PROLOTHERAPY
STEPHEN W. BLIEVERNICHT, M.D.,F.A.C.S. 

George S. Hackett, M.D., and two Philadelphia osteopathic surgeons, Doctors Gedney and Shumann, discovered Prolotherapy in the 1920’s. Since its inception, it has been called Proliferative Therapy, Reconstructive Therapy and Sclerotherapy. 

Prolotherapy is an injection technique that has been shown to cause proliferation (growth) of cells and tissue to stabilize and strengthen weakened joints, cartilage, ligaments and tendons. The injected solution intentionally causes controlled irritation in the injected tissue. This irritation is an inflammatory response, which increases the blood supply and thereby stimulates the tissue to heal and regrow new tissue. 

For example, let’s look at the spine. It is composed of bone, tendons, ligaments, discs and cartilage. Discs and cartilage serve as shock absorbers and keep bones from rubbing against one another. Ligaments function as the primary stabilizers of joints. They connect bones to each other and function to limit the range of motion that bones can move. Tendons connect muscles to bones in order to provide motion. In acute injuries, the ligaments and tendons become torn and are unable to stabilize joint areas. This causes the discs or cartilage to become worn down from increased stress, pressure and friction. Discs and cartilage may also be worn down by repeated motion. This ultimately leads to joint instability resulting in constant pain, less and less mobility, and lack of endurance. 

Stimulating repair of the supportive tissues of the spine (or any joint) through Prolotherapy can result in greatly improved stability, mobility and decreased pain. Each treatment session results in the stimulation of more and more tissue repair in the treated areas. Thus, the natural functions of the body are regained. In almost all cases, pain reduces significantly or disappears entirely. Prolotherapy can be administered wherever ligaments, tendons, cartilage and/or discs are torn and worn. It is not effective for all joint pain. Rheumatoid arthritis, for example, is not helped by Prolotherapy, but Osteoarthritis and degenerative arthritis often respond well. 

Physician assessment of the appropriateness of any particular condition for Prolotherapy will occur during the first office visit. 

Addressing energetic disturbances created by scar tissue on the skin from injury or surgical incisions is also part of Prolotherapy, which a trained physician will address by the injection of a local anesthetic into reactive scar tissue. 

The therapies currently available to persons with chronic joint instability and pain are anti-inflammatory drugs, cortisone, pain medications, exercise, surgery, and chiropractic care.

Persons treated with Prolotherapy are unable to use non-steroidal anti-inflammatory drugs or NSAIDS (like Aleve, Ibuprofen, Aspirin, Celebrex, Vioxx) or Cortisone during the course of their treatment with Prolotherapy. The desired inflammatory response to the injections is critical to Prolotherapy success and cannot be blocked by such drugs without risking failure of the Prolotherapy treatment. In addition, the innate risks of the long-term use of NSAIDs have been demonstrated clinically in the impairment of organ systems as well as the breakdown and deterioration of the musculoskeletal system.

Cortisone drugs (steroids) have numerous serious local and systemic effects. Their chronic use weakens natural defenses, risks further deterioration of joint tissues when injected locally, can be associated with a progressive lack of blood supply to the head of the femur called avascular necrosis which may necessitate hip joint replacement, increases the risk of acquiring diabetes, and has the potential for psychiatric side effects.

Drugs to treat muscle spasm may be used concurrently with Prolotherapy, but those which are compounded with anti-inflammatory drugs, as many are, should be avoided.

Pain medications generally alleviate symptoms while leaving the pathology unaltered. This is akin to someone putting tape over the red engine light on the dashboard of his car. During Prolotherapy, analgesic (pain-relieving) medications may be prescribed for short term use during the immediate post treatment period to relieve the discomfort that may occur during the acute inflammatory process the treatment produces in order to heal. 

Exercise can strengthen muscles but further weaken tendons, ligaments and cartilage that have poor blood supply, worsening the joint instability. Specific stretching exercises, however, can increase blood supply to tendons and ligaments and preserve mobility. 

Surgery often leaves the joint mechanically compromised as removal of tissue permanently alters complex joint physics consisting of levers and pulleys. Surgery remains the method of choice for severed tendons and ligaments, and replacement of eroded bone necessitating joint prosthesis. 

Chiropractic optimizes structure by enhancing nervous system functioning and is capable of removing obstacles to healing. However, it has inherent limitations to effect healing to the degree necessary to stop pain by regenerating new tissue. 

THE “PROS AND CONS” OF PROLOTHERAPY

First, the “Cons”: 

The injections are experienced as being uncomfortable by many patients. (Some of this discomfort during treatment can be ameliorated by a variety of techniques including pre-medication, conscious sedation, guided imagery, and breathing and relaxation exercises. We are happy to explore these adjunct comfort therapies with you). 

The injections typically need to be repeated a number of times over a period of a few months. 

The person treated will likely experience a few days of increased swelling and discomfort at the injection site-a necessary part of the healing process. 

Not all insurance companies reimburse for the treatment. 

And now, the “Pros” and benefits: 

It promotes the body’s own natural healing ability. 

The natural functions of the body are regained and optimized. 

No drugs or surgery are used. 

It relieves pain. 

In a double blind human study where neither the patients nor the researchers knew specifically who was receiving the treatment, 88.5% of those injected with the Prolotherapy solutions showed improvement. 

Results are permanent (though aging continues). 

It is a conservative treatment. 

The solutions used are made from natural ingredients. 

It is considerably less expensive than surgical intervention. 

Enhancing the body’s innate ability to heal is characteristic of many treatments offered at the Phoenix Medical Center and is often the hallmark of a well thought out medical approach, which minimizes adverse effects. Personalizing and tailoring the course of Prolotherapy to the needs of the individual client and his or her physical and emotional constitution are essential elements of our integrated and holistic approaches to pain care.

Adapted from “Prolotherapy for Chronic Joint and Spine Pain” by 
Stephen W. Blievernicht, M.D., F.A.C.S., published in Carolina Health and Healing,1999. 

ADDITIONAL NOTE: Dr. Blievernicht is his own testimonial to the benefits of Prolotherapy. After a lifetime of sports injuries and ergonomically acquired aches and pains, he has undergone Prolotherapy to his neck, shoulders, elbows, hands, back, hip, knees and feet. The treatments have allowed him to continue to enjoy the practice of medicine, his sport and recreational hobbies, and life in general. In addition, he has a greater appreciation of the impact of chronic and acute pain on his patients and empathy for those who seek relief from that experience.