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. Most of the early innovators in injection treatment method were surgeons who were looking for methods to improve surgical outcomes or replace surgery with more conservative methods. The injection of hernias, varicose veins, and hemorrhoids was called Sclerotherapy, because the injection “sclerosed,” or scarred, the area.
Celsus, a Roman encyclopedist and not a physician, described the earliest application of Sclerotherapy in the first century B.C. Saltpeter (Potassium nitrate) was injected to treat hydrocele (accumulation of fluid around the testicle). The instrument and method of injection was, however, not described. Seventeen centuries later, Samuel Sharp, a surgeon at Guy’s Hospital, the oldest teaching hospital of the University of London Medical School, began treating hydrocele by Sclerotherapy and started training others.
The Research and Growth of Prolotherapy
In January 1938, Arthur Steindler and J. V. Luck published a fundamental work related to the diagnosis of lower back pain based on procaine injections. They provided strong evidence that all structures in the lower back, including the ligaments, fascia, tendons, and muscles, receive sensory nerve impulses. They pointed out that these structures are all interrelated anatomically and functionally, and they came up with a list of criteria that had to be met to prove that an injured structure was causing a pain symptom.
This work was monumental in the history of Prolotherapy. Now a method to definitely prove what was causing the pain existed. A person came to the physician with low back pain radiating to the legs. The doctor, with a needle, then tried to exactly reproduce the pain and the radiating pain down the leg. When the exact site was found, an injection of procaine was given. If the correct structures were injected, all of the pain would be completely removed. The latter part of this concept is followed to this day. Prolotherapy can completely remove chronic pain immediately, if the correct structures have been injected, because of the anesthetic part of the solution.
The First Prolotherapy Treatment
In 1937, Dr. Louis W. Schultz, both a dentist and a medical doctor, published a paper in The Journal of the American Medical Association on the treatment of subluxation of the temporomandibular joint (TMJ). In this paper he described how common TMJ syndrome was, and that the traditional treatments of rest, appliances in the mouth, physical therapy, and surgery were only partially successful. He described a simple method of shortening and strengthening the TMJ capsule by injection of Sylnasol, a five percent solution of fatty acid. This was the first true Prolotherapy treatment. Dr. Schultz collected extensive data from both animal research and clinical practice , and concluded that the method he discovered was simple, safe, and essentially 100 percent effective.
The Development of Prolotherapy as a Cure for Chronic Pain
George S. Hackett, M.D. is considered one of the pioneers, or founders, of modern day Prolotherapy because he brought this technique to mainstream medicine. His research was published in some of the main medical journals of his time and presented at the prestigious American Medical Association meetings. Some of the statistics on his research include:
- Sample size: 1,656 patients
- Patient age range: 15 to 88 years old
- Duration of pain: three months to 65 years
- Average duration of symptoms: four and a half years
- Duration of study: 19 years
- Number of injections given: 18,000
Dr. Hackett did a remarkable job in that he followed his patients for 12 years after the prolotherapy treatments were completed. Twelve years after treatment, an impressive 82 percent of the patients considered themselves cured. Dr. Hackett believed that the cure rate was actually over 90 percent, due to improvements in the technique over the years. He used Sylnasol, a fatty acid, as the proliferant, which is no longer available. Later proponents of the Hackett technique of Prolotherapy found that a simple dextrose solution diluted with local anesthetics was as effective as the Sylnasol, and solutions such as this are still used today. Dr. Hackett also proved in the laboratory that Prolotherapy induces the growth of ligament and tendon tissue and is especially effective at strengthening the weld of these structures to the bone, by proliferating their fibro-osseous junction.
In 1955, at an American Medical Association meeting, Dr. Gustav Hemwall was astonished to see so many doctors at one particular exhibit. The presenter was talking about a very successful treatment for chronic low back pain. Nothing was worse at the time for Dr. Hemwall than having a chronic low back pain patient come to him, because the treatments he was able to offer were not very successful. The doctor doing the presentation was George S. Hackett, M.D., and he was discussing the technique of Prolotherapy.
Once the crowd diminished, Dr. Hemwall asked Dr. Hackett how he could learn the treatment described in his book, Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hemwall went to Dr. Hackett’s office in Canton, Ohio, to learn the technique. Dr. Hemwall became so proficient at administering the technique that Dr. Hackett would later refer patients to him.
Prolotherapy owes a great debt to Dr. Hemwall. Between 1955 until his retirement in 1996, he was the main instructor and proponent of Prolotherapy in the United States. He was not a researcher but a clinician, and perhaps the world’s greatest Prolotherapy doctor. He treated more than 10,000 patients world wide and collected data on 8,000 of these patients. In 1974, Dr. Hemwall presented his largest survey of 2,007 Prolotherapy patients to the Prolotherapy Association. The survey related the following:
- 1,871 patients completed treatment
- 6,000 treatments were administered
- 1,399 (75.5 percent) patients reported recovery and cure
- 413 (24.3 percent) reported general improvement
- 25 (0.2 percent) patients showed no improvements
- 170 patients were lost to follow up.
More than 99 percent of the patients who completed treatment with Prolotherapy found relief from their chronic pain. These results are similar to those published by Dr. Hackett, showing that Prolotherapy is completely curative in many cases (75 to 90 percent) and provides some pain relief in nearly all patients treated.
At the age of 87, in June of 1996, Gustav A. Hemwall M.D. electively retired from the practice of medicine and turned over the helm of his private practice to Dr. Ross Hauser. He had been on the medical staff of West Suburban Hospital in Oak Park, Illinois for 60 years.
The opinions expressed here does not necessarily reflect the views of the other member physicians of getprolo.com.