Overuse, misuse, trauma, and incomplete healing can result in connective tissue damage. When healing is incomplete or interrupted, the result is weakness within the tendon, joint, or ligament. Anti-inflammatory medications, frequently taken after an injury, tend to dampen the healing response and result in diminished healing. Joint laxity can cascade into joint degeneration, arthritis, decreased mobility, and pain. Inflammation is the natural repair process which your connective tissue goes through when it is damaged during daily use. Your connective tissue is constantly replacing and repairing itself, but it often never fully repairs the damage without the stimulation of the acute healing response that Prolotherapy provides.  

The collagen structures may also be weak because of hormonal changes, such as with pregnancy, which causes laxity of the sacroiliac joints and other associated ligaments in the low back, feet, ankles, and other structures. Other individuals are predisposed because of genetic variation, possibly because of weaker collagen or more elastic ligaments (double-jointedness), otherwise known as Benign Congenital Hypermobility Syndrome or Ehlers-Danlos Syndrome (EDS), thyroid disease, and other as yet undiscovered causes. The result of the reduced structural stability is a chronic strain of the remaining ligament and tendon fibers, which are connected to the extremely sensitive periosteum of the bone, which, through nerves, sends pain signals to the brain. 

Prolotherapy using  a heated needle was originally used by Hippocrates over 2500 years ago to heal the shoulder pain of javelin throwers. The technique was used in the late 1800’s for hernia repair and for  jaw pain in the early 1900’s. The concept was investigated, utilized, and refined by George Hackett, MD, an Orthopedic Surgeon, in the 1930’s, and enhanced by Gus Hemwall, MD who learned the technique from Dr. Hackett. Prolotherapy was presented at AMA meetings in the 1960’s. 

Steroid injections were discovered in the 1960’s. The immediate pain relief often seen with steroid injection reduced the medical professions’ enthusiasm, acceptance and teaching of Prolotherapy. However, the overuse of steroid injections and the resultant connective tissue damage that steroid injections produce when repeated excessively have led to a renewed recognition that we need better tools to repair connective tissue injuries. It has since taken several decades for Prolotherapy to once again be accepted and taught in national and international conferences. 

Many physicians worldwide have now learned how to provide Prolotherapy injections, including the former Surgeon General of the United States, C. Everett Koop, MD. Many studies have been published showing the value of Prolotherapy over the past 75 years. 

A solution containing dextrose mixed with local anesthetic and sometimes other solutions is injected into the area to be treated, which is often inside the joint and into the supporting ligaments, capsule, and tendons to initiate a healing response, which results in the growth (or proliferation) of fibrous tissue. The number of injections depends on the size of the area being treated and the supporting structures involved. This creates a stronger bond at these attachment points, lessening the load on the individual fibers. This usually results in less pain, improved range of motion, and improved function, which generally lasts for decades, or longer. 

Dextrose Prolotherapy treatment will usually take 4-6 treatments, provided about every 4-6 weeks. Some patients respond faster with less treatments, some slower and with more treatments. Platelet-Rich Plasma (PRP) is a more powerful solution that is used similarly to Dextrose Prolotherapy. PRP usually requires less treatments and may be more effective in treating challenging injuries. 

Prolotherapy involves a series of injections using very small diameter needles into irritated and damaged structures. Most patients consider it very tolerable. Local anesthetic will typically reduce the pain involved. Some patients will find that pain medication or anti-anxiety medication taken before the procedure will help reduce the discomfort and anxiety associated with the procedure. Nitrous oxide (Laughing gas) can also be used, if necessary, to reduce anxiety, but that is not commonly needed.

There is usually mild to moderate soreness for several days after the procedure. Activity is encouraged, and there is usually minimal downtime after a procedure. Most patients return to their normal activity within 2-3 days after the procedure. 

Prolotherapy involves using small needles in many structures in a given visit, so there is a possible risk of infection, nerve injury, and lung puncture, but these are extremely rare. We often use fluoroscopy (X-Ray) and ultrasound guided techniques to guide our needle placement, particularly when a very precise placement is needed, and also to reduce risk in areas that might be sensitive or challenging without such equipment.