What are Prolotherapy Injections?

The primary ingredient in Prolotherapy injections used in many offices is dextrose, a corn extract. How does a corn extract accelerate healing?

When a joint becomes injured, the cells in that area burst and release dextrose and trigger an influx of inflammatory cells, initiating the wound-healing system to the specific area.

In this basic Prolotherapy injection solutions we also use an alkaline extract of the pitcher plant called Sarapin. Almost all pain issues have some kind of nerve component, which Sarapin helps to relieve. In our experience, Sarapin enhances the healing effects of injection treatments and has an excellent safety profile. It is one of the few materials found in the Physicians’ Desk Reference that has no known side effect. Also in the basic solution, to help ease the pain of the injection procedure, as well as provide pain relief to the area, procaine or lidocaine is added in very small quantities. Often, this helps to ease the pain right away after the procedure, but is used in such a small amount to not cause any adverse effect to the joint repair/wound healing cascade.

When a stronger inflammatory reaction is desired, additional natural ingredients can be used in the dextrose-based injections. These can include mineral additives, such as zinc or manganese. Another common Prolotherapy additive includes fatty acids, which increase the inflammatory effect. Lastly, certain hormones may be helpful for triggering localized repair of damaged tissue in difficult long-standing osteoarthritis patients.

In research, histologic studies of ligaments and tendons following Prolotherapy injections have shown an enhanced inflammatory healing reaction involving fibroblastic and capillary proliferation, along with growth factor stimulation.4-6

Animal research has documented that Prolotherapy-injected ligaments have an increased ligament mass, extracellular matrix, thickness and junction strength with bone.7-11

Prolotherapy is given to the articular ligaments of the entire spine, pelvis and peripheral joints to tighten unstable joints. Case series have documented the efficacy of Prolotherapy for ligament injuries of the sacroiliac joint 12-14, low back 15-16, neck 17-18, shoulder 19, elbow 20, knee 21-22 temporomandibular joint 23,24 and other articulations 25.


Stem Cell Therapy and Platelet Rich Plasma Therapy


As regenerative medicine advances, Prolotherapy practitioners are taking notice of which methods can be incorporated into dextrose Prolotherapy treatments to help direct a person’s own stem cells and/or growth factors into the exact places where healing needs to take place within a joint. This is called Autologous (From your own cells) Prolotherapy, or Cellular Prolotherapy. Many offices utilize Platelet Rich Plasma (PRP) Prolotherapy, which involves concentrating platelets/growth factors found in the blood and injecting them directly into the joint.

Many offices offer Stem Cell Therapy or Stem Cell Prolotherapy using a person’s own bone marrow and/or fat cells, which are collected and injected during the same day procedure. With any Cellular Prolotherapy procedure done in our office, patients also receive dextrose Prolotherapy to the surrounding joint attachments, in order to ensure the area of pain and instability is comprehensively treated.

Next > A discussion of Prolotherapy as non-surgical option

References

4. Maynard J. Morphological and biomechanical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research. 1985;3:236-248.  [PubMed]
5. Hackett G. Joint stabilization: An experimental, histologic study with comments on the clinical application in ligament proliferation. American Journal of Surgery. 1955;89:968-973.
6. Kim HJ, Kim SH, Yun DH. The effects of anti-inflammatory drugs on histologic findings of the experimental prolotherapy model. Journal of the Korean Academy of Rehabilitation Medicine. 2006;30:378-384.
7. Liu Y. An in situ of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connective Tissue Research. 1983;2:95-102. [PubMed]
8. Jensen KT, Rabago DP, Best TM. Response of knee ligaments to prolotherapy in a rat injury model. American Journal of Sports Medicine. 2008;36:1347-1357. [PubMed]
9. Klein R. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measures of lumbar spine mobility before and after treatment. Journal of Neurology, Orthopedic Medicine and Surgery. 1989;10:141-144. [AAOM Citation]
10. Harman R, et al. A retrospective review of 62 cases of suspensory ligament injury in sport horses treated with adipose-derived stem and regenerative cell therapy. Proceedings of the Veterinarian Orthopedic Society, 2006.
11. Dahlgren LA. Use of adipose derived stem cells in tendon and ligament injuries. American College of Veterinarian Surgery Symposium on Equine Small Animal Proceedings. 2006;150-151.
12. Hackett, G. Shearing injury to the sacroiliac joint. Journal of the International College of Surgeons. 1954;22:631-642.
13. Lee JD, Lee DW, J CW. Effects of intraarticular prolotherapy on sacroiliac joint pain. Korean Journal of Pain. 2009;229-233.[PubMed Citation]
14. Cusi M, Saunders J, Hungerford B. The use of prolotherapy in the sacroiliac joint. British Journal of Sports Medicine. 2010;44:100-104. [PubMed Citation]
15. Hackett G. Back pain following trauma and disease-Prolotherapy. Military Medicine. 1961;July:517-525.
16. Hackett, G. Low back pain. The British Journal of Physical Medicine. 1956;19:25-35.
17. Hooper RA, Frizzell JB, Faris P. Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy. Pain Physician. 2007;10:313-318.[PubMed Citation]
18. Centeno CJ, Elliott J, Elkins WL. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005;8:67-72.[PubMed Citation]
19. Jo D, Ryu K, Yang S. The effects of Prolotherapy on shoulder pain. Korean Journal of Anesthesiology. 2004;46:589-592.
20. Hauser R, Hauser M, Holian P. Hackett-Hemwall Dextrose Prolotherapy for unresolved elbow pain. Practical Pain Management. 2009;October:14-26. [PPM Citation]
21. Kim JM. The effect of prolotherapy for osteoarthritis of the knee. Journal of the Korean Academy of Rehabilitation Medicine. 2002;26:445-448.
22. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alternative Therapies. 2000;6:68-79.
23. Hakala RV. Prolotherapy in the Treatment of TMD. The Journal of Craniomandibular Practice. 2005;23:1-6.
24. Schultz, L. A treatment of subluxation of the temporomandibular joint. Journal of the American Medical Association. September 25, 1937.
25. Reeves KD, Topol GA, Fullerton BD. Evidence-based regenerative injection therapy (prolotherapy) in sports medicine. In Seidenberg PH, Beutler PI. (Eds). The Sports Medicine Resource Manual. Saunders (Elsevier); 2008:611-619.

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