Prolotherapy is a safe, effective injection treatment which provides increased strength in joints, ligaments and tendons by making new connective tissue. It can eliminate even chronic longstanding back, neck and joint pain. The solution used is usually 20% glucose or less, mixed with a local anaesthetic called lignocaine. It was developed by a USA surgeon, George Hackett in the 1940s and has been refined and researched by many other doctors since then. It is used in several different ways:
Strained ligaments leave muscles and joints weak and unprotected, and cause muscle spasm and instability leading to osteoarthritis in joints. They can also become strained if overstretched constantly, for example, the typist’s upper back.
Strengthening ligaments for low back, neck eg whiplash, sprained ankles, pelvis and many other injuries, has been the mainstay of prolotherapy treatment for decades. Surprisingly mobility has been shown to increase. This is because stiffness is often due to protective muscle spasm, and once the pain from the ligaments is relieved the muscles relax.
When tendons are overused they become painful and occasionally fail to heal due to excess VEGF. The swollen or torn tissue can be seen on ultrasound, and with modern techniques, neovessels can be seen around the tendon. They have nerves alongside them which are very painful. The usual treatment for tendinopathy in knees, Achilles tendon and elbows is rest, then very slow increase in exercise. This can take months or years. The glucose in the prolotherapy solution inhibits VEGF and allows the healing to occur much more quickly.
Pain can be due to injury to the nerves themselves. If there is restriction of the fibres of a nerve, the nutrients can’t flow down the fibres, so the nerve can’t repair itself, and becomes painful. These points are extremely tender. Inflammation in the nerve (neurogenic inflammation) causes inflammation in the soft tissues and joints, preventing healing. The glucose allows healing in the nerve itself and the tissues it supplies. This new technique was developed by Dr John Lyftogt in NZ and is called Neural Prolotherapy. It is done with very fine short needles as the nerves are cutaneous nerves, close to the skin.
Ligaments are vital for joint stability. If strained and loose, the joint slips and slides out of the track it was designed to follow, and the cartilage becomes worn causing osteoarthritis. Prolotherapy for worn joints (knees, hips, fingers and shoulders) involves treatment of the ligaments around the joint and usually injection into the joint, as it also stimulates regrowth of cartilage. This has been seen on xray in some knees.
The solution is injected to where the pain is coming from. Usually many different points must be injected. The local anaesthetic brings relief of pain for a short time. This is useful diagnostically; especially if there has been some doubt where the pain is coming from. The inflammation begins – and pain may occur and may last up to 2 days. Pain relief is used if necessary.
A series of 6 or 8 injections are usually necessary for low back pain, 4 – 6 for neck problems, 2 – 3 for upper back, elbow or foot, while the knee is variable. The spacing of the treatments varies from weekly to monthly. Two weeks apart is a good time.
Since 1998 I have trained over 250 doctors and 150 podiatrists to use this technique and there are more than 70 research reports published in medical journals, most showing that the technique is more effective than most other treatments for these problems.
For low back pain, 20% of patients have no pain and a further 50% of patients have more than 50% reduction in their level of pain. Legs and arms are easier. Sports injuries are usually more successful as people are often younger or fitter and eating better, for example, 92% of groin injuries respond in 2-3 treatments. Middle aged people need more treatments and may need to return in a few years for another course. Older folk sometimes have injections every 2 months or so, to enable them to be pain-free and avoid dangerous anti-inflammatory drugs.
No aspirin, other anti-inflammatory drugs or liniments should be used for pain relief while having prolotherapy, as they will prevent the inflammatory process that is being encouraged.
For pain relief use paracetamol or codeine. Ask your pharmacist if in doubt.
Exercises are necessary to re-educate correct muscle patterns. This is particularly so for the low back – walking is excellent. They can begin immediately or when the pain has decreased. They should not be painful.
Nutrients are very important to encourage good health and repair of ligaments and discs and bones and should be taken until three months after the end of treatment.
- Vitamin C 1000 – 2000 mg/day (makes strong connective tissue, helps healing).
- Manganese (as chelate) 5-10mg/day. (essential for discs, cartilage).
- Zinc (usually as chelate)15-30mg/day (wound healing, important for new protein).
People who eat lots of vegetables, wholemeal bread, nuts and animal protein will do better than those who eat lots of sweet foods and breakfast cereals and white bread. People who are terribly needle phobic, or whose problem is mild, may find that these measures alone, will give great relief.