With the advancement of technology and medicine, new procedures and treatments for orthopedic conditions have come along, including orthobiologic therapy, smart implants, 3D printing technology, minimally invasive surgeries, and more. Yet, regenerative prolotherapy, a non-surgical regenerative injection treatment, is still an effective and low-cost treatment option for musculoskeletal injuries to muscles, tendons, and ligaments.
In this article, we’ll discuss the origins of regenerative prolotherapy and the role it has played in regenerative medicine for centuries.
What is Regenerative Prolotherapy?
Before getting into the origins of regenerative prolotherapy, it’s important to know what it is and exactly how it works. Regenerative prolotherapy, which is short for proliferation therapy, is a non-invasive treatment that involves injecting an irritant solution into a weak or damaged part of the body to regenerate and repair tissue. This solution, which often consists of dextrose (sugar), lidocaine (a local anesthetic), and sterile water is injected into tendons, joints, ligaments, and in adjacent joint spaces during several treatment sessions. This is to promote growth and improve the health of normal cells and tissues.Regenerative prolotherapy works by the same process the body uses to stimulate the natural healing system. That process is called inflammation. The irritant that’s injected into the body during regenerative prolotherapy causes an inflammatory response, which helps enhance the healing process.
So to understand regenerative prolotherapy, imagine what happens when you get a cut or sprain an ankle. Your body initiates an inflammatory response to heal whatever is “broken”. With a cut, your body works to form a scab and regenerate new skin cells. With an ankle sprain, your body initiates an inflammatory response, which causes the formation of blood clots. Then, your blood vessels trigger redness, swelling, and warmth. Finally, your body begins to produce new cells in the ligaments of your ankle.
In a nutshell, regenerative prolotherapy results in the same response your body undergoes after an injury. It involves injecting an irritant, which your body recognizes as a foreign invader. As a result, inflammation occurs. This helps create new ligament and tendon tissue. These ligaments and tissue grow back thicker and stronger. This creates a stronger bond at these attachment points, which means a decreased load on individual fibers. After regenerative prolotherapy, patients often experience significantly less pain, improved range of motion, and improved function in the treated area.
The History of Regenerative Prolotherapy
The Ancient Egyptians used a form of regenerative prolotherapy to treat lame animals. They would use branding or hot iron cautery to stimulate muscles and ligaments that weren’t functioning. Regenerative prolotherapy was first used on humans by Hippocrates. The Greek physician used a hot poker in the axilla (armpit) to repair a dislocated shoulder. From the 1830s to the 1920s, Regenerative prolotherapy was a common treatment for hernias, varicose veins, and hemorrhoids During the 1940s and 1950s, the use of prolotherapy for the musculoskeletal system other than hernias became more popular. Regenerative prolotherapy can be used to treat a variety of conditions:
- Joint pain and instability
- Back and neck pain
- Ligament sprains
- Tennis/golfer’s elbow
- Ankle pain
- Shoulder and knee pain
- Plantar fasciitis
- …and more.
What Can Patients Expect During a Regenerative Prolotherapy Visit?
Before your physician begins the procedure, he or she will discuss the potential risks and benefits of regenerative prolotherapy. Once you provide consent to undergo the procedure, your physician will position you on an exam table as well as prep and sterilize the treatment area, Your physician will then inject a local anesthetic, followed by the prolotherapy injection(s). Your physician will then cover the area to prevent infection. Overall, treatment of a single area of the body may take 10 to 15 minutes per session.
On average, patients receive 4 to 6 injections, The injections are usually administered 4 to 6 weeks apart. After the procedure, you may be sore for a few days. It’s also common to experience aching, burning, swelling, muscle spasms, numbness, and bruising after your visit. This is due to the fact that the injection produces irritation and inflammation that is intended to repair, strengthen, and heal the affected tissue.
How Long Before Patients Start Seeing Results from Regenerative Prolotherapy Injections?
It may take a little while for patients to see a significant improvement in the areas of treatment. Most patients should see some improvement in pain or functioning after two or three treatments. If a patient does not respond after 2 or 3 treatments, they will have to discuss future care plans with Dr. Janiga.
What If Your Condition is Too Severe for Regenerative Prolotherapy to Be Effective?
Some more severe painful conditions will require stronger regenerative prolotherapy solutions. There are many forms of regenerative prolotherapy. Any injection method that strengthens or repairs a patient’s ligaments or tendons is prolotherapy. Examples of stronger prolotherapy solutions: platelet-rich plasma (PRP) which utilizes a patient’s own growth factors from their own blood or utilizing amniotic allograft growth factors, or even using a patient’s own stem cells from their bone marrow.
How Do Platelet-Rich Plasma Injections Work?
Platelet-rich plasma (PRP) injections involve injecting a concentration of your own platelets to accelerate the healing of injured tendons, ligaments, muscles, and joints. To put it plainly, PRP injections use your own healing system to improve orthopedic problems. If you have chronic musculoskeletal pain, PRP therapy may be right for you. PRP therapy works similarly to prolotherapy in that it initiates the body’s natural healing process, The difference is, PRP involves the use of your own platelets instead of an irritant. For example, when an injury occurs, the body sends platelets — small, colorless cell fragments in our blood that form clots to stop or prevent bleeding — to the site of the injury in an effort to fix the damage. PRP therapy helps harness and boost your body’s natural healing ability.
How Does Bone Marrow Concentrate Work?
Bone marrow concentrate (BMC) is another regenerative procedure that can be used to treat a number of orthopedic conditions. Bone marrow contains healing cells taken from your own body. These cells are concentrated and reinjected into the area of need to bolster the healing response and help new tissue formation. Bone marrow concentrate is usually for patients with osteoarthritis, or moderate to severe orthopedic injuries.
Call on a Trusted Physician for Your Regenerative Prolotherapy Injections
If you’re looking for a trusted doctor to treat your orthopedic condition, we’re here to help. Dr. Mark Janiga specializes in prolotherapy injections for patients in need. Schedule an appointment today for an evaluation of your condition.
1 Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesthesia and Pain Medicine. 2020 Dec 16. [Google Scholar]
2 Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesthesia and Pain Medicine. 2021 Jan 31;16(1):81. [Google Scholar]
3 Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. [Google Scholar]
4 Johnston E, Kou Y, Junge J, Chen L, Kochan A, Johnston M, Rabago D. Hypertonic Dextrose Stimulates Chondrogenic Cells to Deposit Collagen and Proliferate. Cartilage. 2021 Jun 10:19476035211014572. [Google Scholar]
5 Shan Sit RW, Keung Wu RW, Rabago D, et al. Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial. Ann Fam Med. 2020;18(3):235‐242. doi:10.1370/afm.2520 [Google Scholar]
6 Sert AT, Sen EI, Esmaeilzadeh S, Ozcan E. The Effects of Dextrose Prolotherapy in Symptomatic Knee Osteoarthritis: A Randomized Controlled Study. J Altern Complement Med. 2020;26(5):409‐417. doi:10.1089/acm.2019.0335 [Google Scholar]
7 Rabago D, Kansariwala I, Marshall D, Nourani B, Stiffler-Joachim M, Heiderscheit B. Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project. The Journal of Alternative and Complementary Medicine. 2019 Jan 28. [Google Scholar]
8 Wee TC, Neo EJ, Tan YL. Dextrose prolotherapy in knee osteoarthritis: A systematic review and meta-analysis. Journal of Clinical Orthopaedics and Trauma. 2021 May 20. [Google Scholar]
9 Giordano L, Murrell WD, Maffulli N. Prolotherapy for chronic low back pain: a review of literature. Br Med Bull. 2021 Apr 21:ldab004. doi: 10.1093/bmb/ldab004. Epub ahead of print. PMID: 33884404. [Google Scholar]
10 Solmaz İ, Akpancar S, Örsçelik A, Yener-Karasimav Ö, Gül D. Dextrose injections for failed back surgery syndrome: a consecutive case series. European Spine Journal. 2019 Jul;28(7):1610-7. [Google Scholar]
11 Dasukil S, Arora G, Shetty SK, Degala S. Impact of Prolotherapy in TMDs: a quality of life assessment. British Journal of Oral and Maxillofacial Surgery. 2020 Oct 27. [Google Scholar]
12 Louw WF, Reeves KD, Lam SK, Cheng AL, Rabago D. Treatment of temporomandibular dysfunction with hypertonic dextrose injection (prolotherapy): A randomized controlled trial with long-term partial crossover. InMayo Clinic Proceedings 2019 May 1 (Vol. 94, No. 5, pp. 820-832). Elsevier. [Google Scholar]
13 Majumdar SK, Krishna S, Chatterjee A, Chakraborty R, Ansari N. Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study. J Maxillofac Oral Surg. 2017 Jun;16(2):226-230. [Google Scholar]
14 Zhou H, Hu K, Ding Y. Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation. Br J Oral Maxillofac Surg. 2014 Jan;52(1):63-6. doi: 10.1016/j.bjoms.2013.08.018. [Google Scholar]
15 Cezairli B, Sivrikaya EC, Omezli MM, Ayranci F, Cezairli NS. Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series. The Journal of Alternative and Complementary Medicine. 2017 Oct 10. [Google Scholar]
16 Taşkesen F, Cezairli B. Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility. CRANIO®. 2020 Dec 18:1-9. [Google Scholar]