our body.  Moreover Prolo-therapy may reduce pain and improve function of the damaged area.

Certainly the first documented use of Prolotherapy was in the 1930’s in America by Dr Earl Gedney. He used it on himself to heal his injured thumb caught in a door with subsequent impressive results, according to reports by his peers and himself.

However Prolotherapy fell into oblivion until it was reintroduced in the 70’s by doctors and chiropractors in America. Since then Prolotherapy use has increased but at a slow rate, especially since PRP therapy appeared in the 80’s which displaced it.

Most importantly the main advantage of Prolotherapy over PRP is its cost as the former is significantly cheaper. However Prolotherapy is not as effective as PRP when it comes to help tissues to regenerate.

Commonly Prolotherapy injections are normally given in damaged joints, ligaments or tendons hoping to alleviate pain and to initiate the repairing process.

That is to say Prolotherapy injections are made of an irritant solution, usually dextrose or saline water. Prior to the injection a local anaesthetic will be injected to numb the skin to minimise discomfort.

 

2 – What is Prolotherapy used for?

Prolotherapy may be used to alleviate the pain and to restore lose of function in the following conditions:

  • Back and neck pain affected by facet joint Osteoarthritis
  • Knee and shoulder osteoarthritis
  • Rotator cuff injuries and tennis/golf elbow
  • Fibromyalgia – Tender points
  • Plantar fasciitis
  • Ligament sprains – MCL and LCL in knees
  • Joint laxity and instability
  • Muscle injury and tears.

However Prolotherapy has its own limitations. For instance Prolotherapy may help a partial tendon tear to repair itself but not a full tear where surgery might be needed.

3 – How is Prolotherapy given?

Prolotherapy is usually an office-based procedure. In some cases the aid of an ultrasound scan may be needed. This can be done in the doctor’s office too.

The treatment consists of several one-single injections (between 3 and 4) given at 4 week intervals. This will increase the Prolotherapy repairing effect and reduce the pain.

After your doctor explains you the treatment, uses and possible adverse reactions or complications, you will sign a consent form.

A local anaesthetic is then used to numb the skin at the injection site. This usually reduces any discomfort to a minimum.

Then your doctor will inject the Prolotherapy into the damaged area.

The whole procedure is done under aseptic clean conditions to minimise the risk of infection.

You will be asked to wait in the premises for 10-15 mins. You may take paracetamol but anti-inflammatories are not recommended for 48 hrs. as they could interfere with your Prolotherapy treatment.

Your doctor will advise you not to carry out any high impact or strenuous exercise following the injection for 2-3 days, such as jogging or playing football.

4 – Is Prolotherapy safe?

Needless to say Prolotherapy has been proven to be a safe, effective and relatively inexpensive non-surgical treatment.

Use of ultrasound guidance for injections may or may not be needed, depending on the specific problem being treated. Ultrasonography is a painless and harmless image diagnostic technique.

Most importantly there is no evidence so far despite concerns on cancer or tumour growth after Prolotherapy or PRP.

5 – Is Prolotherapy for me?

An open honest conversation with your doctor is necessary to find out if Prolotherapy is the right treatment for your specific condition. Sometimes other treatments such as PRP therapy or surgery may be recommended. Subsequently every particular case needs to be assessed by the doctor.

Prolotherapy is not a very expensive procedure. For further details please contact us for a quote.

Conclusion

Prolotherapy is a low cost, effective and minimally invasive treatment for multiple musculoskeletal conditions such as knee osteoarthritis. Furthermore, Prolotherapy is underused in Australia when compared to its widely and popular use in America.

However Prolotherapy is not effective in conditions where a surgical repair may be needed, for instance in a full thickness tendon tear.

Furthermore Prolotherapy is not as effective as PRP therapy, being the latter more expensive.

To sum up Prolotherapy presents as a promising new regenerative treatment for musculoskeletal conditions.

 

Bibliography

Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Bertrand H et al. Arch Phys Med Rehabil. 2016 Jan; 97(1):17-25.

Prolotherapy for Refractory Rotator Cuff Disease: Retrospective Case-Control Study of 1-Year Follow-Up. Lee DH et al. Arch Phys Med Rehabil. 2015 Nov; 96(11):2027-32.

Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. Abd Elghany et al. J Back Musculoskelet Rehabil. 2019;32(1):55-62.

Utility of Prolotherapy for Upper Extremity Pathology. Dwivedi S et al. J Hand Surg Am. 2018 Jun 23.

Effects of dextrose prolotherapy on contusion-induced muscle injuries in mice. Tsai SW et al. Int J Med Sci. 2018 Jul 30;15(11):1251-1259.