Prolotherapy

Prolotherapy (or Reconstructive Injection Therapy) was originally used by Hippocrates over 2500 years ago to heal a javelin thrower’s shoulder pain. The concept was investigated, utilized, and refined by George Hackett, MD, over 75 years ago, and other physicians since, including the former Surgeon General of the United States, C. Everett Koop, MD. The cause of a great deal of musculoskeletal pain is related to laxity or relaxation of connective tissue, which normally controls joint movement and provides support for standing, sitting, and movements of the extremities. These tissues are frequently damaged by trauma, and the initial healing response may not adequately “weld” the structures back together.


Anti-inflammatory medications, frequently taken after an injury, also seem to dampen the healing response and result in diminished healing. The structures may also be weak because of hormonal changes, such as with pregnancy, which causes laxity of the Sacroiliac and 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), 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.

Injections containing relatively harmless dextrose (sugar), local anesthetic, and other agents are placed at the attachments of ligament and tendon tissue to initiate a healing response, which results in the growth (or proliferation) of fibrous tissue. This creates a stronger bond at these attachment points, lessening the load on the individual fibers. The attachment points may also become less sensitive. This results in significantly less pain, improved range of motion, and improved function, permanently.

Numerous studies have shown a success rate of 80-90% over many thousands of patients, with success judged as at least 50% reduction in pain. This is quite remarkable, given that the treatment has minimal side effects and cost compared to other surgical and nonsurgical treatment. It is estimated that over 2,000,000 patients have been treated with Prolotherapy in the last 75 years.

The injections are administered approximately 4-6 weeks apart, with an average number of 4-6 injections. The response is directly related to the speed of healing within our bodies. The typical time frame for a course of treatment is 4-6 months. The body continues to “remodel” the bond so that even more strength and stability occurs over the year following the treatment.

A slower than typical response mandates a review of the cause of the pain. Sometimes, augmented solutions may provide a better or faster response, using additives such as Sodium Morrhuate (a cod liver oil extract), platelet-rich plasma (PRP), or Mesenchymal Stem Cell concentrates (MSC’s) derived from bone marrow or fat tissue.

Read more from the New York Times Article August, 2007 (NYT Prolotherapy) and from USA Today January, 2009 (USAT Prolotherapy)