Prolotherapy, A Safe and Effective Treatment for Musculoskeletal Pain

"I have been a patient who has benefited from Prolotherapy....My intractable pain was not intractable and I was remarkably improved."

--Former U.S. Surgeon General C. Everett Koop

"Prolotherapy was the right choice for me. My knee joint was painful, hot to the touch, and the knee cap snapped and popped. X-rays showed the joint had deteriorated significantly. After three treatments the ligaments and tendons had regained normal function and flexibility and I was pain free. Prolotherapy is a proven technique that has been around since the 1930s and I had read about it in golf magazines. Unlike cortisone, an injection which masks the pain, Prolotherapy restores joint integrity. Prolotherapy costs significantly less than orthopedic surgery and with no downtime. I had not realized that over time I had given up horseback riding, golfing, hiking, snowshoeing, and cross country skiing because it hurt. I no longer use the excuse 'I can't, I have bad knees.' I'm enjoying an active life again thanks to Dr. Neustadt and Prolotherapy."

--Joan, age 54, Bozeman, MT

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Musculoskeletal pain can be debilitating. Whether it's pain in the knees, low back, neck wrists or ankles, everyone experiences this discomfort at some time in their lives. It's been estimated that over their lifetime, 80% of Americans suffer from low back pain. There are many potential reasons for musculoskeletal pain. It can be from tight muscles, from direct injury from sports or a car accident, and even from food allergies or infections. But the most commonly overlooked cause of musculoskeletal pain is ligament or tendon instability.

Ligaments are bands of connective tissue that connect two or more bones. Tendons are bands of connective tissue that connect muscles to bone. Both of these structures--ligaments and tendons--are frequently damaged just by normal wear and tear. There are a lot of nerves at the spots where the ligaments and tendons attach to bones. When the ligaments and tendons are weakened, additional stress can be placed on these attachments and cause pain. George Hackett, MD, one of the founders of the modern techniques and education in prolotherapy in the U.S. concluded that up to 90% of people have degenerative changes in their weight bearing joints (low back, hips, knees, etc.) by the age of 40.

There are many causes for pain, and an integrative pain specialist will conduct a thorough interview with the patient and a detailed physical exam. Many pain treatments just suppress the symptoms with anti-inflammatories (eg, Aleve, Ibuprofen, Tylenol) and steroids. However, if the underlying cause is ligament or tendon instability, then in most cases it can be corrected with prolotherapy. The pain is relieved and function is restored.

Prolotherapy is a simple, natural technique. It has been used and studied for more than 70 years. Usually all that's injected is a simple solution contain dextrose, glucosamine, some vitamin B12 and a local anesthetic.

The underlying cause of musculoskeletal pain is often a weakened ligament. Prolotherapy can restore joint integrity and relieve pain from:

• arthritis
  
• whiplash
  
• sciatica
  
• disk problems
  
• low back pain
  
• rotator cuff (shoulder) pain
  
• tennis elbow
  
• old sports injuries that are now acting up
  
• knee pain (osteoarthritis, ACL or PCL injuries)
  
• TMJ (temporomandibular joint) dysfunction.
  

Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body's healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which "turns on" the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after Prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases!

The concept of strengthening ligaments goes back to the time of Hippocrates. Reports of shoulder joint instability and its many repair methods date back to Hippocrates' treatise, "On Joints." Hippocrates described the practice of using cautery to cause the capsule to scar and thus tighten around the joint. While his technique is no longer used, the underlying concept is similar to Prolotherapy—strengthen the ligaments.

In the 1930s many case reports emerged in France and the United States of musculoskeletal disorders, such asTMJ, knee pain, and sacroiliac joint (SI joint, which holds yourpelvis to your lower back), being successfully treated with Prolotherapy. In 1956, George Hackett, MD, a surgeon, published thefirst edition of the textbook Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hackett reported a 12-year success rate of 82% in the treatment of 1,800 patients with back pain using Prolotherapy.

Then, in 1983, microscopic examination of rabbit tendons after Prolotherapy treatment confirmed the that Prolotherapy stimulates connective tissue repair. This study was published in the journal, Connective Tissue Research (Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. 1983;11[2-3]:95-102). Another landmark study was published in 1987 in the prestigious journal Lancet by Dr. Thomas Dorman. The study demonstrated the effectiveness of using Prolotherapy to treat back pain (Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LF. A new approach to treatment of chronic low back pain. 1987;2:143-146). Interestingly, Dr. Dorman was Dr. Neustadt's mentor. Dr. Neustadt spent more than 300 hours studying directly with Dr. Dorman at Dr. Dorman's private clinic, the Paracelsus Clinic in Kent, WA (www.paracelsusclinic.com).

More recently, in 2005, the Mayo Clinic featured Prolotherapy in its Health Letter publication, which stated that Prolotherapy stimulates tissue growth and is used for tendon and ligament pain (Alternative Treatments. Dealing with Chronic Pain. Mayo Clinic Health Letter. 2005 Apr;23(4):1-3). Numerous clinical trials have proven Prolotherapy to be helpful in the treatment of musculoskeletal pain.

You may also learn more by reading Dr. Neustadt's FAQ on prolotherapy and a summary of Prolotherapy Research.