What is Prolotherapy?

Prolotherapy is also known as "proliferation therapy," "regenerative injection therapy," or "proliferative injection therapy". It involves injecting an otherwise non-pharmacologic and non-active irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. The precise mechanism or mechanisms of action for prolotherapy agents is currently unclear.

The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times where hot needles were poked into the shoulders of injured gladiators. Prolotherapy use began in the 1930s and was originally used in the treatment of ligamentous laxity.  In the 1950s Dr. George S. Hackett, a general surgeon in the United States, began performing injections of irritant solutions in an effort to repair joint and hernias.  This practice is what would eventually evolve into modern day prolotherapy. He was joined in this practice by Gustav Anders Hemwall in the 1950s. In 1955, Dr. Hemwall became acquainted with George Hackett at an American Medical Association meeting and started practicing prolotherapy. Dr. Hemwall was regarded as an expert in prolotherapy.

Prolotherapy in clinical practice

Prolotherapy involves the injection of an irritant solution into a joint space, weakened ligament, or tendon insertion to relieve pain.  Most commonly, hyperosmolar dextrose (a sugar) is the solution used; glycerine, lidocaine, phenol and sodium morrhuate, a derivative of cod liver oil extract, are other commonly used agents.  The injection is administered at joints or at tendons where they connect to bone.

Prolotherapy treatment sessions are generally given every two to six weeks for several months in a series ranging from 3 to 6 or more treatments.  Many patients receive treatment at less frequent intervals until treatments are rarely required, if at all.

Possible indications for prolotherapy

Indications for prolotherapy may include one or more of the following: