Prolotherapy, short for proliferation therapy is a controversial technique that involves a series of injections of an inactive irritant substance into a painful joint, or area where ligaments or tendons insert into bone. The injected substance can be dextrose, phenol, saline solution, glycerol, lidocaine, or even cod liver oil extract. Prolotherapy injections are intended to artificially initiate the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue.
Some of the signs that might benefit from prolotherapy include:
- Joint laxity, such as in the shoulder, that does not resolve with standard treatment
- Distinct tender points at tendons or ligaments as they attach to the bones
- Unresolved, intermittent swelling or fullness involving a joint or muscle
- Popping, clicking, grinding, or catching sensations in joints
- Temporary benefit from chiropractic manipulation or manual mobilization
- Aching or burning pain that is referred into an upper or lower extremity
- Recurrent headache, face pain, jaw pain, ear pain
- Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
- Spine pain that does not respond to surgery, or where there is no definitive diagnosis despite X-rays, MRIs and other tests.
So why is prolotherapy considered “controversial?” Because, according to the federal government (Health Care Financing Administration) there is currently no strong, compelling study that proves prolotherapy can cure cases of soft tissue pain. A “strong” study is one that has at least several hundred test subjects; has a control group (who get a placebo, or fake treatment) and is done in a “double-blind” methodology where the test subject and the administering doctor do not know if the injection is a prolotherapy agent (only a third member of the research study knows). However, there are numerous studies in the literature using smaller test populations (less than a hundred) that support prolotherapy as an effective treatment for pain.
A 2005 study entitled A systematic review of prolotherapy for chronic musculoskeletal pain (Clin J Sport Med. 2005 Sep;15(5):376-80) analyzed major studies on prolotherapy and reached the following conclusion:
- Two RCTs (randomized controlled trials) on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy
- Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.
There is a research project at the University of Wisconsin involving prolotherapy to treat knee osteoarthritis that is due to publish its results soon.
So, if you have chronic musculoskeletal / joint pain, especially related to trauma, that has not resolved with cortisone injections, chiropractic, physical therapy, personal training, surgery, and time, prolotherapy may be worth investigating. The good thing about it is that it is generally safe.