Prolotherapy: Definition, Technique, Mechanism of Action and Different Applications

This treatment has been used in clinical practice for more than 80 years.

Standardized and reviewed in clinical application by Dr. George Hackett in the 1950s, prolotherapy has been shown to be an effective treatment in patients suffering from joint instability due to ligament damage and overuse and musculoskeletal osteoarthritis and related.

The popularity of prolotherapy as a treatment for chronic pain has intensified in the last two decades among physicians and patients, as clinical and anecdotal observations have demonstrated in many cases its dependence as a non-surgical option for joint and back pain. .

Prolotherapy is a non-surgical regenerative injection technique that introduces small amounts of an irritating solution to the site of degenerated and painful tendon attachments (entheses), joints, ligaments, and adjacent joint spaces during several treatment sessions to promote cell growth and normal tissues.

Irritating solutions often contain dextrose (d-glucose), a natural form of glucose normally found in the body, but may also contain combinations of polidocanol, manganese, zinc, human growth hormone, pumice stone, ozone, glycerin, or phenol.

In severe cases, autologous cellular solutions may also be needed, such as platelet-rich plasma (PRP), bone marrow, or adipose tissue.

For the patient, the goal of prolotherapy in chronic musculoskeletal pain and instability is the stimulation of the body’s natural healing and regeneration processes in the joint that will facilitate the repair and regeneration of connective tissue, ligaments, tendons for the resistance to tension and cartilage and other joints.

Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body’s healing system, a process called inflammation. The technique involves injecting a proliferant (a mild irritant solution) that causes an inflammatory response that “ignites” the healing process.

Then the growth of new ligaments and tendon tissue is stimulated. The ligaments and tendons produced after Prolotherapy closely resemble normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, demonstrating continuous new tissue creation.

prolotherapy technique

While no formal practice guidelines have been published, prolotherapy treatment commonly consists of several injection sessions administered every 2 to 6 weeks over the course of several months.

During an individual prolotherapy session, therapeutic solutions are injected into painful and tender attachment sites of ligaments and tendons, and into adjacent joint spaces.

Historically, injected (“proliferating”) solutions have involved local irritation, with consequent inflammation and scarring of tissues, resulting in enlargement and strengthening of damaged ligamentous, tendon, and intra-articular structures.

These processes were thought to improve joint stability, biomechanics, function, and ultimately decrease pain.

Mechanism of action

The mechanism of action for prolotherapy has not been clearly established and, until recently, received little attention. Backed by pilot-level evidence, it has been hypothesized that the three most widely used prolotherapy solutions act through different pathways:

  • Hypertonic dextrose due to osmotic rupture of local cells.
  • Phenol-glycerin-glucose (P2G) due to local cellular irritation.
  • Morrhuate sodium due to chemotactic attraction of inflammatory mediators and sclerosing of pathological neovascularity associated with tendinopathy.

The potential of prolotherapy to stimulate the release of growth factors that promote soft tissue healing has also been suggested as a possible mechanism.

Pain treatments

Knee pain

Clinical result of bone marrow concentrate in knee osteoarthritis.

This study evaluated the clinical effectiveness of bone marrow concentrate with autologous lipoaspirate as a treatment option for osteoarthritis of the knee.

A retrospective study on dextrose prolotherapy for unresolved knee pain

In this study, the Hackt-Hemwall technique of dextrose prolotherapy used in patients who had a five-year duration of unresolved knee pain was shown in this observational study to improve their quality of life.

They reported less pain, stiffness, disability, depressed and anxious thoughts, medications, and other pain therapy use, as well as better ability to walk, range of motion, ability to work, and activities of daily living.

Standard clinical x-ray studies document cartilage regeneration in five degenerated knees after prolotherapy

Prolotherapy improved pain and function in five knees with osteoarthritis. All five degenerated knees showed evidence of articular cartilage regeneration on their standard weight-bearing radiographs after prolotherapy.

Hip pain

A retrospective study of Hackett-Hemwall dextrose prolotherapy for chronic hip pain at an outpatient charity clinic in rural Illinois

The Hackett-Hemwall technique of Dextrose Prolotherapy used in patients with unresolved hip pain for more than five years was shown in this retrospective pilot study to improve their quality of life even 19 months after their last Prolotherapy session.

All 61 patients with 94 hips treated reported significantly less pain, stiffness, feeling of contraction, disability, depressed and anxious thoughts, medications and other pain therapy use, as well as better ability to walk, range of motion, sleep, ability. of exercise and activities of daily life.

Head and neck pain

Treatment of trigeminal neuralgia using neural prolotherapy: a case report.

We present a case of trigeminal neuralgia successfully treated with neural prolotherapy. The patient is a 70-year-old man with a 15-year history of trigeminal neuralgia refractory to drug treatment.

After a neural prolotherapy treatment, the patient reported 5 months of complete resolution of his symptoms.

Traumatic upper cervical instability treated with dextrose prolotherapy: a case report

A 47-year-old woman with a history of trauma presented to our clinic in 2013 with headaches, chronic pain in her neck and upper extremities, and intermittent tingling in one arm. The pain was exacerbated by movement of the head.

Cell Prolotherapy-Stem Cell Therapy

The use of stem cell therapy in the treatment of degeneration of the joints and spine

It is important to note that we do not use stem cell therapy for all patients. In fact, we use stem cell therapy in very few of our patients.

It was found that the main treatment, simple dextrose prolotherapy, administered in a manner documented in research over 70 years, can in many cases provide equal and sometimes superior results in some patients.

Stem cell therapy research is exploding in the medical field because physicians and researchers see enormous potential in its future applications.

But how about today? Stem cell therapy may provide benefits for some patients, but not for all. In many people who come to our office, we find that they have an unrealistic expectation of success of what stem cell therapy can actually do.

For example, stem cell therapy cannot make a meniscus out of thin air. If you don’t have a meniscus, stem cell therapy injection will not produce a new one. If you have a meniscus tear, injury, or hole in your cartilage, stem cell therapy can help create a patch.

Stem cell therapy can help turn degenerative joint disease into a more healing joint environment. But, treatment, like any medical treatment, has its limitations.

For most, in our opinion, stem cell therapy is not some kind of one-shot miracle cure. Thinking that it is, in fact, is an excessive expectation of what the treatment can do.

Can a bone in the bony knee be repaired without stem cell therapy?

Why Stem Cell Therapy Didn’t Work or Won’t Work for Knee Pain: An Update

Let’s also note that stem cell therapy for musculoskeletal conditions is not approved by the FDA.

While research has shown that stem cell therapy in various forms can provide benefits for patients with musculoskeletal conditions, there is also research suggesting that stem cell therapy will not benefit certain patients.

Research on treatment is inconclusive and certainly ongoing. Stem cell therapy doesn’t work for everyone.

In stem cell therapy, we use a person’s healing cells from the bone marrow. They are injected directly into the area that has a cell deficiency, along with injections into all supporting joint structures for a more comprehensive stem cell therapy treatment.

The objective is the same: to stimulate the repair of injured tissues. Stem cells assist in fibroblast proliferation, where cell growth, proteosynthesis, repair, tissue remodeling, and chondrocyte proliferation occur.

Our bone marrow contains stem cells, also called mesenchymal stem cells and progenitor cells, among other names. These immature cells have the ability to develop into tissues such as cartilage, bones, and ligaments.

Stem cell therapy or prolotherapy?

Not all injuries require stem cells to heal. For many patients, the success rate with traditional prolotherapy in this office is in the range of more than 90% for all patients.

However, for advanced arthritis, meniscus tears, labral tears, bone on bone, or aggressive injuries, our prolotherapy professionals may choose to use stem cell injections to enhance healing.

This, in combination with dextrose prolotherapy to strengthen and stabilize the surrounding support structures for meniscus repair.

In research published in The Open Stem Cell Journal, Rationale for the use of direct bone marrow aspirate as a proliferant for regenerative injection therapy (prolotherapy).

Not only was the benefit of bone marrow derived stem cells shown as a proliferative Prolotherapy solution, but also this exciting field of medicine needs doctors and scientists to work together to expand research and technical guidelines.

Usually the tissue we are trying to stimulate to repair with stem cell therapy or cell prolotherapy is articular cartilage, but we can also proliferate soft tissue structures like ligaments and tendons. This is a new technology, so we are studying it as we use it to treat patients.

Bone marrow prolotherapy involves direct (or concentrated) bone marrow aspiration to deliver stem cells to the injury site. Does the above study suggest that direct bone marrow injections without expanded culture and without the scaffold would work?

Possibly, but only time will tell as the investigation progresses. But in our experience we have found that these stem cells act as excellent proliferating solutions for prolotherapy.

Bone marrow stem cells are used in conjunction with other prolotherapy solutions to treat large joint defects in the labral and meniscus areas. Generally, patients are seen every two months. Most patients need 3-6 visits.

Improved Combined Platelet Rich Plasma Therapy Technique

We agree that stem cell therapy has benefits, but may not provide a complete cure. That is why we recommend the use of platelet rich plasma therapy in conjunction with stem cell therapy. The previous study involved cultured stem cells.

According to some opinions, stem cell therapy is more effective if the stem cells are better directed. This is where growth factors in blood platelets can be very effective.

Platelets assist stem cells in their various jobs, including differentiation, and then help differentiated cells create the extracellular matrix to repair injured tissue.

The Goal of Stem Cell Therapy -Cellular Prolotherapy

The ultimate goal with all forms of prolotherapy is to get patients back to doing the things they want to do without pain.

It is our hope that stem cell therapy (cellular prolotherapy) treatments will form functionally, structurally, and mechanically the same, if not better, than living tissue that has been designed to replace (or work alongside) damaged tissue.

If you are looking for prolotherapy, you should first make sure that the prolotherapy doctor or prolotherapist is experienced in the full prolotherapy procedure and has successfully treated cases like yours.