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Prolotherapy is also known as sclerotherapy, proliferative injection therapy, regenerative injection therapy, and ligament reconstructive therapy.

Prolotherapy is an alternative treatment used for the treatment of chronic back pain or other musculoskeletal pain that may be caused by (at least in part) by damaged, weak, or lax ligaments.

Ligaments do not heal as quickly as muscle because of poor blood supply. If ligaments are severely overstretched (sprained) they may take a very long time to heal and sometimes remain a little lax. Ligaments also lose some strength and elasticity with aging and are more vulnerable to tearing when stretched beyond their normal limits.

Ligaments, tough bands of fibrous tissue, connect the bones of a joint. In the spine, ligaments connect the vertebra and also connect the spine and pelvis (sacroiliac joint). Facet joints (spinal joints) and ligaments help protect the spine by limiting how far the spine can bend. The ligaments have enough elasticity to allow a normal range of motion.

What is the Theory behind Prolotherapy?

Proper spinal alignment depends upon strong balanced muscles but healthy ligaments also play an important role.

Muscles support the spine and allow movement. Muscles of the back, abdomen and buttocks stabilize the spine and maintain proper posture. Muscles protect the spine by absorbing shock before it reaches the discs and facet joints. Ligaments connect the vertebrae and limit the range of motion of the spinal joints to protect the spine.

Lax ligaments may result in muscle pain (if the muscles work harder to compensate) or the pain in the ligaments themselves. Ligaments and tendons have many nerve fibers and pain may come directly from damaged ligaments and tendons, especially at the point where they attach to bone. The nerves fibers not stretch, and when the ligaments stretch there is a pulling on these nerve fibers.

If the ligaments are too loose, joints are not properly stabilized and abnormal stresses are placed on the spinal joints and vertebral discs.

What Causes Lax Ligaments

Like muscles, ligaments and tendons may become injured due to overuse or acute injury. Sudden movements can cause injury to the ligaments because the muscles don't have time to react - e.g. in a fall or car accident. The muscles don't contract enough to keep the spine within its normal range of motion, causing ligaments to stretch or tear.

Unlike muscles, ligaments and tendons have limited blood supply and are much slower to heal. If an acute injury causes severe overstretching or tearing of a ligament or tendon, it may never heal to its original strength.

Aging causes degeneration of discs that separate the vertebrae, causing the space between each vertebra to become smaller. The ligaments attaching the vertebrae will not be as tight as a result. The ligaments also lose strength and elasticity with aging and are more easily injured.
Weight-bearing exercises help strengthen ligaments and tendons though not as quickly as muscle and bone. Click here for back exercises.

How is Prolotherapy Performed

Prolotherapy is an injection or series of injections (often containing a sugar solution, which is an irritant) into the affected ligament or tendon where it attaches to bone to cause irritation and trigger local inflammation, which is believed to stimulate repair and the growth of new healthy, dense, fibrous tissue.

Prolotherapy causes acute inflammation. The inflammation goes away after about a week. Anti-inflammatory medications are to be avoided for several days after a treatment as they dampen the effects of prolotherapy.

A person who has received prolotherapy is usually given exercises to do to help the ligaments heal properly.

Number of Prolotherapy Treatments Needed
Usually five or six treatments (one treatment may consist of multiple injections) about two weeks apart are commonly performed.

Risks and Side Effects of Prolotherapy
Temporary side effects that may last a few days include increased pain and stiffness. As with any injection there is a small risk of infection, bleeding, bruising, tissue damage, and allergic reaction.

Isn't inflammation harmful

Chronic inflammation is harmful. Chronic inflammation eventually causes damage to the tissues. Acute inflammation, though painful, is an essential part of the healing process.

Conditions treated with Prolotherapy

While most commonly used for chronic low back pain, prolotherapy is also used to treat shoulder pain, knee pain, and hip pain, etc .where it is believed that lax ligaments or tendons may be causing or contributing to the pain. Back conditions treated with prolotherapy include spinal osteoarthritis, sciatica, herniated discs, whiplash, and fibromyalgia.

Is there any proof that Prolotherapy relieves pain

There is a lack of strong clinical evidence for the efficiency of prolotherapy. Large clinical trials are needed. Current evidence is conflicting.

From the Cochrane Database of Systematic Reviews: Five high quality randomized controlled trials with a total of 366 participants on prolotherapy injections for chronic low back pain was reviewed. Three studies showed that prolotherapy injections alone are not more effective for chronic low back pain than control injections. Two studies showed that when used in combination with spinal manipulation, exercises, and other treatments, prolotherapy injections are more effective than control injections in reducing pain and disability.

In collaboration with the National Center for Complementary and Alternative Medicine (NCCAM), the University of Wisconsin, Madison is currently conducting a clinical trial titled The Efficacy of Prolotherapy in Osteoarthritic Knee Pain that began in 2004 with an estimated Study Completion Date May 2016.

Prolotherapy in Summary

Prolotherapy is gaining in popularity as a treatment for chronic musculoskeletal pain. The risks of prolotherapy appear to be low. More clinical studies are needed. Health insurance does not usually cover prolotherapy (and many other alternative treatments) because of insufficient evidence of its efficiency. Like any therapy, results will vary from person to person.