SPORTS & SPINE ASSOCIATES
7756 Northcross Drive, Suite 203
Austin, Texas 78757
Phone: (512) 358-0500
Fax: (512) 358-0520
The cause of a great deal of musculoskeletal pain is related to laxity or relaxation of the connective tissues that control joint movement and provides support for joints. These connective tissues are frequently damaged by trauma or repetitive stresses. The initial healing response may not adequately "knit" the structures back together. Anti-inflammatory medications frequently which are taken after an injury, diminish the healing response and result in diminished healing. The structures may also be weak because of hormonal changes, such as with pregnancy, which causes laxity of the sacroiliac and associated ligaments in the low back, feet, ankles, and other structures. Other individuals may be predisposed because of genetic variation, (possibly because of weaker collagen and other connective tissue or more elastic ligaments); thyroid disease, and other as yet undiscovered causes. The result of the reduced structural stability is a chronic strain of the remaining ligament, tendon and muscle fiber attachments. Those are connected to the extremely sensitive periosteum of the bone, which through nerves, sends pain signals to the brain.
Injections containing dextrose (sugar), local anesthetic, and other agents are placed at the attachments of ligament, tendon and muscle tissue to initiate a healing response, which results in the growth (or proliferation) of fibrous tissue. This creates a stronger bond at these attachment points, lessening the load on the individual fibers. The attachment points may also become less sensitive. This results in significantly less pain, improved range of motion, and improved function, permanently.
Numerous studies have shown a success rate of 80-90% over many thousands of patients, with success judged as at least 50% reduction in pain (in properly selected patients). This is quite remarkable, given that the treatment has minimal side effects and cost compared to other surgical and nonsurgical treatment.
The injections are administered approximately 4-6 weeks apart, with an average number of 4-6 injections. The response is directly related to the speed of healing of a given individual and the size of the area treated. The typical time frame for a course of treatment is 4-6 months. The body continues to "remodel" the bond so that even more stability occurs over the year following the treatment.
Prolotherapy (or Proliferant Solution Injection) was originally used by Hippocrates over 2500 years ago to heal a javelin thrower's shoulder pain. The concept was investigated, utilized, and refined by George Hackett, M.D., over 60 years ago, and other physicians since, including the former Surgeon General of the United States, C. Everett Koop, M.D. Its use is gaining momentum, as more patients are seeking non-surgical alternatives.
Publications Supporting Prolotherapy
(provided by David K. Harris, M.D.)
Hackett, George A., and Henderson, Donald G., "Joint Stabilization: An Experimental, Histologic Study with Comments on the Clinical Application in Ligament Proliferation", American Journal of Surgery, 89 (May 1955), pp.968-973.
Klein, Robert G., "Proliferant Injections for Low Back Pain: Histologic Changes of Injected Ligaments and Objective Measures of Lumbar Spine Mobility Before and After Treatment," Journal of Neurology, Orthopedic Medicine and Surgery, 1989, 10:141-144.
Klein, Robert G., Mooney, Vert, et al, "A Randomized Double-Blind Trial of Dextrose-Glycerine-Phenol Injections for Chronic Low Back Pain", Journal of Spinal Disorders, 1993, 6:23-33.
Lui, Y. King, et al, "An In Situ Study of the Influence of a Sclerosing Solution in Rabbit Medial Collateral Ligaments and Its Junction Strength", Connective Tissue Research, 11 (1983), pp.95-102.
Ongley, Milne J., Dorman, Thomas A., Klein, Robert G., Eek, Bjorn C. and Hubert, Lawrence J., "A New Approach to the Treatment of Chronic Low Back Pain", The Lancet, (July 18, 1987), pp.143-146.
Dorman, Thomas A., editor, Prolotherapy in the Lumbar Spine and Pelvis, Spine: State of the Art Reviews, Volume 9, Number 2, Philadelphia, Hanley and Belfus, Inc, 1995.
Hackett, George S., and Hemwall, Gustav A., and Montgomery, Gerald A., Ligament and Tendon Relaxation Treated By Prolotherapy, 5th Edition, 2nd printing, Oak Park, Illinois, 1993.
Hauser, Ross, Prolo Your Pain Away, Curing Chronic Pain with Prolotherapy, Beulah Land Press, Oak Park, Illinois, 1998.