What is Prolotherapy?

Prolotherapy is a simple technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. The way Prolotherapy works is simple.  A substance is injected into the affected areas, which leads to local healing response. This “fools” the body into believing that a new injury has occurred.  The body then mounts a healing response, resulting in new collagen deposition, which is the material that ligaments and tendons are made of. This results in a stronger healthier tissue.  This treatment may significantly improve chronic pain.

Prolotherapy involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments and tendons generally have a poor blood supply, incomplete healing is common after injury. This incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.

The greatest stresses to the ligaments and tendons are where they attach to the bone, the fibro-osseous junction. The most sensitive structures that produce pain are the periosteum (covering of the bone) and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), the periosteum ranks first, followed by ligaments, tendons, fascia (the connective tissue that surrounds muscle), and finally muscle. Cartilage contains no sensory nerve endings. If you are told that your cartilage is the cause of your pain, you have been misinformed; the cartilage cannot hurt because they contain no pain sensing nerves. If there is cartilage damage, the ligaments are typically the structures that hurt. Ligaments are weakest where they attach to bone. The periosteum is the most sensitive area to pain and the ligaments second. It is now easy to understand why this area hurts so much. This is where the Prolotherapy injections occur, and thus eliminate the chronic pain of many conditions including arthritis, mechanical low back pain, degenerative disc disease, cartilage injury, and sports injuries.

How Does Prolotherapy Work?

First we must understand what we’re trying to treat. The spine functions in a way very different than what you might think. Traditional theory suggests that the spine is a series of blocks, one stacked upon the other with gravity just bearing down on it. There are several bits of information that clearly refute this. The first is the fact that the intervertebral discs in the back simply would not be able to withstand the pressure of having the entire body weight on it. Recently the concepts of Tensegrity have been applied to not only the spine, but all aspects of biology. In the Tensegrity model, forces are transferred from one bone to the next – not through the cartilage between the bones, but through the ligaments holding the bones together. In this way, rather than the crushing weight of the body causing herniation to spinal discs, the spinal bones are suspended above the discs by the ligaments. Viewed in this way, spinal problems such as bulging or herniated discs as well as facet problems are really a function of loose or sagging spinal ligaments.

pic1To the left, is a model of a segment of the spine using Tensegrity principles. The wooden pieces represent “bones”. The strings between the” bones” represent the ligaments. Each of these “bones” has projections very similar to spinal vertebrae. You will notice that none of the “bones” are touching because they are suspended from the strings. In fact you could press down quite firmly on the top “bone” and it would not collapse this structure. However if one of the strings were stretched or torn that portion of the structure would partially collapse. This would result in the discs between these “vertebrae” being squished. This would result in a bulging or herniated disc.

It is not just the spine, but all joints in the body that function on this Tensegrity principal. So if your knee is bone on bone, it’s not your cartilage’s fault – it’s the ligaments. If your feet hurt and you’ve lost some of your arch, it’s your ligament.

pic2It gets much more interesting because the connective tissue itself is made out of Tensegrity units. The next illustration (right) shows this intricate lattice structure of the connective tissue. Knowing that it is the connective tissues and not the cartilage and disks that carry the weight it is now possible to design better treatment strategies. Knowing that it is primarily injury to the ligaments that result in all of these joint problems, doesn’t it make sense to treat the ligaments? Prolotherapy is the method used to treat ligaments and tendons to improve their strength and position.

So what is Prolotherapy?
Prolotherapy is a technique used to strengthen ligaments and tendons. By injecting specific substances into the ligaments and tendons, it is possible to convince the body that an injury exists. This “fake” injury results in stimulation of the body’s healing response. Often chronic injuries are ignored by the healing processes of the body. By stimulating the healing processes of the body, chronic injuries can be cleared up.

How is prolotherapy accomplished?
Prolotherapy is accomplished through a series of treatments. Depending on how your body responds to the therapy, you may require one, two, or up to 10 or more treatments. Each treatment consists of a series of injections into the tendons and ligaments of the affected area of your body. This could mean just a few injections for a finger joint or it could be more than a dozen injections to treat low back pain.

Does it hurt?
Prolotherapy is started by first giving a medicine to numb the skin in the area to be treated. However, even with this there is some discomfort. Most people describe it as a dull aching sensation. This can persist for some time. Some people will experience an unpleasant discomfort for up to two weeks. Most people will have pain relief within just a few days.

What is a typical session like?
The patient will arrive at the clinic like he/she would for any other visit. After checking in, the patient will be taken to the prolotherapy room. The area to be treated will be examined and your history will be updated. Any new issues will also be discussed. The sites for prolotherapy will be selected. Local anesthetic will be used to numb the skin in the areas to be treated. Often ultrasound will be used to guide the needle into the proper position and the prolotherapy solution will be injected. Injections will be repeated until the treatment is complete.

Is prolotherapy covered by insurance?
Prolotherapy is not covered by most insurance companies. The cost of prolotherapy varies by the area to be injected. Obviously, a smaller area will cost less and a larger area will cost more. A typical joint will cost about $250 per treatment. The joint is typically treated once every 4-6 weeks for 3-10 visits. Many pain therapies are quite expensive. Prescription pain medications can be several hundred dollars per month and can be addictive and have side effects. An EMG/NCV test can cost $1200. MRI scans are typically $2500. What about Arthroscopy? This can cost as much as $13,000 and surgery as much as $25,000. By those examples prolotherapy is a bargain.