How it Works

Prolotherapy is an innovative injection technique developed in 1930s by Dr George Hackett, surgeon in the USA, effective in treating most chronic injuries. It is an elegant refinement of the centuries-old sclerotherapy which produced scar tissue to stabilise joints and relieve pain.

When an acute injury fails to heal, the strain or sprain is usually at the enthesis (attachment to the bone) – the weakest point. If laxity is not corrected, pain receptors in the ligaments are constantly stimulated by movement, and muscle spasm results.

Prolotherapy involves injection of hyperosmolar glucose or other irritating solution to the enthesis. This initiates the wound healing cascade. Inflammatory mediators attract fibroblasts which secrete collagen. The new collagen matures, gradually restoring strength to the enthesis and relieving pain. Banks 1993 . The tendency of collagen to contract as it matures, which is a disadvantage in burns, is of benefit in prolotherapy as it can correct the laxity of strained ligaments.

Light and electron microscopic studies of human posterior sacro-iliac ligaments have shown marked fibroblastic hyperplasia and increase in collagen fibril size. The treated ligaments and entheses become 30-40% stronger when compared with saline controls. This is used to treat low back pain, whiplash and other neck pain, headache and migraine, chronic upper thoracic pain, sports injuries to ankles, knees, wrists, fingers, and elbows, tennis elbow, Osgood Schlatters knees in teenagers, temporo-mandibular joint dysfunction, calcaneal spur and many other problems.

It is an excellent addition to musculo-skeletal and orthopaedic practice and as a result of Yelland’s trial in Spine2004, Bogduk recommends, in Management of chronic low back pain, in MJA 2004 that “Injections into tender attachment sites for ligaments are a simple treatment that GPs can perform. They can achieve complete relief of pain in 20% of patients and significantly reduce pain in 40%. These figures are no worse than those for the best alternatives, and better than most.” Cyriax described use of ‘sclerosants’ in his book, Orthopaedic Medicine in 1983.