Dr. Mark S. Cantieri • Doctor of Osteopathic Medicine
Prolotherapy is a series of injections using safe solutions facilitating the healing of tendon, ligament and joint injuries.
Stimulating your body's healing abilities to provide lasting relief.
Prolotherapy is an injection treatment that has been shown to safely and effectively relieve chronic low back pain and pain in degenerated joints. The affected cartilage, ligament or tendon area is injected with a proliferant solution which stimulates the growth of healthy, strong new connective tissue that helps strengthen weak or damaged areas. As the affected tendon or ligament grows stronger, the patient feels less pain and achieves greater strength and endurance. Prolotherapy has been practiced in the United States for over eighty years as a treatment for musculoskeletal injuries.
Common symptoms & conditions that respond well to Prolotherapy:
Neck, lower back, and upper back pain including those from a failed surgery
Chronic sprained and torn ligaments
Achilles tendon injuries
Tennis and golfer’s elbow
Rotator Cuff Tears
Prolotherapy (also known as sclerotherapy, stimulated ligament repair, or proliferative therapy) is also recommended for weak joints; joints requiring a brace; joints that continually pop, snap, and grind; or joints that cannot maintain alignment (particularly when osteopathic or chiropractic manipulations fail to provide lasting relief.)
Many remedies besides prolotherapy are used to treat these afflictions (such as rest, medication, traction, exercise, cortisone injections, physical therapy, and surgery) but for many patients, these fail to provide the lasting relief. In many cases, prolotherapy, a non-surgical method that stimulates the body’s natural healing abilities to repair injured tissues and joints, can provide an answer.
Unlike muscles and tendons, ligaments that are weakened from trauma, overuse, underuse, functional hormone imbalances and nutritional deficiencies cannot be strengthened with exercise.
Ligaments, tendons, cartilage, and bones have poor healing abilities due to the lack of blood supply to these tissues. This is why injuries to these areas become chronic pain problems. In order to compensate, the body may form bony, arthritic spurs. This causes increased pain and weakness, and a loss in joint mobility.
Prolotherapy is a series of injections using safe solutions at ligament/tendon-bone (fibro-osseous) junctions facilitating the healing process for specific injuries. In the case of injured joints, a local anesthetic and a natural irritant (sodium morrhuate, a purified derivative of cod liver oil), dextrose, phenol, minerals, or other natural substances are injected into areas where ligaments, tendons, and cartilage are torn or injured. These injections trigger a well localized inflammatory, healing, remodeling and strengthening response over a period of weeks or months. As the ligament, tendon and joint strength improve, the pain decreases.
Is Prolotherapy painful?
The injection is considered mild to moderately painful, and there is typically a “flare” of soreness for 3-7 days afterwards. A mild pain medication, such as Ultram or Tylenol, is usually sufficient to control the discomfort. The doctor can prescribe stronger medication if needed.
Prolotherapy and Medication interactions?
Because the effect of Prolotherapy is to initiate a “healing cascade” which requires Inflammation, the patient is advised to avoid anti-inflammatory medication, both over-the-counter and prescription. Aspirin may also interfere with the process to some degree, but if an individual is taking Aspirin to reduce risk of stroke or heart attack, a small amount of Aspirin, such as a “Baby Aspirin” (80 mg) is acceptable. The results of Prolotherapy while taking these medications may be slower and less consistent than if the patient avoids these medications.
Is Prolotherapy safe?
There is occasionally some bruising, and very rarely, a nerve may be injured, usually transiently. The procedure has been used for over 60 years. In the late 1950’s, some solutions were used which were much more potent and placed inappropriately into the spine region, and this led to nerve injury and even a lethal reaction. Those who currently practice Prolotherapy strive to keep the technique safe by providing educational seminars emphasizing correct technique and solutions. Possible rare complications include: infection, spinal headache, and puncture to the lung.
Is Prolotherapy “sugar water”?
The dextrose is actually quite irritating in the standard 50% concentration. This is then diluted with sterile water, an anestheic such as lidocaine or procaine to a concentration of 12-15%. This is thought to “dehydrate” the injected tissues, causing an injury signal for the body, and initiating the healing process. Dextrose has been shown to be a growth stimulant on it’s own as well.
What does Prolotherapy treat?
The ligaments, which connect bones together, may be stretched and torn. Tendons attach muscles to bone and may also be torn. The capsule surrounding joints may become lax (loose) and also contribute to pain. All of these may be strengthened and “tightened” with Prolotherapy, reducing the “play” in the joints, reducing arthritis, and bonding the clicking or popping structures in a way that is much more functional and normal. Cartilage has been shown to be repaired and thickened after a series of Prolotherapy injections.
Are back and neck pain always resolved with Prolotherapy?
No. Prolotherapy is an excellent treatment for many spine disorders and can reduce pain and improve function in a great many cases which conventional physicians might consider “psychological”, or at least not evident on imaging tests such as MRI or CT scans. The general public often expects these tests to be infallible, but the truth is that these tests often miss the true source of pain in the spine, joints, and pelvis. Pain from ligaments frequently is “referred”, that is, travels down the arm, buttock, or leg, much in the same way that pain can refer from a “nerve pinch.” If one is unaware of these referral patterns, it is not surprising that the true cause of the pain remains an enigma. Some conditions are better treated with epidural Steroid injections, physical therapy, chiropractic, or surgery. However, it is clear that prolonged treatment with any of the above, if not resulting in clear progress, may be futile and that an alternative should be sought. If you are told that the “pain is in your head”, and you can put your finger on it, you should see a Prolotherapy specialist.
Do you treat muscle pain with Prolotherapy?
It is not appropriate with Prolotherapy to inject the muscle bellies themselves, as one might have experienced with trigger point injections. However, used to strengthen the attachments of these same muscles where their tendons connect to the bones, this type of pain is very treatable with much more permanent results. Myofascial pain is frequently cured with this approach, unlike the traditional and well-known practice of massage, trigger point injection, spray and stretch, and similar techniques. When these techniques do not provide resolution of pain within 3-4 months, the patient should strongly consider the more permanent and cost-effective technique of Prolotherapy.
Does Prolotherapy involve steroid injections?
No. Occasionally, the physician may try a steroid injection first, as this is a mainstream, accepted approach for these types of injuries. If this is not curative with 1-2 efforts, then repeat steroid injections are unlikely to resolve the problem and Prolotherapy is a safer, more permanent solution. Steroid injections are well known to have complications, usually mild but occasionally significant, and repeating them unnecessarily increases the risk. Each steroid injection weakens the underlying connective tissue and may result in a need for additional Prolotherapy injections to regain any lost ground from steroid injections. Even if a steroid injection provides temporary benefit, which is usual for 3 days to 2-3 weeks, the typical recurrence of pain when the steroid “wears off” often occurs.
Are headaches treatable with Prolotherapy?
The muscular attachments of the neck muscles on the base of the skull frequently become torn from injury, and can lead to dizziness, nausea, headaches, eye and ear pain, TMJ pain, and facial pain. These attachments are strengthened with Prolotherapy, and the pain and symptoms resolve accordingly. If you experience frequent headaches, even if you are told you have “migraine” headaches, muscle tension headaches, or “post-concussive headache” from head injury, you should consider seeing a specialist in Prolotherapy.
How does Prolotherapy treat TMJ and other joint problems?
Prolotherapy compliments the use of oral dental splints in the treatment of TMJ disorders.
Does Prolotherapy treat foot and ankle pain?
Many foot and ankle problems are treated and resolved with Prolotherapy. The most common and notable are Plantar Fasciitis, Morton’s Neuroma, bunions, and chronic ankle sprains. Each of these are the result of stretching of ligaments and joint capsules, which respond quite well to Prolotherapy. If steroid injections do not provide long-term relief for these, you should strongly consider Prolotherapy. You certainly can bypass steroid injections and surgery; treatment with Prolotherapy can and usually does achieve a great deal of success.
How can I test myself to see if Prolotherapy could help me?
The signature finding is pain that you can put a finger on. This may be at the top of the neck or base of the skull for headache pain, the top of the shoulder, the inner or outer elbow, the sides of the knee, or the groove between the inner edge of your hip bone and your tailbone (the sacroiliac joint), or a number of other common places where these tissue injuries occur. If you have stiffness and pain in your low back every morning, or pain from standing in one spot, these indicate a ligament injury. If you can precisely point to your source of pain, there is an excellent chance that Prolotherapy will resolve or at least greatly improve it.
Should I be skeptical of Prolotherapy because my doctor is not familiar with it?
Prolotherapy has been a part of the medical literature since the first article was written in 1937. Independent medical reviews have documented that the level of medical evidence for prolotherapy is as substantial as the literature for epidural steroid injections, facet joint injections, and other invasive spinal procedures done by pain physicians.
So Prolotherapy is a cure for everything?
Of course not. Many diseases and illnesses are not resolvable with Prolotherapy. Pain can originate in many tissues, and a complete, thorough examination is absolutely essential. The physician who practices Prolotherapy is usually one who has a great deal of experience with the treatment of musculoskeletal disorders and should also examine and test the patient for other causes of pain using appropriate studies, lab tests and other manner of testing to ensure that your condition is correctly managed. At times, consultation with a surgical specialist, a gynecology specialist, a gastrointestinal specialist, etc. may be necessary to ensure that your evaluation is complete.
Will Prolotherapy improve my loose joints?
Prolotherapy has been shown to increase the ligaments around joints by approximately 30-40% in strength and mass. This can remarkably improve torn ankle, knee, and other ligaments. Even if there is minimal pain with some of these injuries, the weakness can ultimately tear further and create greater dysfunction. Many athletes utilize Prolotherapy to strengthen their weak ligamentous tissues to reduce future risk of tears and injury. Prolotherapy is the only clinically proven method of regenerating and repairing torn cartilage inside joints.
Does Prolotherapy treat Fibromyalgia?
Many people diagnosed have been improperly diagnosed with fibromyalgia. A physician who performs prolotherapy can help you determine if your problem is truly fibromy or an injury that would respond to prolotherapy.
How many visits are necessary, and how frequent are they scheduled?
Most conditions are treated with 4-6 visits, but some may take more. After 2 visits, the patient should be experiencing improvement of their pain. Treatments are repeated every 3-4 weeks. 8-12 treatments may be required for more extreme injuries.
How long does it take to know if I will be improved or cured with Prolotherapy?
After 2 treatments, patients should note some improvement in their pain and function.
Is Prolotherapy expensive?
Prolotherapy costs between $250 to $350 per treatment session. Most insurers unfortunately still consider prolotherapy experimental and do not provide payment for it.
Are there any activity restrictions following the injection?
Patients should activities they know by experience will aggravate their pain. Movement, though, is important after injections and is encouraged. Physical therapy is an important part of successful prolotherapy. Manipulation should only be performed as needed.