3716 Pacific Ave, Suite H, Tacoma WA 98418 Phone Number 253.383.3506 Fax 877.513.8012
Prolotherapy & PRP
Prolotherapy (Proliferative Therapy), also known as Non-Surgical Ligament and Tendon
Reconstruction and Regenerative Joint Injection, is a recognized orthopedic procedure that
stimulates the body’s healing processes to strengthen and repair injured and painful joints and
connective tissue. It is based on the fact that when ligaments or tendons (connective tissue) are
stretched or torn, the joint they are holding destabilizes and can become painful. Prolotherapy,
with its unique ability to directly address the cause of the instability, can repair the weakened
sites and produce new collagen tissue, resulting in permanent stabilization of the joint. Once the
joint is stabilized, pain usually resolves. Traditional approaches with surgery have more risk and
may fail to stabilize the joint and relieve pain, and anti-inflammatory or other pain relievers only
act temporarily. The original term for this therapy was “sclerotherapy”, coined in the 1930’s
when this treatment was discovered and included both joint and vein injections. Today the term
“prolotherapy” is used for joint, ligament and tendon injections, while “sclerotherapy” is used for
the treatment of varicose veins, spider veins, hemorrhoids and other vascular abnormalities.
Prolotherapy works by stimulating the body’s natural healing processes to lay down new tissue
in the weakened area. This is done by an injection to the injury site, “tricking” the body to repair
again. The mild inflammatory response created by the injection encourages growth of new,
normal ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional
treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength
to the area.
Prolotherapy injections contain natural substances that stimulate the healing response, as well as
local anesthetic agents to help with the pain of the injection. Traditional formulas include
ingredients such as dextrose, saline, sarapin and procaine or lidocaine. In the last several years
newer formulas include Platelet Rich Plasma (PRP) and autologous (from the same person) adult
stem cell sources, typically taken from bone marrow or adipose (fat) tissue. Each treating
physician tailors the selection of the appropriate formula according to the patient’s need.
Any pain involved with the injection will vary according to the structure or joint treated, the
choice of solution, and the skill of the physician administering the injection. The treatment may
result in a temporary increase in pain with mild swelling and stiffness. The discomfort usually
passes in a few days and can be reduced with pain relievers such as Tylenol or other prescribed
medication. Anti-inflammatory drugs, such as aspirin and ibuprofen, are not recommended for
pain relief because their action suppresses the desired inflammatory healing process produced by
the prolotherapy injections.
Each patient must be evaluated thoroughly with patient history, physical exam and sometimes
imaging. When indicated, laboratory work should be ordered or evaluated prior to treatment.
With this information, your physician can evaluate your potential success with this therapy.
Success depends on factors which include the history of damage to the patient, the
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3716 Pacific Ave, Suite H, Tacoma WA 98418 Phone Number 253.383.3506 Fax 877.513.8012
Prolotherapy & PRP
patient’s overall health and ability to heal, and any underlying nutritional or other deficiencies
that would impede the healing process. In appropriate patients, prolotherapy has a high success
rate.
Physicians who administer this form of therapy receive training by The American Osteopathic
Association of Prolotherapy Regenerative Medicine, or other authorized training group or
physician. Postgraduate training is a prerequisite before treating any patient with a medical
orthopedic problem which might benefit from prolotherapy.
Areas/problems treated include: Low back or mid-back pain and sacro-iliac joint
instability/dysfunction, neck pain, knee pain, knee meniscal tears, wrist or hand pain,
osteoarthritis, shoulder pain including rotator cuff tears, elbow pain including golfers or tennis
elbow, foot pain including plantar fasciitis, ankle pain or instability, hypermobility, osteitis
pubis, IT band syndrome, piriformis syndrome, temporal mandibular joint syndrome (TMJ), or
other musculoskeletal pain or injury. Some areas or problems can be more challenging than
others, and it is therefore important to be evaluated by a physician trained and experienced in this
procedure so that an accurate assessment and treatment plan can be given.
Treatment intervals vary depending on the specific problem and severity of the area being
treated, as well as the protocol of the physician. Typical intervals between treatments are every
three to six weeks, with an average interval of once a month, for a total of four to ten treatments.
However this can vary and may be more frequent, or take longer, depending on the condition
being treated.
The anticipated rate of success depends on a number of variables, including the patient’s history
and ability to heal, and the type of solution used. In patients with low back pain, studies have
shown an 85% to 95% of patients experience improvement with prolotherapy (compared to
studies showing a 52% improvement with back surgery). Many studies done over the years have
shown a high success rate when prolotherapy is used for various ligament, tendon or joint
pain/injuries.
Prolotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder
joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the
shoulder joint. Advances in medicines greatly improved on this process, and led to the modern
techniques of strengthening the fibrous tissue and creating new, normal collagen, rather than
producing scarring to fuse tissues. Hippocrates described vein sclerotherapy around 400 B.C.
using "slender instruments of iron" to treat varicose veins. Injection sclerotherapy of veins was
first reported in 1623, and modern forms of injection sclerotherapy for varicose veins, hernias
and hermorroids has been performed since the early 1900's. Earl Gedney, D.O., a well-known
Orthopedist, decreased his surgical practice and began to inject joints in the 1940s and 1950s,
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3716 Pacific Ave, Suite H, Tacoma WA 98418 Phone Number 253.383.3506 Fax 877.513.8012
Prolotherapy & PRP
and spent the rest of his life researching and publishing on the subject. Also, George Hackett,
M.D., wrote a book on this injection therapy, with Gustav Hemwall. MD adding to that
publication in the 1950’s. Both Gedney and Hackett’s work is still used today in training
physicians. In the years since this early work, techniques and medications have advanced to
move from a scarring or fusing effect to a strengthening, regenerative effect, which restores the
weakened joint to its original level of stability, without loss of flexibility and function. Advances
in Regenerative Medicine have made the use of more advanced formulas possible, such as
Platelet Rich Plasma (PRP) which contains growth factors, and autologous Adult Stem Cell
sources, for even more enhanced healing.
If you are interested in learning more, or seeing if you would be a good candidate for
prolotherapy, contact Blue Horizon Medical at (253) 383-3506.
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