Application of Prolotherapy for Veterinary Rehabilitation Therapists & Healing
The term prolotherapy was coined by Dr. George Hackett in 1956 as an approach for healing damaged ligaments and tendons, and derives from the Latin “proles,” offspring or progeny and the English “therapy.”The medical definition of the prolotherapy in the Merriam-Webster Dictionary is “an alternative therapy for treating musculoskeletal pain that involves injecting an irritant substance (as dextrose, also known as d-glucose) into a ligament or tendon to promote the growth of new tissue,”7 although some practitioners object to the “alternative” appelation.Multiple agents are used in prolotherapy, some classified as irritants (such as phenol), some as chemoattractants (commonly sodium morrhuate), and others as osmotic agents (commonly dextrose).
Prolotherapy (sometimes known as regenerative injection therapy and more inaccurately as sclerotherapy), is not new. The concept of irritating tissue to promote healing dates as far back as the ancient Greeks and our old friend Hippocrates, who treated Olympic javelin throwers with unstable shoulders by touching with what he described as a “slender hot iron” to the ligaments holding the shoulder joint together. The heat would irritate the ligament capsule, causing it to tighten up.
Prolotherapy was used in France to treat hernias before modern surgical techniques became available.
The techniques we use today were developed in the 1930s by G.S. Hackett, MD, a surgeon from Ohio, along with other MDs and DOs. The same techniques subsequently have been used successfully for pain relief from ligament laxity for nearly 60 years.
Hackett coined the term prolotherapy because his initial work demonstrated that the new tissue laid down during the healing process was new healthy tissue, not scar tissue. (This distinguishes prolotherapy from a related treatment known as sclerotherapy.) “Prolo-” stands for proliferative, implying that new cells and collagen fibers are proliferating and growing. The term regenerative injection therapy, which is now being used by some practitioners is fairly new and is an attempt to portray more accurately what is actually taking place physiologically.
Clinical Uses
Since its introduction, perhaps as early as Hippocrates, injections of irritants into tissues has been increasingly used to treat various musculoskeletal injuries including osteoarthritis, musculoskeletal pain, low back pain, refractory lateral epicondylosis and joint pain, and laxity
Prolotherapy is a series of injections that, over time, help an unstable or painful body part regenerate and heal. The injection is a mixture of dextrose (a type of sugar) and local anaesthetic into an injured joint, ligament or tendon. This injection causes localized inflammation which stimulates the body to strengthen and repair itself, stabilizing and healing damaged tissue.
Age, injury, and repetitive strain can stretch and damage tendons, and ligaments. This wear and tear can destabilize joints causing painful sensations in the many nerve endings that are in and around the joint. Joints that are not well supported by tight ligaments and tendons don’t fit as well together, and your muscles will have to work harder to keep them in place causing painful spasms. Prolotherapy injections help repair weakened sites to permanently stabilize the joint, often resolving the pain.
Prolotherapy is often used as a lower risk alternative to surgery. It can also be used instead of anti-inflammatories and ‘pain killers’. These medications generally only provide temporary pain relief and have significant risks, especially when used chronically. Surgery and medications also do not promote new growth of healthy tissues, and thus may not fix the underlying issue. The side-effects of prolotherapy are usually mild and of short duration and include stiffness, soreness, bruising, and swelling at the site of injection.
How many treatments are needed to have lasting effects on pain?
Prolotherapy works best combined with other treatments at the suggestion of your health care team. These may include physical therapy, lifestyle changes, trigger-point injections, and other treatments. The length of treatment depends on the underlying problem and how long it has been present. Most patients need 4-8 treatments with around 2-6 weeks between treatments. Since ligaments and tendons take several months to heal, most people notice benefits after 3-4 treatments.
Because an inflammatory response is key to kicking in the body’s healing process, it is recommended not to take anti-inflammatories (for example Alleve or ibuprofen) for a minimum of two weeks after prolotherapy injections.
SCIENTIFIC EVIDENCE
Hackett was the first to demonstrate clinically and scientifically a method of strengthening ligaments, and was the first to coin the word prolotherapy. He showed that by creating controlled inflammation, permanent increases in ligament size (35–40%) resulted. He reported an 82% patient-reported cure rate of backache in a series of 1,600 patients treated with prolotherapy. His final examinations were performed from 2 to 12 years following the conclusion of injection therapy thus indicating the permanency of the treatment.
More recent studies have confirmed his initial studies. In 1983, Liu et al injected a proliferative solution (Sodium Morrhuate) into rabbit MCLs (medial collateral ligaments of the knee). The ligaments showed a significant increase in ligament mass, thickness, ligament-bone junction strength, and weight-to-length ratio compared with controls. This effect was confirmed by Maynard et al in 1985 in a study on Achilles tendons in rabbits. In a human study in 1989, Klein et al documented cellular evidence of new collagen growth when comparing pre- and post-injection sacroiliac ligament.
PHYSIOLOGY
In a sense, prolotherapy creates in injury. Figure 2 shows schematically what happens during healing. Cellular debris and humoral factors at the injury site attract an initial influx of granulocytes. The granulocytes proceed to secrete a number of factors, among them proteolytic enzymes, which debride to wound area and attract other cells. Ultimately fibroblasts are recruited and are stimulated to produce new intracellular matrix, including new collagen. As this collagen is produced it creates tissue remodeling and strengthening of the area, including the wound contraction we see in Figure 2. This contraction of the wound as a result of the production of new collagen/ligaments creates a tightening of the wound, and reduction in joint laxity and therefore the reduction in pain. The whole process is called the wound healing cascade, and, in the very basic model that is very briefly described above, is characteristic of all healing wounds.
Prolotherapy is an alternative therapy that may help repair body tissues. It’s also known as regenerative injection therapy or proliferation therapy.
The concept of prolotherapy dates back thousands of years, according to experts in the field. There are different types of prolotherapy, but they all aim to stimulate the body to repair itself.
Dextrose or saline prolotherapy involve injecting a sugar or salt solution into a joint or other part of the body to treat a range of conditions, such as:
- tendon, muscle, and ligament problems
- arthritis of the knees, hips, and fingers
- degenerative disc disease
- fibromyalgia
- some types of headache
- sprains and strains
- lax or unstable joints
Many people say the injections help relieve pain, but scientists cannot explain how it works, and research has not confirmed that it is safe or effective.
How does prolotherapy treat joint pain?
Dextrose prolotherapy and saline prolotherapy involve injecting a solution containing irritants — a saline or dextrose solution — into a specific area where damage or injury has occurred.
It could help:
- reduce pain and stiffness
- improved strength, function, and mobility of the joint
- increase the strength of ligaments and other tissues
Supporters say the irritants stimulate the body’s natural healing response, leading to the growth of new tissues.
People mostly use it to treat tendon injuries resulting from overuse and to tighten unstable joints. It may also relieve pain due to osteoarthritis, but research has not confirmed that this is the case, and there is not yet any evidence of long-term benefit.
The American College of Rheumatology and Arthritis Foundation (ACR/AF)Trusted Source do not recommend using this treatment for osteoarthritis of the knee or hip.
Platelet-rich plasma (PRP) injections are another type of prolotherapy that some people use for OA. Like saline and dextrose prolotherapy, PRP does not have the backing of research.
What are the risks of prolotherapy?
Prolotherapy is likely to be safe, as long as the practitioner has training and experience in these types of injections. However, there are risks involved with injecting substances into a joint.
Possible adverse effects include:
- pain and stiffness
- bleeding
- bruising and swelling
- infection
- allergic reactions
Depending on the type of prolotherapy, less common adverse effects are:
- spinal headache
- spinal cord or disk injury
- nerve, ligament, or tendon damage
- a collapsed lung, known as pneumothorax
There may be other risks that experts aren’t aware of yet, due to the lack of rigorous testing.
In the past, adverse reactions have occurred following injections with zinc sulfate and concentrated solutions, neither of which are commonly in use now.
Speak to your doctor before seeking this kind of treatment. They may not recommend it. If they do, ask them for advice on finding a suitable provider.
Promoting Healing with Prolotherapy
Compiled & Shared by- Team, LITD (Livestock Institute of Training & Development)
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