Prolotherapy is an injection technique that stimulates growth of cells and tissue that stabilize and strengthen weakened joints, cartilage, ligaments and tendons. The injected solution intentionally causes controlled irritation in the injected tissue. This irritation is an inflammatory response, which increases the blood supply and thereby stimulates the tissue to heal and regrow new tissue.


GetProlo is happy to be the web’s largest listing of Prolotherapy doctors. GetProlo.com is a referral and informational site only. If you would like to know if you are a good candidate for Prolotherapy or other Regenerative Injection Therapy, please contact a Prolotherapy physician’s office directly for an opinion. Thank you for using GetProlo.com!

Sugar-Water Injections Relieve Knee Pain More Than Exercise

More research on the benefit of Prolotherapy from the University of Wisconsin School of Medicine and Public Health and published in the Annals of Family Medicine.

Injections with a form of sugar known as dextrose provide significant pain relief and improved knee-related quality of life compared to exercise among people who suffer from knee osteoarthritis.

That’s according to research at the University of Wisconsin School of Medicine and Public Health and published in the Annals of Family Medicine.

The practice known as prolotherapy involves injecting a non-pharmacological solution in painful tendons, ligaments and joints.

Lead author Dr. David Rabago, assistant professor of family medicine at UW, said the study involved 90 people between age 40 and age 76. All had at least three months of knee arthritis pain and had unsuccessfully used other treatments such as physical therapy.

They were divided randomly into three groups: two received blinded injections of either dextrose (sugar) or saline solution. The third group was involved in an exercise program.

Injections with dextrose and saline were done at one, five and nine weeks and if needed, at 13 and 17 weeks.

Participants were contacted by phone after 26 and 52 weeks, and a scoring system was used to rate pain, stiffness, and how the arthritis was affecting normal activities of daily living such as walking up and down stairs or doing household chores.

Rabago said the scores indicated that while participants in all groups made some gains compared to their baseline status, those in the prolotherapy group improved about twice as much as those receiving saline injections or exercise from nine to 52 weeks

“This suggests there is a biological effect to prolotherapy,” he said. “Though the study is of modest size, the data are clear and consistent, showing a robust effect compared to blinded and non-blinded therapies.”

Rabago noted that these results do not show that prolotherapy is a cure for osteoarthritis, and that more study of both effects and why it works still need to be investigated.

“We don’t have a detailed understanding about why prolotherapy has a biological effect,” he said. “One theory suggests that injected solutions act as a positive irritant and, when injected locally at points of tenderness and pain, stimulate the native healing response. Prolotherapy may work with the person’s own immune response to create a local healing response at the injured tissue.”

“The assessment involved overall knee outcomes made up of separate scores for knee pain, stiffness and function,” he added. “Did participants report complete knee recovery? No, but they did report robust improvement in all three knee outcomes by a margin that is clinically relevant.”

While prolotherapy rated higher at relieving pain than exercise did, Rabago said patients with knee arthritis should not give up on exercising if they are also using prolotherapy.

“While we have not studied the effect of exercise plus prolotherapy in patients with knee osteoarthritis, prior studies have reported that patients using prolotherapy for other injuries; for example, Achilles tendon inflammation, had positive results when they combined with exercise versus using either exercise or prolotherapy alone,” he said. “It’s reasonable to suggest that monitored, progressive at-home exercise or formal physical therapy would be good care.”

Rabago said the study will continue for two more years to determine if the participants still feel pain relief beyond 52 weeks.

“The data support a plateau effect between 26 and 52 weeks,” he said. “We will follow these patients in a follow-up study to determine whether the positive effect is stable.”

Some insurance carriers will cover prolotherapy with prior authorization, but most patients pay for the treatments out-of-pocket. Prolotherapy is not covered under Medicare.

The study was funded by the NIH National Center for Complementary and Alternative Medicine.

Date Published: 05/21/2013

More Spinal Surgery – Is it Necessary?

Ross Hauser, MDRoss Hauser, MD

In the many thousands of patients who have visited us, in more than 95 percent of our patients, we find that the true diagnosis causing the pain is different from the diagnosis the patients had been previously given.

Very rarely will a doctor acknowledge a ligament or tendon injury as a cause of chronic pain. The main reason is because they find abnormalities on MRI scans. Ironically most MRI findings have nothing to do with why the person has pain and this is the reason for most back surgery failures.

“Nearly one-fourth of patients undergoing lumbar discectomy demonstrated radiographic evidence of recurrent disc herniation at the level of prior surgery, the majority of which were asymptomatic.

Asymptomatic disc herniation was not associated with clinical consequences by 2 years. Clinically silent recurrent disc herniation is common after lumbar discectomy.

When obtaining MRI evaluation within the first 2 years of discectomy, providers should expect that radiographic evidence of reherniation may be encountered and that treatment should be considered only when correlating radicular symptoms exist.”1

Sadly many surgeons proceed with low back surgery after misdiagnosing the cause of pain. Even worse, the uses of MRI’s seem to be increasing and are even being performed in surgeons’ offices. A study recently released by the Stanford University School of Medicine showed that MRI scan rates increase when a doctor buys or leases MRI equipment. The study also showed that patients were 34% more likely to receive back surgery when they had an MRI scan done by their doctor. In other words, seeing a doctor who has an in-office MRI scan increases your chances of getting a scan and getting surgery. Interestingly, the study author noted that MRIs and surgery are controversial because there are no proven benefits. She goes on to say that most people with low back pain do not need an MRI and even fewer need surgery. Therefore a patient should take caution when his doctor prescribes an MRI, especially if it is in the same office because your chances for receiving surgery may be increased. Unfortunately most doctors send patients straight to an imaging test without performing a physical examination or health history to determine the root cause of the problem. Since imaging tests tend to show abnormalities, even in patients with no pain at all, root causes of pain are misdiagnosed and wrong treatments are chosen.

1. Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ.Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine (Phila Pa 1976). 2011 Dec 1;36(25):2147-51.

The Key to Treatment of Any Joint Pain Lies in the Foot

Scott R. Greenberg, MDScott R. Greenberg, MD

I know what you are thinking – how could my neck pain be linked to damage in my foot? How could my back pain be affected by weakness in my arch?

Why won’t my knee get better after everything I have been through. The answer, my friends, may lie in the foot.

While this idea may seem so foreign to you, it’s time to get up out of your chair and feel the effect that the foot has on the rest of your body. First, take off your shoes and stand on a level floor, preferably one without carpet. Now, roll your ankle inward, and feel and look what happens. Does the inside of your knee start to ache? Do you feel pressure in your hip and lower back? Do your shoulders feel out of balance, and does your neck start to get tight? If so, now you can understand the importance in evaluating the feet for almost every pain problem in the body. IF you feel nothing, just stand a little longer, and eventually you will start to feel it!

The feet are so important to our daily functions of walking and standing. Without them, we would simply not be able to walk. We are also the only mammals that exclusively use our feet for support (others rely on hands or paws!). We also like to run, wear high heels, walk barefoot, and engage in other behaviors with our feet that might not be optimal for our other joints.

Any instability in the foot or ankle will cause an abnormality in the gait (walking cycle). Any abnormality in the gait can easily damage the knee, hip, and lower back. This happens as the bones in the lower leg may rotate to compensate for damage in the foot/ankle complex. As I mentioned in my prior article about the tilted pelvis, the connection between the foot and the hip can cause the pelvis to tilt, resulting in one of our legs acting short. I see this phenomenon in the majority of my patients who present with back pain, headache, or neck pain. Why? As the pelvis tilts, the sacrum becomes unstable. The instability is then carried up the spine, causing damage to the ligaments, muscles, and tendons that support the spine. This results in chronic neck pain, headaches, and back pain.

Furthermore, many of the tendons of the back, hip, pelvis, spine, and knee are intimately connected to the tendons of the feet.

Orthotics are not the answer-they are only supportive and may be exacerbating the condition if they were made incorrectly. We must correct the damage in foot and change the gait, and correct the pelvic tilt. This is how healing should begin with any joint problem. I am always amazed in my private practice, when patients come in limping, and after a few adjustments and injections, leave walking straight without any limp. Remember, if you are not getting better, ask your physician to evaluate your foot.

Pain Killers Prevent Healing

Marc Darrow, MDMarc Darrow, MD

As chronic pain specialists, our office sees many new patients looking for an alternative to a lifetime of pain killers and anti-inflammatories because of the risks associated with habitual use of these medications.

These risks including:
■ ulcers,
■ gastrointestinal distress,
■ liver and other major organ damage,
■ and overdose.

Patients also come to see us because they do not want to live their life in a drug induced “stupor.” Sometimes patients even become more sensitive to the pain and require higher doses of narcotics.   Here is another risk: They don’t let you heal! A study in the American Journal of Bone and Joint Surgery said that not only does chronic use of opioid medications can lead to dependence but they can adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. In patients they studied, a significantly higher prevalence of complications was seen in the opioid group. Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries.

Most patients we see, visit us because they have already been given the surgical ultimatum – live with the pain or get the surgery. These patients want another choice to their knee replacement prognosis and diagnosis that include osteoarthritis (bone-on-bone caused by cartilage disintegration), weakness or tears in the meniscus and the ligaments. Supportive of this diagnosis will usually be a long history of MRI images, failed physical therapy and other conservative treatments. Many times they bring in a shopping bag filled with prescription pain-killers and anti-inflammatories and the long-list of over-the-counter remedies they take.   Three options they have usually never tried or been informed of are Prolotherapy, Platelet Rich Plasma therapy, and Stem Cell Therapy. These treatments are injection therapies designed to rebuild cartilage, repair torn meniscus and ligaments, and reduce swelling and pain.   They work similarly. First a proliferant, something in the injection that will cause tissue to regrow is introduced. The treatments work at growing new cells, Chondrocytes, the cells that comprise knee cartilage, and fibroblasts, the most common cells in the connective tissue (those that make up ligaments and tendons.)

Weight gain after joint replacement

Scott R. Greenberg, MDScott R. Greenberg, MD

When examining patients who have thought of getting a knee replacement, two of the main reasons they give in favor of the procedure is that is can reduce pain, and secondly, it can help them be more active and they can maintain an ideal body weight.

Research is suggesting that knee replacement patients actually gain more weight after the surgery. Worse, the younger the patient, the greater the risk for substantial weight gain following the surgery! 1

This new research goes against older research that says the opposite – usually joint replacement patients lost weight.2

In other research, it becomes a little more clear “Total hip or knee replacement patients who are overweight or obese often consider their disabling joint disease a cause for their increased weight”. . . BUT…”Postoperatively, both hip and knee replacement patients gained weight. Younger hip patients gained a significant amount of weight.3

All three studies seemingly confirm the same thing, it is up to the doctor and patient who are predisposed for weight gain, to work together to form a non-weight gaining plain following treatment.

Of course, inactivity may lead to the weight game following a joint replacement surgery. This is why Prolotherapy is a sought after option. Under a doctor’s care a patient during treatment, may continue normal activity and avoid the problems of inactivity.

1. Riddle DL, Singh JA, Harmsen WS, Schleck CD, Lewallen DG. Clinically important body weight gain following knee arthroplasty: A five-year comparative cohort study. Arthritis Care Res (Hoboken). 2012 Nov 30. doi: 10.1002/acr.21880. [Epub ahead of print]

2. Stets K, Koehler SM, Bronson W, Chen M, Yang K, Bronson M. Weight and body mass index change after total joint arthroplasty. Orthopedics. 2010 Jun 9;33(6):386. doi: 10.3928/01477447-20100429-13.

3. Heisel C, Silva M, dela Rosa MA, Schmalzried TP. The effects of lower-extremity total joint replacement for arthritis on obesity. Orthopedics. 2005 Feb;28(2):157-9.