Prolotherapy
[UPDATED DECEMBER 2022]
Introduction
I have long been interested in prolotherapy but not had the time to develop this as a treatment for my patients. It is a simple idea – inject connective tissue with a mildly irritant substance such as glucose 25% and this stimulates fibrous tissue to be laid down. This strengthens the tissue and subsequent contraction helps restore normal anatomy.
The Work of Dr Taylor
Do have a look at How prolotherapy works which is reproduced below -
"Prolotherapy is an innovative injection technique developed in 1930s by Dr George Hackett, surgeon in the USA, effective in treating most chronic injuries. It is an elegant refinement of the centuries-old sclerotherapy which produced scar tissue to stabilise joints and relieve pain.
When an acute injury fails to heal, the strain or sprain is usually at the enthesis (attachment to the bone) - the weakest point. If laxity is not corrected, pain receptors in the ligaments are constantly stimulated by movement, and muscle spasm results.
Prolotherapy involves injection of hyperosmolar glucose or other irritating solution to the enthesis. This initiates the wound healing cascade. Inflammatory mediators attract fibroblasts which secrete collagen. The new collagen matures, gradually restoring strength to the enthesis and relieving pain. Banks 1993 1. The tendency of collagen to contract as it matures, which is a disadvantage in burns, is of benefit in prolotherapy as it can correct the laxity of strained ligaments.
Light and electron microscopic studies of human posterior sacro-iliac ligaments have shown marked fibroblastic hyperplasia and increase in collagen fibril size2. The treated ligaments and entheses become 30-40% stronger when compared with saline controls.3 This is used to treat low back pain, whiplash and other neck pain, headache and migraine, chronic upper thoracic pain, sports injuries to ankles, knees4, wrists, fingers, and elbows, tennis elbow, Osgood Schlatters knees in teenagers, temporo-mandibular joint dysfunction, calcaneal spur and many other problems. It is an excellent addition to musculo-skeletal and orthopaedic practice5/6 and as a result of Yelland’s trial in Spine20047, Bogduk recommends, in Management of chronic low back pain, in MJA 20048 that “Injections into tender attachment sites for ligaments are a simple treatment that GPs can perform. They can achieve complete relief of pain in 20% of patients and significantly reduce pain in 40%. These figures are no worse than those for the best alternatives, and better than most.” Cyriax described use of 'sclerosants' in his book, Orthopaedic Medicine in 1983."
References
- Banks AR: A rationale for prolotherapy. J Orthopaed Med 1993; 13:54-59
- Klein R, Dorman T, Johnson: Proliferant injections for low back pain: Histological changes of injected ligaments & objective measurements of lumbar spine mobility before & after treatment: J Neurol & Orthop Med & Surg 1989; 10:123-126
- Liu, An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res 1983;11:95-102
- Reeves KD, Hassanein K, Randomised prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Health Med 2000; 6: 68-80
- Reeves KD, Prolotherapy: Basic science and technique: in Pain Procedures in Clinical Practice, 2nd edition, ed Lennard TA, pub. Hanley & Belfus
- Dorman TA and Ravin TM: Diagnosis and Injection Techniques in Orthopedic Medicine, 1991 pub Williams & Wilkins.
- Yelland M, Glaziou P, Bogduk N et al, Randomised controlled trial of prolotherapy injections, saline injections and exercise in the treatment of chronic low back pain. Spine 2004; 29: 9-16
- Bogduk N, Management of chronic low back pain. MJA 2004; 180: 79-83
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