Frequently asked questions about Prolotherapy
What is Prolotherapy?
Prolotherapy is a recognized orthopedic procedure that stimulates the body’s natural healing processes to strengthen joints weakened by over-use or traumatic injury. It is also know as proliferative therapy, ligament reconstruction therapy, or fibro-osseous injection therapy. The ligaments that hold the joint together are what is targeted by Prolotherapy. When ligaments about a joint are injured they can become painful and or lead to a hypermobile joint. Traditional approaches, e.g. surgery or anti-inflammatory drugs, often fail to stabilize the joint or relieve pain permanently. Prolotherapy directly address the cause of the instability – the stretched, torn, or fragmented ligaments.
How does Prolotherapy work?
Precise injections of proliferant solution are made directly into the torn or stretched ligament or tendon. Prolotherapy creates a mild, controlled inflammatory response that stimulates the body’s natural healing mechanisms leading to new tissue that strengthens weakened areas. The mild inflammatory response thus created, encourages new ligament or tendon fibers growth thus resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue and restoration of strength.
What is in the solution that is injected?
Prolotherapy injections contain anesthetic agents and natural substances which stimulate the healing response. Usually Dr. Mizera injects 10 to 20% concentrations of Dextrose with 0.5% Lidocaine.
Is the Prolotherapy treatment painful?
Some pain from an injection can be expected. It will vary according to the structure to be treated, the choice of solution used and the skill of the physician administering the injection. Usually, there will be pain at the site of the injections and when the skin is numbed. Treatment may cause mild swelling and stiffness. The discomfort passes rapidly and can be reduced with Tylenol. Note: Anti-inflammatory drugs, such as aspirin, Ibuprofen (Motrin), Celebrex should not be used for pain relief for three weeks after the injections because their action suppresses the desired inflammatory process.
Can Prolotherapy help everyone?
Each patient must be evaluated thoroughly with patient history; physical exam, and if needed X-ray exam and laboratory tests. This work up is done on a separate visit before Prolotherapy will be administered. With this information, Dr. Mizera can evaluate your potential success with this therapy. Success depends upon many factors including the kind of damage you have, your overall health and ability to heal.
If you are allergic to lidocaine, novacaine or any of the local anesthesias (like what the dentist uses to numb your teeth) you should not get this therapy. Tell the Doctor or nurse immediately if you have this allergy.
Who administers Prolotherapy?
Physicians who administer this form of therapy are trained by the experts in the field. It is not commonly taught in residencies. Physicians attend seminars and workshops to learn these injection techniques. One of the pioneers of Prolotherapy was Dr. Hemwall. He was the originator of the techniques I have learned. His work of training doctors has been carried on after his death by his foundation. My experience has been a training course set up in Honduras and in Madison WI under the auspices of the Hacket-Hemwall Foundation as well as AAO Prolotherapy courses.
What areas of the body can be treated?
Prolotherapy is most commonly used to treat back problems anywhere from the neck to the low back. It can be used in the treatment of joint problems such as sprains, pains and loose joints. It has been used to treat knee, ankle, elbow and even temporal-mandibular joint (TMJ) problems.
How often do I need these treatments?
It is best if treatments to the same area are done every 3-4 weeks. Treatments to different areas can be spaced one week apart.
What’s the rate of success in treatment?
The anticipated rate of success depends on a number of variables, including the patient’s history of how the problem began, the patient’s ability to heal, the type of solution injected and the skill of the doctor injecting. In patients with low back pain, 80% to 95% of patients treated experience remission of pain with this form of therapy. In comparison, the Journal of Bone and Joint Therapy reports on a 52% improvement in patients treated surgically for disc involvement.
Is this form of therapy really new?
Prolotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the shoulder joint. Advances in medicines greatly improved on this process, and led to the modern techniques of strengthening the fibrous tissue rather than scarring tissues.
In the 1940-50s Dr. Earl Gedney, an Osteopathic physician and orthopedic surgeon had great success in injecting joints and ligaments with the newer solutions. Prior to this time some physicians had used Prolotherapy with great success in treating hernias and hemorrhoids.
In 1950, George Stuart Hackett, M.D., wrote the book “Ligament and tendon relaxation treated by Prolotheapy”. This seminal work is still used today for training physicians.
What do you actually do?
Prolotherapy involves injecting small amounts of solution into ligamentous structures that are painful and or weak. Depending on the site and size of area involved, this may necessitate many injections during one office session. These sessions are uncomfortable because they require multiple needle sticks. Many patients tolerate this well but some patients, prior to the procedure, may require some medication for pain control.
What will happen after the injections?
After the injection procedure, most patients feel fullness and numbness in the areas injected. After Prolotherapy the response of patients usually fall into one of three groups:
In the first group, pain is immediately relieved by the numbing medicine that is injected. Then, during the next 24 to 48 hours their pain may return and may be, initially, more severe. Over the next 4-10 days the pain gradually decreases in intensity as healing and strengthening occur.
The second groupof patients has little or no pain post injection. The pain stays relieved permanently.
The third groupof patients has their pain relieved initially only to return after 2-3 weeks, necessitating further injections.
Of course, there are some patients who do not benefit from these injections. The number of injections needed varies from patient to patient and injury to injury.
Some people are relieved totally with one session of injections, whereas others require a number of sessions. Generally, several injection sessions are needed for most problems. If, after 3-4 sessions, there is no improvement in function or decrease in pain, Prolotherapy will usually not be continued.
After Prolotherapy, I encourage regular stretching exercises to allow for proper healing and strengthening. However be careful not to over-stretch or excessively stress the areas that have been treated.
Also do not forget that even if your pain is relieved and the underlying structures strengthen, it is possible to re-injure yourself.
There are only a few contraindications to doing Prolotherapy – mostly these are allergy related. For example if you are allergic to lidocaine then this therapy is not possible. Diabetes is not a problem for the small amount of dextrose does not affect a diabetic’s blood glucose levels.
(Thank you to Bruce W. Kuhlmann DO for Prolotherapy FAQ and their answers)