What is in Prolotherapy injections?

When you get a Prolotherapy treatment or “prolo,” as some call it, you are getting injections. What type of injections?

These are the type of questions our staff gets via phone and email and if you are reading this article, it is likely the same questions you have.

Prolotherapy is a customizable treatment. It can be all these injection solutions and more. Prolotherapy can give given with stem cells. Prolotherapy can be combined with Platelet Rich Plasma Therapy. Prolotherapy can be simple dextrose. At Caring Medical our philosophy is to always offer the least complicated and simplest methods first and then move on to blood platelets and stem cells if there is not sufficient response.

Video: What type of treatment do I need?

In this video, Danielle R. Steilen-Matias, MMS, PA-C, offers a brief introduction to treatments. Explanatory and summary notes are below:

A major factor in determining which treatment to get is the extent of your injury and whether this is a recent injury or a problem with degenerative joint disease or degenerative arthritis.

  • General patient type 1: Younger patient, athlete, active, or with a physically demanding job. Recent injury, such as a sprain that has not healed all the way.
    • Injury is still causing pain and discomfort.
    • This is the type of injury that does very well with dextrose Prolotherapy injections.
    • Dextrose is a sugar water that when injected into the injured joint attracts you own healing repair cells into the area to fix damaged soft tissue such as ligaments and tendons.
  • General patient type 2: Chronic problems from an “old” injury, such as a sprain that happened a few years ago,
    • Injury “never really healed,” has progressively worsened. Causing pain, discomfort.
    • Injury has not responded long-term to more conservative care options such as NSAIDs, medications, cortisone, physical therapy
    • Soft tissue damage continues, joint instability has become more permanent.
    • In this patient, it may not be enough to attract your own cells to this damaged area with Prolotherapy, in this type case we may have to put cells there by injection. Our first option would be Platelet Rich Plasma Therapy (PRP). This would put the healing factors found in your blood platelets into the damaged joint.
    • WE DO NOT offer PRP as a stand-alone treatment or injection. While PRP brings healing cells into the joint, it acts to repair degenerative damage. In our experience, while PRP addresses damage deep in the joint, we must still address the joint instability problem created around the joint. We do this with Prolotherapy. Here damaged or weakened ligaments that are simply “stretched,” can be strengthened with treatment to help restore and maintain normal joint mobility.
    • Simple PRP on the inside, Prolotherapy on the outside of the joint.
  • General patient type 3: Chronic long-term degenerative problems. Possibly in need of a joint replacement
    • This is a patient who may have had degenerative joint disease for many years even decades. These are the “bone on bone people.” They have exhausted all means of conservative care, they may have had short-term success with PRP treatments, hyaluronic acid treatments, cortisone injections, but none of these are helpful anymore.
    • It is important to realize and it will be explained in this article, that it is rare that we would need to go to stem cell therapy in many of these patients. When we do recommend stem cells it would be from your own stem cell sources and mostly taken from bone marrow. We do not offer “stem cell therapy,” from donated source material.

However, fitting all this under the term Prolotherapy can be confusing to patients, doctors, and researchers and can lead some to the question of Prolotherapy’s effectiveness

Not only are patients confused, but researchers as well.

Doctors at Ohio State University wrote in the medical journal Physical Medicine and Rehabilitation that Prolotherapy is a technique that involves the injection of an irritant, usually dextrose solution for the treatment of chronic painful musculoskeletal conditions. Despite its long history and widespread use as a form of complementary therapy, there still are disparities over its optimal indications and injection preparations.(1)

In one paper, even the researchers were not sure if the patients received Prolotherapy or some other procedure called Prolotherapy. Doctors at the Chonnam National University Hospital, Korea wrote in The Journal of Alternative and Complementary Medicine:

“Controversy exists regarding the efficacy of ligament Prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies.”(2)

In other words, success for Prolotherapy was dependent on technique. So when someone says “Prolotherapy did not work or was not supported in the research,” was it Prolotherapy or some other procedure called “Prolotherapy?”

The effectiveness of Prolotherapy does depend upon the technique of the individual doctor, as well as the overall health and dedication of the patient to encourage the healing process after each treatment.

This was pointed out by research from the University of Wisconsin School of Medicine and Public Health and our friend and colleague David Rabago, MD. Publishing in the medical journal Primary care clinics in office practice Dr. Rabago wrote:  “Prolotherapy techniques and injected solutions vary by condition, clinical severity, and practitioner preferences.”(3)

What do we use in our Prolotherapy injections?

Prolotherapy Knee Injection SitesThe Prolotherapy technique we use at Caring Medical is called Comprehensive Prolotherapy or Hackett-Hemwall-Hauser (H3) Prolotherapy. This type of Prolotherapy incorporates the teaching and techniques of doctors George S. Hackett, MD, and Gustav A. Hemwall, MD, two of the pioneers in the field, as well as developments made in our 3 decades of clinical experience and analysis of results.

The primary ingredient in Prolotherapy injections used at Caring Medical is dextrose. How does dextrose accelerate healing?

This technique involves using the simple and safe base solution dextrose as the primary proliferant, along with an anesthetic (such as procaine or lidocaine), that is given into and around the entire painful/injured area(s). Many injections are given during each treatment, versus just a few injections. Most treatments are provided every 4 to 6 weeks to allow time for the growth of new connective tissues.

In these basic Prolotherapy injection solutions, we also use an alkaline extract of the pitcher plant called Sarapin. Almost all pain issues have some kind of nerve component, which Sarapin helps to relieve. In our experience, Sarapin enhances the healing effects of injection treatments and has an excellent safety profile. It is one of the few materials found in the Physicians’ Desk Reference that has no known side effect. Also in the basic solution, to help ease the pain of the injection procedure, as well as provide pain relief to the area, procaine or lidocaine is added in very small quantities. Often, this helps to ease the pain right away after the procedure, but is used in such a small amount to not cause any adverse effect to the joint repair/wound healing cascade.

Prolotherapy Hip Injection SitesWith a comprehensive approach, we utilize many different types of Prolotherapy solutions, individualizing each treatment according to the patients’ unique needs. The solutions are changed depending on the individual patient and the amount of inflammatory reaction required to produce sufficient healing and new collagen growth. We also use cellular proliferants such as blood, PRP (platelet rich plasma), bone marrow, and stem cells.

For more information on these treatments please see our articles:

As with other medical procedures, Prolotherapy is a specialty. If you are looking into Prolotherapy, you first want to make sure that the Prolotherapy doctor or Prolotherapist experienced in the Comprehensive Prolotherapy procedure and has successfully treated cases like yours.

1. Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R. 2011 Jun;3(6 Suppl 1):S78-81. [Google Scholar]
2. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec;16(12):1285-90. [Google Scholar]
3. Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010 Mar;37(1):65-80. [Google Scholar]

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