Non-Surgical Solutions for Treating Pain
Dr. Philip Lim's Medical Musculoskeletal Clinic

Prolotherapy

What is Prolotherapy?

  • First, it is important to understand what the word prolotherapy itself means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of ligament or soft tissue. Regenerative Injection Therapy is an alternative description.
  • Prolotherapy is a safe, effective non-surgical treatment that provides stimulation of the body’s capacity to heal wounds and regenerate repair of injured tissue.
  • Ligaments are the structural “rubber bands” that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the patient may feel pain in the areas where the ligaments are damaged or loose. Ligament laxity can result in joint dysfunction (therefore the joint going “out”) and accelerate wear and tear (osteoarthritis).
  • Tendons are the name given to tissue which connects muscle to bones, and in the same manner tendons may also become injured, and cause pain.

The Technique

  • There are many proliferants or stimulating agents used in prolotherapy.15-25% Dextrose with 1% local anaesthetic is used and it is safe and effective, acting as an osmotic shock agent by dehydrating the cells at the injection site, triggering a wound-healing cascade.

Prolotherapy Graph

  • Platelet Rich Plasma (PDGF) is also favoured strongly by the author (refer to PDGF section on website)
  • Corticosteriod or Cortisone is NOT used in prolotherapy.
  • Platelet Rich Plasma (PDGF) is potentially the best stimulant available in regenerative medicine with many growth factors identified in the activated blood plasma.

Risks of Prolotherapy

  • Post injection pain at and around the injection site is to be expected because the intention of the technique is to create inflammation. The usual duration is 2 to 4 days. Sometimes it can be for over 1 week.
  • Since the skin is broken with a needle, infection is a possibility, but very few infections have been reported.
  • Serious complications are very rare. Injuries to nerves and pneumothorax (punctured lung) may occur.
  • Prolotherapy is a proven safe therapeutic technique in well trained hands.

What is the Success Rate with Prolotherapy?
Prolotherapy is effective in markedly reducing or curing musculoskeletal pain 80-90% of the time. Many end-stage medical problems are worth a trial of prolotherapy, especially if the only alternative is a destructive or permanent alteration of a joint, such as a surgical fusion or the destruction of a nerve. The greater the anatomical injury, the more difficult it is resolving the problem.

There are several reasons why prolotherapy may not resolve a problem:

  • Not enough treatments were attempted.
    Usually a positive response is seen in 2-3 treatments, but may take 4-6 more.
  • The solution used was not strong enough.
    Typically, a mild solution is used first, and if the response is insufficient, a stronger solution is used after 2-3 treatments.
  • The points treated were not the source of the pain.
    Usually, it is fairly clear on examination from where the pain originates, but some structures are not easily provoked with a finger or thumb because of the depth. In such a case, the referral pattern helps to locate the injured structure, but the patterns often overlap. A thorough reassessment every visit or two is needed to ensure that the correct points are being treated.
  • The patient is taking anti-inflammatory medication.
    Such medicine inhibits a complete response. The only such medicine which we accept is a low-dose Aspirin to prevent cardiac (heart attack, angina) or neurological (stroke) problems. Progress may be made despite these medicines but is likely to be delayed and reduced.
  • The patient has an underlying healing deficiency.
    This may be from an immune system dysfunction, rheumatoid illness, chronic infection, nutritional deficit, or hormonal deficiency. The common issues are hypothyroid, testosterone deficiency, estrogen or progesterone deficiency, adrenal insufficiency, bowel injection with yeast, among others. These same conditions appear to underlie Fibromyalgia and Chronic Fatigue Syndrome. Further investigation is warranted after 4-6 treatments if the response is poor.