What is Prolotherapy?
Ross Hauser, M.D.

Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. Notice I said "a little assistance". Because often, that's all the body needs, the rest it can take care of on it's own. In most cases, commonly prescribed anti-inflammatory medication and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.
 

The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local Inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness, but depends upon the technique of the individual Prolotherapist. The most important aspect is injecting enough of the solution into the injured and weakened area. If this is done, the likelihood of success is excellent.
 

Prolotherapy involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint. A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments and tendons generally have a poor blood supply, incomplete healing is common after injury. This incomplete healing results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.
 

The greatest stresses to the ligaments and tendons are where they attach to the bone, the fibro-osseous junction. The most sensitive structures that produce pain are the periosteum (covering of the bone) and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), the periosteum ranks first, followed by ligaments, tendons, fascia (the connective tissue that surrounds muscle), and finally muscle. Cartilage contains no sensory nerve endings. If you are told that your cartilage is the cause of your pain, you have been misinformed; the cartilage cannot hurt because they contain no pain sensing nerves. If there is cartilage damage, the ligaments are typically the structures that hurt. Ligaments are weakest where they attach to bone. The periosteum is the most sensitive area to pain and the ligaments second. It is now easy to understand why this area hurts so much. This is where the Prolotherapy injections occur, and thus eliminate the chronic pain of many conditions including arthritis, mechanical low back pain, degenerative disc disease, cartilage injury, and sports injuries.
 

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. Yes, you heard me right. 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!
 

In 1983, Y. King Liu performed a study using the knee ligament in rabbits. This study was done in order to quantify the strength of the tissue formed by Prolotherapy. In this study, a proliferant was injected into the femoral and tibial attachments of the medial collateral ligament, the inside knee ligament. The ligaments were given five Prolotherapy treatments and then compared to non-injected ligaments. The results showed that in every case Prolotherapy significantly increased ligamentous mass, thickness, and cross sectional area as well as the ligament strength. In a six-week period, ligament mass increased by 44 percent, ligament thickness by 27 percent, and the ligament bone junction strength by 28 percent. This research was yet another attestation to the effectiveness of Prolotherapy, showing that Prolotherapy actually causes new tissue to grow. Imagine what it would mean to an athlete to run 40 percent faster, jump 40 percent higher, or be 40 percent stronger? This new growth of stronger, healthier tissue is the normal and desired outcome with Prolotherapy.

The concept behind Prolotherapy

The term Prolotherapy was coined by George S. Hackett, M.D., the "father of Prolotherapy", in 1956. He describes Prolotherapy as follows:

"The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the weld of fibrous tissue and bone to stabilize the articulation (where the bone and ligament meet) and permanently eliminate the disability. To the treatment of proliferating new cells, I have applied the name 'Prolotherapy' from the word 'Prolo' (Latin) meaning offspring; 'proliferate' - to produce new cells in rapid succession (Websters Dictionary). My definition of Prolotherapy as applied medically in the treatment of skeletal disability is 'the rehabilitation of an incompetent structure by the generation of new cellular tissue.'"

Dr. Hackett, after 20 years of experience, arrived at the conclusion that injured ligaments were the primary cause of chronic pain. Injured tendons were the second most common cause. He referred to this weakness in the ligaments and tendons as laxity. Prolotherapy involves the injection of substances that stimulate new tissue growth at the junction between the fibrous tissue (ligaments and tendons) and the bone. Most things break down at a junction site because this is the weakest part of the structure; this is especially true in weight bearing joints. A good example of this is when the leg of a chair is wobbly or loose. This is usually due to a loose connection where the leg attaches to the seat of the chair. By tightening the attachment of the leg to the seat, the chair becomes more stable.
 

Dr. Hackett used the word "weld," which is a very accurate description of Prolotherapy. Prolotherapy welds the ligaments and tendons to the bone. When welding steel, the welder is applying a very hot probe or flame to melt two pieces of metal together. Two large pieces of metal would require welding many areas all along the long seam. Why do so many spots need to be welded? The reason is to make a stronger connection. If one area weakens in the future due to wear and tear, the others will hold the structure together.
 

This is the concept behind Prolotherapy. All of the injured tissue must be treated for injuries for chronic pain to be eliminated. Prolotherapy causes the proliferation of new ligament and tendon tissue exactly where the injections are given. It is just like spot welding. It strengthens the exact spot where the weld or injection takes place. The more injections, the stronger the weld.
 

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