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.

Current Newsletter

Prolotherapy After Arthroscopy
Here we will look at a patients’ actual arthroscopy reports with my opinion regarding what they need to look for and questions they need to find out.

Degenerative Disc Disease in the Cervical, Lumbar and Thoracic Spine
This article discusses the case of 57 year-old Bill B, a dentist, who suffered from chronic pain from ligamentous laxity and degenerative disc disease in the cervical, lumbar and thoracic spine. His headaches and back pain were treated successfully with Prolotherapy even after many years of other treatments with failed results.

Lumbar Spinal Stenosis

Many patients come into our office with a date for surgery or, and more unfortunate, a diagnosis of failed back surgery. For the patients who had put off surgery, they have explored their options and have discovered that surgery is not the answer for them. For the patients who had the surgery, they need more options than before.
 

Labral tear, rotator cuff tendonopathy, and headaches
treated with Prolotherapy and PRP (platelet rich plasma) in a competitive athlete

Treatment of Joint Hypermobility Syndrome, Including Ehlers-Danlos Syndrome, with Hackett-Hemwall Prolotherapy
Some of the rationale for using Prolotherapy for patients with Joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) include that it has a high safety record, is comprehensive (all or most joints can be treated at each visit), is an outpatient procedure, is cost effective (compared to surgery), pain relief is often quick, and it provides joint stabilization. Perhaps its greatest asset is the fact that this one treatment modality can handle most of the painful musculoskeletal conditions that occur in individuals with EDS and JHS.

Facet Joint Injections for Neck and Back Pain
A facet joint injection can be performed for one of two purposes. One purpose is diagnostic in that it confirms or denies that the facet joint is the cause of back pain or neck pain. The second purpose is therapeutic in treating the facet joints. Diagnostically, a small amount of anesthetic is injected into the facet joint near the area of pain. If pain relief results then the facet joint is deemed the culprit of pain. Once the facet joint is pinpointed as the problem area, further injections of anesthetics and anti-inflammatory agents are injected to try to achieve more permanent pain relief.

Ligament Injury and Osteoarthritis
In this Prolotherapy research article from the Journal of Prolotherapy, the relationship of ligament injury and osteoarthritis is  examined and shown to be a convincing one. When there is insufficient ligament support to stabilize joint motion, the resultant increase in joint laxity leads to the development and acceleration of articular cartilage injury. The biomechanical abnormalities caused by joint instability greatly increase impact loading via increased shear and compression forces across areas of contact on opposing cartilage surfaces. Even with early recognition of ligament injury and deficiency, traditional medical interventions do not treat the etiology of the disease. It is for this reason that the prevalence of osteoarthritis will increase as will the number of joint replacements.

A Pain in the Buttock (and back) treated with Prolotherapy and PRP
Many of us who have had back pain will also feel the pain radiating down the leg, into the hip, and into the buttock.  It takes a great degree of skill, experience, and knowledge to determine what the appropriate treatment is for a patient with these symptoms.  We cannot just rely on the MRI, no matter how abnormal the disc or joint may seem.  The following case will illustrate this:

Hip Arthritis Prolotherapy Injection Technique

Prolotherapy techniques and solutions have improved to the point that even severe degenerative hip osteoarthritis can be helped with Prolotherapy. In general, the number of Prolotherapy treatments will depend on the extent of the arthritis. In my experience it is not uncommon for more advanced cases to need 10 to 14 treatments given one to six weeks apart. Most commonly, I see patients for hip treatments at two-week intervals. One can expect at least a 70% overall success, though with less advanced arthritis the success rate is higher. During the treatment course the patient follows standard post-Prolotherapy instructions. Patients are to be active and exercise to pain tolerance and use heat and avoid ice and other anti-inflammatory
medications.

Ankle and Foot Treatment with Prolotherapy
My ankle hurt A LOT immediately! I had gone up to block the spike and came down on the foot of the spiker (who followed through under the net!). The ankle quickly swelled and the throbbing pain prevented me from sleeping at all that night. I had severely sprained the lateral ligament complex while playing my favorite sport, volleyball. I quickly began a series of Prolotherapy treatments on my own ankle. It went like this (initially). I sprained my ankle on Thursday night. On Friday morning I treated the ankle with Prolotherapy. By the following Thursday it felt good and the swelling was down, I played volleyball Thursday night which led to swelling and pain again (you think?). I repeated this scenario for about six treatments before pausing to consider why I wasn’t getting better, like my patients did with Prolotherapy!

Dextrose Prolotherapy for
Unresolved Low Back Pain

A Retrospective
Case Series Study

Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for chronic low back pain.

Design: One hundred forty-five patients, who had been in pain an average of four years and ten months, were treated quarterly with Hackett-Hemwall dextrose Prolotherapy. This included a subset of 55 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of 26 patients who were told by their doctor(s) that surgery was their only option. Patients were contacted an average of 12 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms and activities of daily living, before and after their last Prolotherapy treatment.

The Use of Hormones for Chronic Pain
Anabolic hormone therapies and Prolotherapy are innovative approaches to treating chronic pain. They are complimentary and can be simultaneously administered.

Prolotherapy, a non-surgical alternative for torn meniscus
Recently we saw a retired school teacher. She twisted her knee getting out of a car. She had an MRI which showed a meniscus tear. Surgery was recommended with the impression that it would be repaired and that she would regain full pain-free function of her knee.  What did her surgery report show?  As with nearly all of these “meniscus repair” reports that we see, most show that the meniscus was indeed not repaired, but removed.

Grade I Lumbar Retrolisthesis
Prolotherapy is indispensable when considering biomechanical correction in the treatment of pain associated with ligament laxity. This 51 year old male was referred for assessment and treatment of a 15 year history of chronic low back pain. He had been very active his whole life and had sustained numerous injuries playing a variety of sports including hockey and football. He had been spending approximately $5,000 per year on massage therapy, craniosacral therapy, chiropractic care and standard physiotherapy. He was also put on a variety of medications including courses of anti-inflammatory medications, tricyclic antidepressants for analgesia, and benzodiazepines with no relief.
 

Prolotherapy After Arthroscopy
I cannot tell you how often I ask my patients why they received an Arthroscopy and what the post surgery report showed, and the answer is so often “I don’t know.” Unfortunately, people agree to procedures, surgeries, or medications without really knowing the reasons for them. Here we will look at a patients’ actual arthroscopy reports with my opinion regarding what they need to look for and questions they need to find out.

The Theoretical Basis for and Treatment of
Complex Regional Pain Syndrome
with Prolotherapy
In this Prolotherapy article from the Journal of Prolotherapy, Ross Hauser, M.D. says that Prolotherapy, by stimulating ligament regeneration, not only resolves the pain, but also the sympathetic hyperactivity and the related symptoms of CRPS. Prolotherapy is a treatment that patients with CRPS and the doctors who treat them should consider.

The Ligament Injury Connection to Osteoarthritis
In this Prolotherapy research article from the Journal of Prolotherapy, the relationship of ligament injury and osteoarthritis is  examined and shown to be a convincing one. When there is insufficient ligament support to stabilize joint motion, the resultant increase in joint laxity leads to the development and acceleration of articular cartilage injury. The biomechanical abnormalities caused by joint instability greatly increase impact loading via increased shear and compression forces across areas of contact on opposing cartilage surfaces. Even with early recognition of ligament injury and deficiency, traditional medical interventions do not treat the etiology of the disease. It is for this reason that the prevalence of osteoarthritis will increase as will the number of joint replacements.

Prolotherapy and Disc Problems
While disc problems cause back pain and are often responsible for sciatica (leg pain), ligaments that are strained or lax are the most common cause.

Prolotherapy after back surgery
Many people only become aware of Prolotherapy after they have undergone a surgical procedure for back pain. Although the pain may not be as severe as it was before the surgery, most people continue to experience significant back pain after surgery. Why? Because the back surgery involved removing supporting structures, such as a lamina, facet, or disc, thus weakening surrounding segments.

Platelet rich plasma, PRP, Prolotherapy
What is PRP? In basic terms, PRP involves the application of concentrated platelets, which release growth factors to stimulate recovery in non-healing injuries. PRP causes a mass influx of growth factors, such as platelet-derived growth factor, transforming growth factor and others, which exert their effects of fibroblasts causing proliferation and thereby accelerating the regeneration of injured tissues. Specifically PRP enhances the fibroblastic events involved in tissue healing including chemotaxis, proliferation of cells, proteosynthesis, reparation, extra-cellular matrix deposition, and the remodeling of tissues.

Prolotherapy for Bursitis
Almost everyone who comes to my office for Prolotherapy for the treatment of bursitis doesn’t have bursitis.  Once in my life I had a true bursitis and when I did, I couldn’t let anything even touch the skin over it because it was that painful. The person who lets a doctor palpate the area with a lot of pressure with the thumb does not have bursitis. They have ligament sprain or tendon strain or other soft tissue injury. 

The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections
The hallmark feature of osteoarthritis is the breakdown in the articular cartilage of joints such as the knee and hip. Both animal and human research has consistently shown that corticosteroid injections into normal and degenerated knees accelerate the arthritic process.

Prolotherapy & Connective Tissue Damage Syndrome:
Why am I hurting, and no one seems to know what is wrong?
Prolotherapy is certainly an important clinical tool to treat damaged connective tissue—ligaments, tendons, cartilage, meniscus, labrum, fascia, etc. But perhaps a greater contribution made by Prolotherapy is that it sheds light on an important medical mystery. That is, when someone has pain in a joint, or in the neck, or back, or when someone has symptoms going down an arm or leg, or various other distressing symptoms, what disease process is actually causing their symptoms? I see patients on a daily basis who have had the origin of their symptoms misdiagnosed. I hear patients on a daily basis give accounts of lengthy odysseys through the health care system, often involving multiple attempted treatments, including operations, who are not better, and perhaps worse, after all the medical attention they have received. Or I see patients with significant symptoms who have been told that “nothing” is wrong—because all their tests are “negative.”

When to use Prolotherapy when to use Platelet Rich Plasma
Platelet-Rich Plasma (PRP) Therapy is a particularly hot topic, nowadays—in the laboratory, the clinic, and on the street. A very recent New York Times (NYT) article describes how two Pittsburg Steelers “used their own blood in an innovative injury treatment before winning the Super Bowl.” The article goes on to cite several other sports figures who have also been successfully treated in this fashion. It refers to PRP Therapy as a means of delivering a “growth-factor cocktail” to such injuries as “tennis elbow” or “knee tendinitis” (sic).

Cervical spine injury
From the very beginning of life, the cervical spine (C-spine) is fraught with significant risks of injury. This includes varying degrees of ligament and musculotendon strain or sprain, along with vertebral dislocation or fracture and even spinal cord trauma (e.g., contusion, hemorrhage) with associated neurological effects.

C-spine whiplash injuries can be compounded by brain stem injury due to direct trauma or edema and stroke due to arterial damage and intracranial injuries of varying severity, including coup-countercoup contusion, translational parenchymal tearing, and hemorrhage. These central nervous system injuries can lead to a wide spectrum of neurological and psychological symptoms commensurate with a closed head injury. Cervical sprain injury can also be associated with signs and symptoms of Barré-Lieou Syndrome due to injury of the cervical sympathetic chain.

Where Does Your Joint Pain Start?
In the Foot?
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!

Cervical radiculopathy
Cervical radiculopathy, though a serious and disabling painful condition, can often be treated conservatively. At times, Prolotherapy, nerve blocks, chiropractic, osteopathy or physical therapy alone can resolve the condition, sometimes a combination of approaches will be needed. While the person is getting treated, close monitoring by the clinicians is necessary to ensure the condition is resolving. With proper care non-operative treatment of cervical radiculopathy is not only effective but recommended, in these authors’ clinical experience.

Prolotherapy for Pelvic Ligament Pain
A Case Report
This case study examines the effect of the addition of Prolotherapy to manual therapy, and pelvic and trunk exercises, in a treatment regime for a patient with pelvic and chronic low back pain (CLBP) who had previously failed manual therapy and exercise alone and in combination. We hypothesized that with continued exercise and the combination of Prolotherapy and manual therapy, there would be better improvement than any single intervention to reduce pain and improve stability in the lumbar spine and pelvis.

Coumadin, Aspirin, Blood thinners, and Prolotherapy
A very common question I hear from patients is, can I get Prolotherapy while on blood thinning medication?

Dextrose Prolotherapy
For Unresolved Neck Pain
An observational study of patients with unresolved neck pain who were treated with dextrose Prolotherapy at an outpatient charity clinic in rural Illinois. Conclusion: In this observational study, patients with unresolved neck pain reported clinically relevant improvements in their pain level and quality of life after receiving Hemwall-Hackett dextrose Prolotherapy.

The Journal of Prolotherapy

Prolotherapy Research at
The Journal of Prolotherapy