Prolotherapy

Content provided by:
Thomas Bond, MD
Lafayette, LA

Sciatica and back pain can be the result of degenerative changes in the joints and soft tissues associated with the spine.  One of the many treatment options available to people suffering with acute or chronic pain is prolotherapy.

Proliferation Injection Therapy, also known as, “Prolotherapy”, is a technique by which a series of injections are used to stimulate the body’s natural healing of damaged tissues.  Various proliferative substances are injected into ligaments, tendons, and joints to encourage repair of damaged areas.  Specifically, Prolotherapy is used to:

• Strengthen weakened and loose ligaments and other joint-support structures; and,
• Stimulate new cartilage production within joints.

History of Prolotherapy
The earliest forms of Prolotherapy were practiced by Physicians in Germany in the late 1800’s.  The German technique was brought to America and later refined by an Ohio general surgeon named George Hackett, M.D.  Hackett, along with 2 osteopathic physicians – Earl Gedney & David Shuman – began using these techniques in the U.S. in the early 1930s. 

They were amazed with the clinical results they were receiving and therefore began publishing there work.  Dr. Hackett was published in the most prestigious medical journals of the day, including the Journal of the American Medical Association, and the American Journal of Surgery.  Hackett’s principal student and disciple was a general surgeon named Gustav Hemwall, who practiced his art in Illinois.  Hackett & Hemwall continued to not only practice Prololiferation Injection Therapy, but also trained other physicians how to perform these techniques. 

After Dr. Hackett’s passing, Dr. Hemwall continued training younger physicians in the ways of Prolotherapy for many years.  Today, the Hackett-Hemwall Foundation is a non-profit medical organization dedicated to the practice of Prolotherapy and to training interested Physicians this powerful set of techniques.  Dr. Jeffrey J. Patterson, Professor, Department of Family Medicine, University of Wisconsin Medical School trained and worked directly with Dr. Gustav Hemwall for many years and is currently the Director for the Hackett-Hemwall Foundation.

Injury & Healing
When any of the tissues of the musculoskeletal system (or the entire body for that matter) are injured, regardless of the cause, the damaged cells release their contents into the local environment.  The design of the overall system is such that if these normally intra-cellular contents are now outside the cell, the “alarms are sounded” that there is a problem in that area. 

“Help” (the working cells of our immune system) is then dispatched to the area to “clean up and fix the problem”.  This process is called our “local immune response” to injury and is characterized by inflammation.  Inflammation is simply part of this response – the immune cells order the blood capillaries to open and “make way” for more incoming immune cells – allowing fluid also into the area. 

Once the immune cells reach the damaged area they work to stabilize and repair the area.  This is accomplished by removal of destroyed cells and tissues, as well as, attempts to reconstruct the larger damaged areas. 

Unfortunately, human beings’ schedules do not typically coincide with those of their immune cells.  and thus, as we continue moving muscles and tissues in and around the damaged area, the “repair job” of the immune cells becomes overwhelming.  At this point, they begin to lay down scar tissue, which for the most part, is unstable and functions in a substandard manner. 

The area where the scar is laid down does not function properly which usually results in painful consequences.  Many forms of chronic pain are caused from this one consequence (the laying down of scar tissue leading to dysfunctional joint motion).  There is a very fine regulation to the inflammatory response during both acute and chronic pain/damage situations. 

How Prolotherapy Works
Prolotherapy works by stimulating the body’s natural healing response.  The particular mixtures and concentrations of the stimulant solutions cause the healing process to shift towards rebuilding the area with new cells, rather than laying down scar tissue. 

The way in which Prolotherapy is able to accomplish this is twofold:

1. Location of the Injection:  Prolotherapy injections are placed at the junction where ligaments and tendons fuse into bone.  This area is known to be rich in proprioceptive and pain fibers, and serves as a transition zone, having many different types of cells.  Some are “bone cells”, which help maintain the integrity of the bone.  Some are “tissue cells”, which maintain the different soft tissues (ligaments, tendon, and cartilage).  Other cells, however, are more impressionable or moldable (“naive cells”) and can be told which function they are to perform.  The specific placement of the prolotherapy stimulant solutions tell these naïve cells to take up the job description of “tissue cell” for that area, thus producing new, functional tissue cells. 
2. Proliferant solutions used:  there are many different types of mixtures which have the above-mentioned effect when appropriately placed, each with their own set of risks.  The classic stimulant solution used by Drs. Hackett & Hemwall:  the mixture of Dextrose, sterile saline, and Lidocaine.  When mixed in the proper concentrations and appropriately placed, this solution will stimulate naïve stem cells to become functional “tissue cells”, producing new collagen and/or cartilage.

Prolotherapy is a viable treatment option for people suffering with acute or chronic sciatica and low back pain.  Assembled below is a list of FAQ’s related to prolotherapy.

Frequently Asked Questions About Prolotherapy

What Types of Conditions Respond to Prolotherapy?
Any clinical pain syndrome whose symptoms stem from degenerative tendon or cartilage tissue, and/or ligament laxity with accompanying abnormal joint motion.  Some of the most commonly treated disorders are:

1. Arthritis
2. Whiplash Injury
3. Chronic Neck, Sciatica, & Back Pain
4. Repetitive Strain Injuries:  Tennis/Golfer’s Elbow, Carpal Tunnel, Rotator Cuff Strain, Bursitis, etc.
5. Sports Injuries:  Ankle sprains, Achilles’ tendonitis, Turf-toe, Jumper’s Knee, etc.
6. Hip and Buttock pain.
7. Fibromyalgia
8. TMJ (Temporo-Mandibular Joint) Syndrome.
9. Chronic Headaches.
10. ….and many, many more….

Are “Cortisone Shots” the same as Prolotherapy?
NO!  Cortisone and all of its derivatives, called corticosteroids, are powerful inhibitors of the local immune response and inflammation.  They actually act in opposition to Prolotherapy solutions.  This is not to say that corticosteroids do not have their place in Sports & Orthopedic Medicine.  They most certainly do.  However, there is ongoing debate as to what exactly the role is and mounting evidence that these substances may in fact turn the naïve osteoprogenitor cells toward the laying down of scar rather than new, functional tissue.

Who should consider receiving Prolotherapy?
Anyone with a painful condition of the musculoskeletal system that is not having success with their current treatment approach.

How do I know if I’m an appropriate candidate for Prolotherapy?
Certain aspects of a patient’s general medical condition can potentially affect the outcomes of Prolotherapy.  Tobacco use, Poor Nutrition, Vitamin and Mineral deficiency, and Obesity are just a few which may negatively affect outcomes.  Because of this fact, many physicians will choose not to perform the procedure on patients with these conditions. 

Who performs Prolotherapy and how can I be assured of his/her competence?
Unfortunately, there are many healthcare providers who claim to “do Prolotherapy” that are not appropriately trained.  Two of the most credible sources of information regarding Prolotherapy are the Hackett-Hemwall Foundation, and the University of Wisconsin Medical School in Madison, WS.

What is the cost of Prolotherapy?
This varies some from region to region and amongst physicians, but the national average is approximately $250/area.  An “area” is defined as a unilateral (one side, either right or left) region.  For example, a left knee = $250, a right shoulder = $250, a lower/lumbar spine = $500 (both sides), a “neck” (cervical spine) = $500. 

Will my Insurance cover the cost of Prolotherapy?
Insurance will cover the initial consult only.  Medicare and other insurances will not cover prolotherapy!

Are these injections painful?
They can be.  This really depends on the patient’s pain level, tolerance, emotional state, etc.  Patients who have difficulty with pain can typically be prescribed some conscious sedation to help them relax and more comfortable.

What type of limitation will I have after the injections?
We advise patients that they will be “sore, stiff, and slow” for 3 – 5 days.  “Sore” meaning tender, “stiff” meaning feeling tight (this is the tightening process of the tissues beginning), and “slow” meaning not as sharp physically.  This time period is variable, but patients can typically resume their pre-procedure activities within 24-48 hours.

Will Prolotherapy take the place of my Pain Medications?
Potentially, YES!  Again, this is variable, but some patients no longer require narcotic pain medications after receiving a series of Prolotherapy.  This is obviously dependent on the specific patient and his/her own unique set of variables and other influences.

Where can I find more credible information about Prolotherapy?
If you have an interest in learning more, you can research prolotherapy further by visiting http://www.prolotherapy-hhf.org or http://www.prolotherapy.org.

Dr. Thomas Bond is the founder and clinical director of Total Care Health and Wellness Center where he specializes in sports and orthopaedic medicine and prolotherapy and spinal injection therapy.  He is a Board Certified physician in both sports medicine and family practice.

Written by Malton A. Schexneider, PT, MMSc · Filed Under Treatment