Prolotherapy  Prolotherapy is also known as nonsurgical ligament and soft tissue reconstruction and is a treatment for chronic pain in ligaments, muscles, soft tissues as well as joints.

Prolotherapy (“Proliferative Injection Therapy”) involves injecting an otherwise non-pharmacological and non-active irritant solution into an injured or inflamed ligament or connective tissue, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. Prolotherapy is also known as “proliferation therapy” or “regenerative injection therapy” or fibroproliferant therapy”.

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Prolotherapy involves a series of injections designed to produce inflammation in the injured tissue. When tissues are injured, inflammation is a common natural response. Injecting the area causes exactly such an inflammatory response which triggers a wound healing cascade. It stimulates substances carried in blood to produce growth factors in the injured area to promote healing. Performing the procedure causes a local reaction, closely resembling natures own perfect healing response to produce these growth factors to repair or heal the local tissue involved. The new collagen that forms as a result replaces the old and injured tissue. As the new collagen matures it naturally retracts and remodels the tissue to the “blueprint” of the original tissue.

Mayo Clinic supporting prolotherapy

As of April 2005, doctors at the Mayo Clinic began supporting prolotherapy. Robert D. Sheeler, MD (Medical Editor, Mayo Clinic). Mayo Clinic doctors list the areas that are most likely to benefit from prolotherapy treatment: ankles, knees, elbows, and the sacroiliac joint located in the lower back. They report that “unlike corticosteroid injections — which may provide temporary relief — prolotherapy involves improving the injected tissue by stimulating tissue growth leading to a more permanent change and improvement.

More recently, Rabago et al. [A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med. 2005 Sep;15(5):376-80] noted: “Two [randomized controlled trials] on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy.”  Gustav Hemwall was a pioneer, beginning his studies and treatments in the 1950s and continuing until the mid 1990s. In his study of almost 10,000 prolotherapy cases, Dr. Hackett found that over 99 percent of the patients found relief from their chronic pain. Worldwide in general it is accepted by Practitioners of Prolotherapy that around 83% of all cases will have a positive response to Prolotherapy.

The Process involves: Injecting the fibroproliferant injection – this provokes an inflammatory repair response  – Ligament injection osmotic shock – cell damage inflammatory mediators(release of prostaglandines in the local tissue) – granulocytic influx  – macrophage influx  –  polypeptide growth factors released resulting in fibroblastic stimulation with ultimate new COLLAGEN FORMATION. This leads to RETRACTION AND REMODELLING of the ligaments. tendons, muscles and soft support tissues.

How is the result measured?

  • Increase in ligament mass
  • Increase in thickness
  • Increase in junctional strength
  • Increase in collagen fibril diameter
  • This leads to a more effective and stronger ligament and muscle action with little or no pain involved.

The procedure: What you can expect

A local anaesthetic will be applied prior to the treatment.The prolotherapy will be performed in sterile conditions in one of the theaters in the Clinic. The prolotherapy solution contains a local anaesthetic that will reduce the experience of pain during the procedure. Mild to moderate to intense pain might be experienced depending on the specific site to be treated. Pain and discomfort in the injection area for 0-4 days is normal.

Aftercare and follow – up

Increasing blood and oxygen supply to the area of treatment is of utmost importance to optimise end results. Keeping the area warm and maximum mobilising of the area right from the beginning is of utmost importance after treatment. Your doctor would advice you about the follow-up treatment which might be 2- 4 weekly and might be repeated 1-3 times per area depending on the response. Full response and results of the treatment is only reached 6 months after the treatment was performed when the neocolagenoses and restoration of new connective tissue growth is completed.

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