Overview of Prolotherapy

by Dr GC Lindeque

Prolotherapy (or Reconstructive Injection Therapy) was originally used by Hippocrates over 2500 years ago to heal a javelin thrower's shoulder pain. The concept was investigated, utilized, and refined by George Hackett, MD over 70 years ago, and other physicians, including the former Surgeon General of the United States, C Everett Koop, MD.

The cause of a great deal of musculoskeletal pain is related to laxity or relaxation of connective tissue, which normally controls joint movement and provides support for standing, sitting, and movements of the extremities. These tissues are frequently damaged by trauma, and the initial healing response may not adequately "weld" the structures back together. Anti-inflammatory medications, frequently taken after an injury, also seem to dampen the healing response and result in diminished healing. The structures may also be weak because of hormonal changes, such as with pregnancy, which causes laxity of the ligaments in the low back, feet, ankles, and other structures.

Other individuals are predisposed because of genetic variation, possibly because of weaker collagen or more elastic ligaments, thyroid disease, and other as yet undiscovered causes. The result of the reduced structural stability is a chronic strain of the remaining ligament and tendon fibers, which are connected to the extremely sensitive periosteum of the bone,which, through nerves, sends pain signals to the brain.

Injections containing relatively harmless dextrose (sugar), local anesthetic, and other agents are placed at the attachments of ligament and tendon tissue to initiate a healing response, which results in the growth (or proliferation) of fibrous tissue. This creates a stronger bond at these attachment points, lessening the load on the individual fibers. The attachment points may also become less sensitive which often results in significantly less pain, and improved range of motion and improved function.

Numerous studies have shown a success rate of 80-90% over many thousands of patients, with success judged as at least 50% reduction in pain. This is quite remarkable, given that the treatment has minimal side effects and less cost compared to other surgical and non-surgical treatment. It is estimated that over 1 000 000 patients have been treated with prolotherapy in the last 70 years.