What is Prolotherapy?
Prolotherapy refers to an injection whose primary intent is to repair connective tissue (that is, ligament, tendon or cartilage). The term proli is Latin for “to grow.”Ligaments in the spine and pelvis provide stability to the joints and discs. These ligaments can be overstretched or torn putting extra stress on the spine that causes pain. Prolotherapy (also called Sclerosant injections) works by causing mild inflammation of the injected tissues through injection of an irritant solution. This is thought to stimulate a healing process leading to the body producing new fibres, making the affected ligament thicker and stronger.
How Does Prolotherapy Work?
Dextrose injection (12.5% to 25% concentration) stimulates a pathway inflammation. After an injury, the body uses primarily inflammation to try to repair the damage. Prolotherapy causes no significant damage, because there is no stretching or tearing of fibers, but the body still begins a repair process, which allows the structure to become stronger and tighter rather than first becoming weaker and looser.
Why do some people get better quickly with prolotherapy?
Healing takes months, but some patients get better quickly. This is likely because dextrose and other solutions have effects on nerves as well. However, this is by a different mechanism and is not the primary goal of prolotherapy (see below).
What about injecting solutions other than dextrose?
There are other solutions that stimulate the same type of inflammation, such as phenol, and they are also used. However, when cells are removed from the human body and then reinjected, that is termed “Bioregenerative Injection”(BRI). The primary goal is still repair but it is by use of tissue from living sources. This includes injection of whole blood, stem cell injection and platelet rich plasma injection.
What does it involve?
- This is usually a day case clinic procedure. It can be done in the out patients clinic or sometimes in theatre if X-ray equipment is needed.
- If prolotherapy is for your back pain, You will be lying on your front for the procedure, which usually takes 10 – 20 minutes. Local anaesthetic is injected to numb the skin and a fine needle is passed toward the ligaments of the back, occasionally under x-ray guidance. Once the needle is in place, the solution is injected. Often several sites are injected during the procedure.
- Ideally, the injections are repeated at intervals of 4-6 weeks.
- A course of treatment usually comprises 4-6 procedures.
What is injected at the clinic?
Sclerosant solution are usually a mix of two products phenol and dextrose at high concentrations supplied as a readymade solution such as P2G (mixture of phenol 2%, glycerol 30% and glucose 30%) or can be made up together by the professional just before injecting. Both injections are always accompanied by local ananesthetic.
Does it work?
- On average, 50 – 70% of patients find that symptoms have improved by greater than 50% for up to a year following an initial course of treatment.
- Injections may need to be repeated on occasion, usually as a single top-up procedure.
- Prolotherapy appears to be particularly useful in patients with sacroiliac pain, whiplash injury, ligament laxity with hypermobility, tendinopathies especially around elbow, shoulder and Achilles, spinal pain and other musculoskeletal conditions.
For further information please arrange for a consultation with our specialist and email [email protected]