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Prolotherapy induces an inflammatory response

When injected near injured tissue, Prolotherapy which is a  hypertonic Dextrose solution, is thought to irritate tissues causing an inflammatory healing response.

As a result, growth factors are released from adjacent tissue to potentially stimulate blood vessel formation. These vessels bring nutrients, oxygen and collagen building blocks to further facilitate healing of damaged tissue. Growth factors also help to recruit fibroblasts which are the cells responsible for collagen production. Collagen is the main component of most healing tissues so the more collagen that is produced, the more efficient the healing will be.

Prolotherapy is a therapeutic technique developed by George Hackett, MD and Gustav Hemwall, MD in the 1950’s. The term “prolo” is in reference to the “proliferative” phase of healing. It is in this phase that collagen production is amplified to stimulate healing of various tissue types (i.e. tendon, ligament, fascia, bone, etc). Prolotherapy utilizes 50% Dextrose solution usually diluted with saline and/or Lidocaine to a concentration of 12-15%. 

Prolotherapy is thought to strengthen ligaments, tendons, fascia, cartilage and bone because the density of collagen increases.

Greater collagen density equates to increased ligament size and mass leading to healing and repair of articular cartilage. A Prolotherapy injection is generally administered into the area of injury with ultrasound guidance for precise placement. Typically, a prolotherapy injection results in 3-7 days of increased mild-moderate pain.

A mild pain medication (e.g. Tylenol, Ultram) may be necessary to manage the 3-7 days of soreness. NO ice or NSAIDs are recommended for 2 weeks following the procedure to allow for full healing effects. Light physical activity to tolerance is encouraged in days following injection. It usually requires 2-3 injections spaced approximately 3 weeks for most conditions. Physical therapy is often employed to encourage mobility as soon as one week following an injection.

Protherapy has been used for over 70 years and is considered safe with minimal side effects. Allergic reactions, infections, nerve bruising are extremely rare but are possible. There is no risk of tendon ruptures, which can be a complication of cortisone injections.

Prolotherapy Vs Platelet Rich Plasma Vs Orthobiologic Treatment

Prolotherapy is no longer used widely since Bone Marrow Aspirate or Platelet Rich Plasma (PRP) is considered more effective. This is likely due to more limited release of growth factors in Prolotherapy versus Bone Marrow Aspirate or PRP. In addition, Prolotherapy is less technically demanding and less expensive than Bone Marrow Aspirate or Platelet Rich Plasma injections.

Prolotherapy’s main value is in adding stability to unstable joints. It is often very effective for strengthening outer ankle ligaments to reduce chronic ankle sprains. It is used to stabilize Cuboid Syndrome (i.e. dislocating or subluxing cuboid bone in the foot after ligament injury). It is still employed for use in healing injured or torn tendons, sprained or torn ligaments, tendinopathy including tendinosis, enthesopathies, and even Plantar Fasciitis.

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