Prolotherapy patient information

Ross Hauser, MDRoss Hauser, MD

Prolotherapy patient information

Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. Notice I said “a little assistance”. Because often, that’s all the body needs, the rest it can take care of on it’s own. In most cases, commonly prescribed anti-inflammatory medication and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.

The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local Inflammation.

Prolotherapy injections

Developed in the 1940′s by Dr. George Hackett, Hackett-Hemwall Prolotherapy stimulates the body to repair painful areas. Dr. Gustav Hemwall took Prolotherapy to the next level and applied its effectiveness to painful areas all over the body so now we see its effects are wide-ranging and include successful treatment of pain associated with the back, the neck, all joints throughout the body, arthritis, migraines fibromyalgia,  sciatica, herniated discs, and TMJ. Most neck, back and other musculoskeletal pain is due to weakness of ligaments and tendons.

Take the low back for example. Back pain results when weak ligaments and tendons cause the spine to become “unstable.” Vertebrae begin to slip, move and rotate from their proper position, causing pressure on the nerves. Limited results in pain alleviation may be achieved with cortisone and other anti-inflammatory agents but these do not address the cause of the pain. Temporary pain suppression is not a cure for the underlying problem: ligament and tendon weakness. Advocates of the technique say Prolotherapy is the long-term solution to chronic pain because it strengthens the ligaments and tendons so they can move the vertebrae back into their proper places.

Prolotherapy involves the injection of an “irritant” solution (something as simple as a sugar or salt solution, cod liver oil or corn extract) into the area where the ligaments have either been weakened or damaged through injury. We give the injections at the points where the ligaments connect to the bone. With these injections, Dr. Hauser’s Prolotherapy injections cause the body to heal itself through the process of inflammation.

When an irritant is introduced, at the site of injury, the immune system is summoned to the area. The body begins a healing process exactly where the painful area is located. New fibrous tissue is laid, repairing and strengthening the ligaments so that they can pull the vertebrae back where they belong and alleviate pain.

Ligament and Tendon Inflammation

The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness, but depends upon the technique of the individual Prolotherapy doctor. The most important aspect is injecting enough of the solution into the injured and weakened area. If this is done, the likelihood of success is excellent.

Prolotherapy involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments and tendons generally have a poor blood supply, incomplete healing is common after injury. This incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.

The greatest stresses to the ligaments and tendons are where they attach to the bone, the fibro-osseous junction. The most sensitive structures that produce pain are the periosteum (covering of the bone) and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), the periosteum ranks first, followed by ligaments, tendons, fascia (the connective tissue that surrounds muscle), and finally muscle. Cartilage contains no sensory nerve endings. If you are told that your cartilage is the cause of your pain, you have been misinformed; the cartilage cannot hurt because they contain no pain sensing nerves. If there is cartilage damage, the ligaments are typically the structures that hurt. Ligaments are weakest where they attach to bone. The periosteum is the most sensitive area to pain and the ligaments second. It is now easy to understand why this area hurts so much. This is where the Prolotherapy injections occur, and thus eliminate the chronic pain of many conditions including arthritis, mechanical low back pain, degenerative disc disease, cartilage injury, and sports injuries.

Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body’s healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which “turns on” the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after Prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. Yes, you heard me right. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases!

Is Prolotherapy an option for you?

In 1983, Y. King Liu performed a study using the knee ligament in rabbits. This study was done in order to quantify the strength of the tissue formed by Prolotherapy. In this study, a proliferant was injected into the femoral and tibial attachments of the medial collateral ligament, the inside knee ligament. The ligaments were given five prolotherapy treatments and then compared to non-injected ligaments. The results showed that in every case Prolotherapy significantly increased ligamentous mass, thickness, and cross sectional area as well as the ligament strength. In a six-week period, ligament mass increased by 44 percent, ligament thickness by 27 percent, and the ligament bone junction strength by 28 percent. This research was yet another attestation to the effectiveness of Prolotherapy, showing that Prolotherapy actually causes new tissue to grow. Imagine what it would mean to an athlete to run 40 percent faster, jump 40 percent higher, or be 40 percent stronger? This new growth of stronger, healthier tissue is the normal and desired outcome with Prolotherapy.

Why I became a Prolotherapy doctor

I became fascinated with pain during my Physical Medicine residency. I began accumulating articles on bizarre pain syndromes and obtained quite a collection. What struck me most was the magnitude of the pain problem. It seemed as though everyone either had pain themselves or knew someone who was suffering from chronic pain. I also saw the lack of significant pain relief by modern treatments such as surgery, Physical therapy, and anti-inflammatory medications.

It appeared that the longer people had pain, the less likely such treatments were going to help cure their chronic pain. Pain clinics and pain programs do help some people, but have a poor cure rate. Pain programs teach people to live with their pain. The psychological aspect of the pain is addressed, but in many cases the cause is not determined.

When I began seeing pain patients during my residency training program in Physical Medicine and Rehabilitation, I thought they were a very difficult group of people to treat. They often appeared depressed, and traditional approaches to pain management did not seem to help. Then I said to myself, “How would I feel if I had pain day after day and no one could find a cure?” The families of many who suffer from pain often begin doubting the reality of their loved ones’ pain. Many chronic pain patients who frequent pain clinics experience broken homes and lose their jobs because of the pain. It became evident to me that these patients’ pain was indeed real and that pain pills and support groups did not cure the pain.

In April 1992, I contacted Prolotherapy pioneer Dr. Gustav Hemwall and he allowed me to observe him in his clinic. I was astonished to see him perform 30, 50, or 100 injections on a patient at one time! He called his treatment Prolotherapy. The only other time I had come across the term was when a fellow resident showed me a book on the treatment. I later discovered that Dr. Hemwall was one of the authors of that book!

During the next few months, I spent a considerable amount of time in Dr. Hemwall’s office. People traveled from all over the world to be treated by this 84-year-old man. To think that someone would travel from places like England, Mexico, Florida, and California to receive pain management was incredible. I learned that if someone suffers from pain and someone else has a technique that will help alleviate the pain, time and expense are minor considerations.

Three months later, I began utilizing Prolotherapy injections in my medical practice as a treatment for chronic pain. I have effectively used Prolotherapy in nearly every joint of the body. In January 1993, I began working alongside Dr Hemwall in his Prolotherapy practice. Since then, my wife and I have opened Caring Medical and Rehabilitation Services, a Natural Medicine clinic that cares for people with chronic diseases using natural methods, including Prolotherapy.

Conditions treated by Prolotherapy

Prolotherapy for Chronic Low Back Pain

Chronic low back pain encompasses a lot of different conditions including degenerative disc disease, spondylosis, spondylolisthesis, sacroiliac ligament laxity and others. Since these conditions generally have as their etiological basis ligaments being stretched, torn, and weakened Prolotherapy is needed. Typically three-six visits are all that is needed to relieve the pain.

Prolotherapy for Chronic Neck Pain

Like chronic low back pain, chronic neck pain has ligament weakness as a common underlying cause. This can lead to Degenerative Disc Disease in the neck, herniated discs, and myofascial pain syndromes. Typically three-six visits are all that is needed to relieve the pain.

Prolotherapy for Chronic Headaches

I believe because most of us are spending more and more time looking at a computer screen with our necks in poor posture, headaches are on the rise. The forward head posture puts a strain on the posterior ligaments. As these weakened, neck muscles spasm and referral headaches occur. Prolotherapy helps all types of headaches including tension, cluster, and migraine headaches.

Prolotherapy for TMJ Syndrome

Perhaps the most used joint in the body is the TMJ. The tempomandibular joint is stressed every time a person talks or eats. Anyone who has clicking in the joint has a good chance of having ligament injury in the jaw. Prolotherapy is a great alternative for TMJ syndrome. It helps strengthen the TMJ ligament, often resolving a chronically painful, clicking joint.

Prolotherapy for Knee Arthritis

Athletes are especially prone to knee arthritis. It is also a very large joint which orthopedic like to inject with steroids. These facts combined with the massive use of anti-inflammatories, make knee arthritis very common. About 250,000 Americans each year get knee replacement . A much better option for knee arthritis is Prolotherapy. Depending on the extent of the arthritis anywhere from 3-15 sessions of Prolotherapy are needed.

Prolotherapy for Rotator Cuff Injury

Most shoulder pain is from an injury to the Rotator Cuff. The most common muscle/tendon of the rotator cuff that gets injured is the supraspinatus. The supraspinatus muscle/tendon is an external rotator of the shoulder. It gets a lot of strain/stress when the shoulder ligaments are weakened. This, in addition to the fact that the blood supply to the supraspinatus tendon attachment on the humerus is poor make injury likely especially in people who use their shoulders a lot. Prolotherapy to the rotator cuff attachments onto the shoulder, as well as the shoulder ligaments, is extremely effective at helping chronic shoulder problems resolve. Typically three-six visits of Prolotherapy are all that is needed.

Prolotherapy for Annular Ligament Injury

People understand the term ‘tennis elbow’ but most chronic elbow problems are annular ligament injury. This ligament is stressed during rotation of the elbow. So any athlete who throws or a person who has an occupation using the elbow, such as carpenters and people who type a lot, are prone to annular ligament injury. Generally again three-six visits of Prolotherapy are needed to resolve the problem.

Prolotherapy for Chronic Ankle Sprains

The most common ligament injury in the body is an anterior talofibular ligament injury or ankle sprain. People don’t realize it but one third of all ankle sprains don’t heal completely. Eventually if the ligament injury is not healed, arthritis occurs in the ankle. It is best to treat ligament injuries early before arthritis develops. Again three-six visits of Prolotherapy are needed. If there is arthritis in the ankle then up to 15 visits may be needed.

Prolotherapy for Trochanteric Pain (Hip Pointer)

It is common for people to have pain on the side of the hip. There is a big bone upon which ‘the pain’ sits called the greater trochanter. This is where the gluteal muscles attach. Typically a person is diagnosed with trochanteric bursitis, but the pain is not from a true inflammation of the bursa (fluid filled sac) but just weakness in the muscle/tendon attachments at this site. Prolotherapy onto the greater trochanter bone typically resolves the problem in three-six visits.

Please see our article on Prolotherapy instead of hip replacement.

Prolotherapy for Fibromyalgia

Yes even people with body pain need Prolotherapy. If a person has whole body pain, they will often have one to three areas that hurt a lot more than others. These are the ones that need Prolotherapy. To get rid of the rest of the body pain the person needs a good nights sleep and to balance body chemistry. So for fibromyalgia typically Prolotherapy is combined with natural medicine. The whole process takes typically a year.

Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951.

Kim E, Lee JH. Autologous Platelet-Rich Plasma Versus Dextrose Prolotherapy for the Treatment of Chronic Recalcitrant Plantar Fasciitis. . PM R. 2013 Jul 19. pii: S1934-1482(13)00369-9. doi: 10.1016/j.pmrj.2013.07.003.