Prolotherapy or proliferative therapy is a regenerative injection technique which involves multiple small injections of an irritant solution at the site of ligament attachments, painful and degenerated tendon insertions and into the joint space depending on the site of pathology, in order to promote the growth of normal and healthy cells. In selected cases, autologous cellular solutions such as platelet-rich plasma (PRP), bone marrow, or adipose tissue are also used to administer prolotherapy.

Dr George Hackett believed that at the root of a lot of of musculoskeletal pain is tendon and ligament relaxation. He treated thousand of patients of lower back pain with prolotherapy to great success. He believed that the degenerative conditions in the back such as degenerative disc disease, sacroiliac joint disease and facet joint disease are all initiated by the relaxation of the adjoining ligaments. Hence prolotherapy which is a proliferative treatment addresses the lax ligament by helping in strengthening it and regaining it’s tautness. the junction of ligament and bone resulted in profuse proliferation of new tissue at this union.”This further strengthens the back and prevents further degeneration. Dr Hackett’s worry was followed by Dr Gustaav Hemwall, who took forward Dr Hackett’s work in extensively treating other musculoskeletal conditions like knee, wrist and ankle pain arising due to joint arthritis, tendonitis and other ligament pathologies.

Prolotherapy is believed to simulate the natural healing process of the body by initiating a local inflammatory cascade which stimulates the release of growth factors and collagen deposition. This is mediated by cytokines which act via chemomodulation leading to proliferation and strengthening of new connective tissue, strengthening of the joint and bringing about a reduction in pain and dysfunction.

The biology of prolotherapy. Prolotherapy induces the three stages of healing and restoration: inflammation, proliferation, and tissue remodeling. Reused from: Steilen D, Hauser R, Woldin B, Sawyer S. Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability. The Open Orthopaedics Journal. 2014;8:326–345, under the terms of a CC-BY 2.5 license.

Studies have shown, exposure to extracellular dextrose concentrations in vitro has resulted in the proliferation and production of a number of growth factors, many of which are essential to repair, structural integrity, functions and optimal growth of connective tissue structures like tendons, ligaments and other tissues.
These include platelet- derived growth factor, epidermal growth factor, basic fibroblast growth factor, insulin like growth factor and connective tissue growth factor.

Prolotherapy thus has been seen to bring about an inflammatory response which brings about strengthening of ligaments, hypertrophy of tendons, extracellular matrix and fibroblastic proliferation.

Prolotherapy treatment generally consists of multiple injections of the proliferative solution , carried out at painful Tendon and ligament insertions and in adjoining joint spaces. These are repeated every 2-6 weeks depending on the condition and the practitioner’s preference. The inflammation produced is expected to cause tissue healing, resulting in enlargement and strengthening of damaged ligamentous, tendon and intra-articular structures. Thus the aim is to use prolotherapy to improve joint stability, biomechanics, function and ultimately, to decrease pain.

• Tendinopathies like Achilles Tendonitis, Plantar Fasciitis and Lateral Epicondylitis/ Tennis Elbow.
• Partial ligament injuries like Partial Anterior cruciate ligaments and Partial Meniscus injuries knee and Chronic Ankle sprains
• Osteoarthritis of the knee, shoulder and hip.
• Chondromalacia Patella knee
• Ligamentous laxity and hyper mobility syndromes like Ehler Danlos syndrome
• Conditions affecting the lower back- Sacroiliac joint dysfunction, Facet joint disease and degenerative disc disease.
• Cervical Instability or Whiplash injury to the neck causing symptoms.

32 doctor reviewed studies have helped us reach the following conclusions

• Prolotherapy is supported in the treatment of tendinopathies in patients who fail conservative therapies
• Treatment of knee osteoarthritis
• Treatment of finger joint osteoarthritis in patients who do not respond to conservative therapies
• Treatment of back pain and,
• Treatment of pelvic pain in patients who fail to respond to conservative therapies.

We would like to conclude by saying that Prolotherapy is a wonderful cost effective, regeneration injection technique which can be utilised in a number of musculoskeletal conditions as a first line treatment option. It is excellent at addressing pain and dysfunction arising from these chronic conditions by improving stability and increasing the inherent strength of the structures treated.