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.
In recent years, it has become clear that much of the benefit also comes from the stimulation of the release of growth factors in the region being treated. Some factors shown to be involved in growth and repair include Human Growth Hormone, Insulin-like Growth Factors I-IV, Transforming Growth Factor Beta, Epidermal Growth Factor, Basic Fibroblast Growth Factor, Platelet Derived Growth Factor, and undoubtedly many others. These have been shown to be released during prolotherapy treatments and appear to be the main basis for repair.
It has been shown that elevating the concentration of Glucose (sugar) by 0.5% in the fluid surrounding the fibroblasts induces the DNA machinery to release numerous factors such as those mentioned above.
The healing effect is a graded, controlled reaction producing repair of the weak and damaged connective tissue. When properly applied, Prolotherapy does not induce scar formation. The bonds are stronger, healthier, and thicker than before treatment, and with each treatment continue to strengthen, until the healing is complete and the pain resolved.
Human Growth Hormone (HGH) has been successfully injected into the joint to induce growth of cartilage. In our experience of approximately 30 patients, with knee, hip, and shoulder pain, over 50% of the patients have substantial improvement in pain. There is x-rays and MRI evidence of improved joint spacing in some patients. We reserve this for our patients who do not respond adequately to standard Prolotherapy solutions. We have seen no significant adverse effects from Prolotherapy in general in our practice experience of over 1000 patients, and Prolotherapy with HGH appears to have similar safety to date. Since Prolotherapy routinely greatly benefits more than 80% of our patients, HGH is not used a great deal, but when these efforts are combined, we see that approximately 90% of our patients with Osteoarthritis, ligament strain, and tendinosis have substantial improvement.
The evidence suggests that we are entering a new realm of Prolotherapy in which additional factors will be discovered that improve upon the excellent results and low risk of Prolotherapy.