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Introduction to Prolotherapy Articles
Prolotherapy is an injection technique that has been shown to cause proliferation (growth) of cells and tissue to 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. 

● Introduction to Prolotherapy
Ross Hauser, M.D.
Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. Ross Hauser, M.D.

● What is Prolotherapy-Indications and Contraindications
K. Dean Reeves, M.D.
Prolotherapy is injection of any substance that acts as a ‘growth factor,’ that is, which promotes growth of normal cells, tissues, or organs. Injection of the hormone, erythropoietin, to produce red blood cells is widely used, and a number of other substances have been used for treatment of patients with various medical disorders. This discussion focuses on prolotherapy for musculoskeletal disorders, including arthritis and back pain. 

● Why Get Prolotherapy?
Donna Alderman, D.O.
When you become a physician, you take the Hippocratic Oath. The first rule of the Hippocratic Oath is "First of all, do no harm." This is why Prolotherapy appealed to me as a physician. I was a doctor at a famous HMO. After learning Prolotherapy, however, I went into private practice.

● What is Prolotherapy?
Alvin Stein, M.D.
Prolotherapy is also known as non-surgical ligament reconstruction, and is a permanent treatment for chronic pain. Prolotherapy is derived from the Latin word "proli" which means to regenerate or rebuild. It is important to understand what the word PROLOTHERAPY itself means. "Prolo" is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

● 10 Tips to Determine if You Are A Good Prolotherapy Candidate
Ross Hauser, M.D.
Pain simply put is just the body’s response telling you that you have some tissue that is breaking down. The same thing happens to an athlete who is in the heat of competition. When the muscles start hurting, it is just a sign that you are working really hard. It also reveals that tissue is breaking down, which is especially important to those who are athletes. The goal of Prolotherapy is to build the tissue back up.

● Non-Surgical Tendon, Ligament and Joint Reconstruction
William J. Faber, D.O.
In acute injuries, the ligaments and tendons become torn. Ligaments function to limit the range of motion that bones can move between each other, and function to stabilize joints and hold the joint together. Tendons function to attach a muscle to bone in order to provide motion. Discs and cartilage serve to absorb shock and keep the bones from rubbing against one another. If the ligaments become torn or over-stretched the joint becomes unstable and resultant friction causes the discs or cartilage to become worn down causing a loss of height.

● How Does Prolotherapy Work?
Marc Darrow, M.D.
The term "Prolotherapy" is short for "proliferation therapy." Proliferation, of course, means "rapid production." What Prolotherapy rapidly produces is collagen and cartilage. Collagen is a naturally occurring protein in the body that is a necessary element for the formation of new connective tissue—the tissues that holds our skeletal infrastructure together. These tissues include, tendons, ligaments, muscle fascia and joint capsular tissue.

● How Safe Is Prolotherapy?
Ross Hauser, M.D.
In now over four decades, no serious side effects from Prolotherapy have been reported in the medical literature despite millions of Prolotherapy treatments given. Prolotherapy is not dangerous, Prolotherapy cures chronic pain.

● The Importance of an Experienced Prolotherapy doctor
Ross Hauser, M.D.
Because of the numerous calls we receive, we have a good idea, (the good, the bad, and the ugly) about what is happening with Prolotherapy around the country. Remember that not all Prolotherapy doctors are created equal and the proof is some of the things our patients have told us and what we have heard from other physicians.

● When Prolotherapy May Not Work
David Harris, M.D.
Prolotherapy is effective in markedly reducing or curing musculoskeletal pain 80-90% of the time. Many end-stage medical problems are worth a trial of prolotherapy, especially if the only alternative is a destructive or permanent alteration of a joint, such as a surgical fusion or the destruction of a nerve. The greater the anatomical injury, the more difficult it is resolving the problem.   

● Twenty Common Questions About Prolotherapy
David Harris, M.D.

● The History of Prolotherapy
Ross Hauser, M.D.
The concept of Prolotherapy originated in the non-surgical treatment of hernias, varicose veins, and hemorrhoids, all conditions which are due to connective tissue weakness. If the connective tissue in the veins becomes weakened, hemorrhoids and varicose veins form. Weakness in the collagen, of course, causes ligament laxity and tendon degeneration with resultant chronic pain.

● Curing Chronic Pain with Prolotherapy
Scott Greenberg, M.D.
Have you ever suffered from chronic musculoskeletal pain? If you have, you are not alone. Statistically speaking, 75% of Americans will experience chronic back pain in their lifetime. Unfortunately, a stressful and active lifestyle may not give our body the chance it deserves to heal.

● Why So Many Turn To Prolotherapy
David Harris, M.D.
The conventional model of pain management relies on medications, such as anti-inflammatory drugs, antidepressants, anti-seizure medications, opiates such as Vicodin and Codiene, “muscle-relaxant” medications related to Valium (which actually act as “brain-relaxants”), and other potentially addictive and risky medications.

● Prolotherapy and Chronic Pain
Ross Hauser, M.D.
It is not a secret that chronic musculoskeletal pain is the number one cause of chronic disability in North America. Nor is it a secret that chronic back pain is the leading cause of disability in Americans under the age of 45. What is a secret is that this rampaging epidemic of pain can conceivably be eliminated in 80-90% of sufferers.

● Peripheral Joints & Prolotherapy
Jay W. Nielsen, M.D.

● The Difference Between Prolotherapy, Trigger Points, and Acupuncture
Marc Darrow, M.D.J.D.

● Prolotherapy: Creating Inflammation in an Area that is Already Inflamed
Marc Darrow, M.D.J.D.
Our bones and muscles are held together by the aptly named connective tissue. Connective tissues are ligaments, which connect bone to bone, and tendons, which connect the bones to muscles. It is also the fascia covering muscles and the joint capsule tissue.

● Growth Factor Basis of Prolotherapy
David Harris, M.D.
For many years, the positive effects of Prolotherapy were thought to be mainly based on the concept of inflammation and minor damage induced by the injection of irritating solutions, with subsequent healing of the injured areas. The benefit of solutions containing strong alcohol solutions, ground-up pumice stone, and other such recipes suggest that this is indeed one of the mechanisms of the strengthening and healing response seen with Prolotherapy.

● What Does It Take To Heal Connective Tissue?
David Harris, M.D.
Healing is a complex process. Many chemical reactions occur after an injury which together fight infection, clear away debris, and rebuild the damaged structure. Complex interplay occurs between nutrition, hormones, underlying disease, circulation, neurological connections, and many other factors. Many patients who do not heal their original injuries have deficiencies of some of these factors, or may have had such extensive injury that the result of healing was insufficient.

● What Do You Mean The Prolotherapy Worked, I Still Have Pain!
Ross Hauser, M.D.
A patient came in for his sixth Prolotherapy visit. The nurse told me the patient didn't feel much improvement in his knee pain, though he had already received five Prolotherapy treatments.

● Can Any Research Prove That Prolotherapy Works?
Ross Hauser, M.D.
Before double-blinded studies, doctors would ask patients if they felt better. If patient after patient told the physician they felt better, than it was presumed and accepted that the therapy was effective. If it was a new therapy, then it was taught doctor to doctor and eventually it was taught in medical schools. If this was still the standard upon which medical therapies were judged, then clearly Prolotherapy would be taught in all the medical schools, but it is not. Why not?

● What is the Proof Prolotherapy is Working?
Ross Hauser, M.D.
This is a common question asked by people just about to receive Prolotherapy for the first time. Typically there are several variables that are looked at to make sure the Prolotherapy is achieving the results the person desires.

● The Healing Powers of Prolotherapy
Vladimir Djuric, M.D.

● How Chronic Non-Joint Pain is Helped by Prolotherapy
K. Dean Reeves, M.D.

● How Does Prolotherapy Work?
Mark Wheaton, M.D.
Prolotherapy works on a very simple principle: injecting the prolotherapy solution at the sites of pain and weakness stimulates the body's own healing mechanism to repair and rebuild injured tissue into a stronger, more supportive, less painful tissue than it was before.

● How Prolotherapy Helps
Allen Thomashefsky, MD, PC 
Every joint in the body is held together by a ligament. When ligaments tear (we call this a "sprain") the joint can become unstable, like in a sprained ankle. When ligaments tear around a vertebrae (i.e. "whiplash"), the spine becomes unstable. You experience muscle spasm because the muscles are trying to make up for the weakness in the spine. 

PROLOTHERAPY
STEPHEN W. BLIEVERNICHT, M.D.,F.A.C.S. 

George S. Hackett, M.D., and two Philadelphia osteopathic surgeons, Doctors Gedney and Shumann, discovered Prolotherapy in the 1920’s. Since its inception, it has been called Proliferative Therapy, Reconstructive Therapy and Sclerotherapy. 

Prolotherapy is an injection technique that has been shown to cause proliferation (growth) of cells and tissue to 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. 

For example, let’s look at the spine. It is composed of bone, tendons, ligaments, discs and cartilage. Discs and cartilage serve as shock absorbers and keep bones from rubbing against one another. Ligaments function as the primary stabilizers of joints. They connect bones to each other and function to limit the range of motion that bones can move. Tendons connect muscles to bones in order to provide motion. In acute injuries, the ligaments and tendons become torn and are unable to stabilize joint areas. This causes the discs or cartilage to become worn down from increased stress, pressure and friction. Discs and cartilage may also be worn down by repeated motion. This ultimately leads to joint instability resulting in constant pain, less and less mobility, and lack of endurance. 

Stimulating repair of the supportive tissues of the spine (or any joint) through Prolotherapy can result in greatly improved stability, mobility and decreased pain. Each treatment session results in the stimulation of more and more tissue repair in the treated areas. Thus, the natural functions of the body are regained. In almost all cases, pain reduces significantly or disappears entirely. Prolotherapy can be administered wherever ligaments, tendons, cartilage and/or discs are torn and worn. It is not effective for all joint pain. Rheumatoid arthritis, for example, is not helped by Prolotherapy, but Osteoarthritis and degenerative arthritis often respond well. 

Physician assessment of the appropriateness of any particular condition for Prolotherapy will occur during the first office visit. 

Addressing energetic disturbances created by scar tissue on the skin from injury or surgical incisions is also part of Prolotherapy, which a trained physician will address by the injection of a local anesthetic into reactive scar tissue. 

The therapies currently available to persons with chronic joint instability and pain are anti-inflammatory medication, cortisone, pain medications, exercise, surgery, and chiropractic care.

Persons treated with Prolotherapy are unable to use non-steroidal anti-inflammatory drugs or NSAIDS (like Aleve, Ibuprofen, aspirin, Celebrex, Vioxx) or Cortisone during the course of their treatment with Prolotherapy. The desired inflammatory response to the injections is critical to Prolotherapy success and cannot be blocked by such drugs without risking failure of the Prolotherapy treatment. In addition, the innate risks of the long-term use of NSAIDs have been demonstrated clinically in the impairment of organ systems as well as the breakdown and deterioration of the musculoskeletal system.

Cortisone drugs (steroids) have numerous serious local and systemic effects. Their chronic use weakens natural defenses, risks further deterioration of joint tissues when injected locally, can be associated with a progressive lack of blood supply to the head of the femur called avascular necrosis which may necessitate hip joint replacement, increases the risk of acquiring diabetes, and has the potential for psychiatric side effects.

Drugs to treat muscle spasm may be used concurrently with Prolotherapy, but those which are compounded with anti-inflammatory drugs, as many are, should be avoided.

Pain medications generally alleviate symptoms while leaving the pathology unaltered. This is akin to someone putting tape over the red engine light on the dashboard of his car. During Prolotherapy, analgesic (pain-relieving) medications may be prescribed for short term use during the immediate post treatment period to relieve the discomfort that may occur during the acute inflammatory process the treatment produces in order to heal. 

Exercise can strengthen muscles but further weaken tendons, ligaments and cartilage that have poor blood supply, worsening the joint instability. Specific stretching exercises, however, can increase blood supply to tendons and ligaments and preserve mobility. 

Surgery often leaves the joint mechanically compromised as removal of tissue permanently alters complex joint physics consisting of levers and pulleys. Surgery remains the method of choice for severed tendons and ligaments, and replacement of eroded bone necessitating joint prosthesis. 

Chiropractic optimizes structure by enhancing nervous system functioning and is capable of removing obstacles to healing. However, it has inherent limitations to effect healing to the degree necessary to stop pain by regenerating new tissue. 

THE “PROS AND CONS” OF PROLOTHERAPY

First, the “Cons”: 

The injections are experienced as being uncomfortable by many patients. (Some of this discomfort during treatment can be ameliorated by a variety of techniques including pre-medication, conscious sedation, guided imagery, and breathing and relaxation exercises. We are happy to explore these adjunct comfort therapies with you). 

The injections typically need to be repeated a number of times over a period of a few months. 

The person treated will likely experience a few days of increased swelling and discomfort at the injection site-a necessary part of the healing process. 

Not all insurance companies reimburse for the treatment. 

And now, the “Pros” and benefits: 

It promotes the body’s own natural healing ability. 

The natural functions of the body are regained and optimized. 

No drugs or surgery are used. 

It relieves pain. 

In a double blind human study where neither the patients nor the researchers knew specifically who was receiving the treatment, 88.5% of those injected with the Prolotherapy solutions showed improvement. 

Results are permanent (though aging continues). 

It is a conservative treatment. 

The solutions used are made from natural ingredients. 

It is considerably less expensive than surgical intervention. 

Enhancing the body’s innate ability to heal is characteristic of many treatments offered at the Phoenix Medical Center and is often the hallmark of a well thought out medical approach, which minimizes adverse effects. Personalizing and tailoring the course of Prolotherapy to the needs of the individual client and his or her physical and emotional constitution are essential elements of our integrated and holistic approaches to pain care.

Adapted from “Prolotherapy for Chronic Joint and Spine Pain” by 
Stephen W. Blievernicht, M.D., F.A.C.S., published in Carolina Health and Healing,1999. 

ADDITIONAL NOTE: Dr. Blievernicht is his own testimonial to the benefits of Prolotherapy. After a lifetime of sports injuries and ergonomically acquired aches and pains, he has undergone Prolotherapy to his neck, shoulders, elbows, hands, back, hip, knees and feet. The treatments have allowed him to continue to enjoy the practice of medicine, his sport and recreational hobbies, and life in general. In addition, he has a greater appreciation of the impact of chronic and acute pain on his patients and empathy for those who seek relief from that experience.