Back More
Salem Press

Table of Contents

Principles of Sports Medicine & Exercise Science

Prolotherapy

Category: Therapies and techniques

Related term: Sclerotherapy

Specialties and related fields: Alternative and complementary medicine, athletic training, chiropractic, occupational therapy, physical therapy

Definition: treatment involving injections of chemical irritant solutions into the area around a loose ligament

KEY TERMS

ligaments: a short band of tough, flexible fibrous connective tissue that connects two bones or cartilages or holds together a joint

myofascial release: an alternative medicine therapy claimed to be useful for treating skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation, and stimulating the stretch reflex in muscles

tendons: a flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone

OVERVIEW

Invented in the 1950s by George Hackett, prolotherapy is based on the theory that chronic pain is often caused by the laxness of ligaments responsible for keeping a joint stable. When ligaments and associated tendons are loose, the body is said to compensate by using muscles to stabilize the joint. According to prolotherapy theory, the net result is muscle spasms and pain.

Prolotherapy treatment involves injecting chemical irritant solutions into the area around such ligaments. These solutions are believed to cause tissue to proliferate (grow), increasing the strength and thickness of ligaments. Increased strength and thickness of ligaments presumably tighten up the joint and relieve the burden on associated muscles, stopping muscle spasms. In the case of arthritic joints, increased ligament strength would allow the joint to function more efficiently, thus reducing pain.

Prolotherapy has not been widely accepted in conventional medicine. Prolotherapy practitioners use the technique to treat many conditions, including back pain, osteoarthritis, fibromyalgia, plantar fasciitis, sciatica, sports injuries, temporomandibular joint disorder, tendonitis, and tension headaches. Most studies have focused on its use in back pain and osteoarthritis. Still, the evidence does not support its effectiveness.

How is prolotherapy performed? Prolotherapy is generally administered at four to six weeks intervals, although studies have used a more frequent schedule. The treatment involves the injection of a mixture containing an irritant and a local anesthetic. A total of four to six treatments is typical. When treating back pain, prolotherapy practitioners frequently use a form of manipulation similar to chiropractic. However, the manipulation is applied after a local anesthetic has been injected and is somewhat intense.

There are several irritant solutions used in prolotherapy. Concentrated dextrose or glucose has become increasingly popular because it is completely nontoxic. Phenol (a potentially toxic substance) and glycerin are also sometimes used. Other nonirritant substances may be added to the solution, such as vitamin B12, corn extracts, cod liver oil extracts, zinc, and manganese; however, there is no evidence that these substances add any benefit.

SCIENTIFIC EVIDENCE

Some animal and human studies have found that prolotherapy injections increase the strength and thickness of ligaments. Six double-blind human trials of prolotherapy have been reported: four involving back pain (with mixed results) and the other two involving osteoarthritis (with positive results).

Back pain. Although two studies have suggested prolotherapy may be effective for low back pain, two more recent studies found prolotherapy to be ineffective. In a review of five studies, three found prolotherapy to be no more effective than control treatments for low back pain. The other two studies suggested that prolotherapy was more effective than control treatments when used with spinal manipulation and exercise therapies. Another review suggested that prolotherapy may be effective with other therapies but not when used alone.

When used alone, prolotherapy is probably no more effective than a placebo injection to treat low back pain. However, there is evidence that the technique may be beneficial when combined with other therapies.

Osteoarthritis. A double-blind, placebo-controlled study evaluated the effects of three prolotherapy injections (using a 10 percent dextrose solution) at two-month intervals in sixty-eight people with knee osteoarthritis. At the six-month follow-up, participants who had received prolotherapy showed significant improvements in pain at rest and while walking. These participants also showed reduced swelling and fewer episodes of “buckling” than those who had received placebo treatment.

The same research group performed a similar double-blind trial of twenty-seven people with osteoarthritis in the hands. The six-month follow-up results showed that range of motion and pain with movement improved significantly in the treated group compared with the placebo group.

SAFETY ISSUES

In studies, prolotherapy has not caused any serious, irreversible injury. After each injection, the discomfort usually lasts for a few minutes to several days, but this discomfort is seldom severe. More concerning is that severe headaches have been reported in treating low back pain in a minority of patients. Also, because phenol is potentially toxic, treatment with a dextrose solution alone is preferable.

CHOOSING A PRACTITIONER

Prolotherapy is practiced by a medical doctor or a doctor of osteopathy. Generally, physicians specializing in orthopedics or physical medicine and rehabilitation are most likely to practice prolotherapy.

Further Reading

1 

Bauer, Brent A. “Prolotherapy: Solution to Low Back Pain?” Mayo Clinic, 25 May 2018, www.mayoclinic.org/prolotherapy/expert-answers/faq-20058347.

2 

Delzell, Emily. “Prolotherapy for Osteoarthritis.” Arthritis Foundation, www.arthritis.org/diseases/more-about/prolotherapy-for-osteoarthritis.

3 

Fletcher, Jenna. “Prolotherapy: Uses, Side Effects, and Costs.” Medical News Today, 17 Dec. 2017, www.medicalnewstoday.com/articles/320330.

4 

Hackett, George Stuart, et al. Ligament and Tendon Relaxation: Treated by Prolotherapy. Institute in Basic Life Principles, 1993.

Citation Types

Type
Format
MLA 9th
"Prolotherapy." Principles of Sports Medicine & Exercise Science, edited by Michael A. Buratovich, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=POSpKin_0120.
APA 7th
Prolotherapy. Principles of Sports Medicine & Exercise Science, In M. A. Buratovich (Ed.), Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=POSpKin_0120.
CMOS 17th
"Prolotherapy." Principles of Sports Medicine & Exercise Science, Edited by Michael A. Buratovich. Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=POSpKin_0120.