Vladimir Djuric, MD
My rather shocking introduction to Prolotherapy was during a fellowship in New Orleans in 1994. Dr. Doyle was a septuagenarian solo practitioner with flair. If her high-pitched voice, Irish accent and up-tempo pace were not enough to get your attention, her style of medicine certainly would. She was the person to see for a variety of chronic painful conditions and prolotherapy was her secret weapon. Although she had mentioned the term on several occasions, the reality of it failed to register until I actually observed the procedure myself. The patient on the other side of the needle was both eager and apprehensive. I soon discovered why. Prolotherapy is not for the faint-hearted.
The term “prolotherapy” was coined by George S. Hackett, an industrial surgeon practicing in Canton, Ohio in the 40’s, 50’s and 60’s. Prolo is short for proliferate; ergo: proliferant therapy or prolotherapy. The treatment involves injection of a pro-inflammatory solution into damaged ligaments and tendons; the connective tissue usually injured during trauma or repetitive motion. This induced inflammation stimulates fibroblast proliferation and collagen synthesis. Collagen, being the chief building block of connective tissue, is necessary for any tissue repair to occur. The goal of the treatment is to stimulate the body to repair itself. Since inflammation is the first step in the healing cascade, injection of an irritant solution gets the process started. An injury-repair sequence is triggered in which the end product is stronger ligaments and tendons and tighter joints.
Various forms of this treatment have been in existence for centuries. Stronger “sclerosing” solutions have been used to treat everything from hernias to varicose veins. What distinguishes prolotherapy are it’s relatively mild sclerosing properties and its multitude of applications. It is an effective treatment for everything from tension headaches and TMJ syndrome to ankle sprains and heel spurs. The most popular solution currently in use is dextrose (sugar water) mixed with local anesthetic. The injections are usually performed at 2-6 weeks intervals with the idea that a cumulative effect will ultimately be achieved. Each simulated “injury” will lead to additional collagen synthesis, thus stronger, tougher ligaments and tendons. Typically 4-6 such treatments are necessary. Both human and animal studies have confirmed.