In the simplest terms, Prolotherapy is the stimulation of the body to heal itself!
As stated on the Prolotherapy page, many musculoskeletal pains are due to ligament and/or tendon relaxation. This means that there is damage to these structures causing instability.
Prolotherapy is the injection of a proliferant solution into these damaged structures which stimulates an inflammatory response (the body's natural healing mechanism).
This response is the first phase in healing damaged structures.
Our bodies are designed to survive. We are built to adapt. We are made to heal!
We have systems that heal our damaged structures. The circulatory system carries chemicals and nutrients to the site of injury to fuel the process of re-building damaged structures.
In the case of ligaments and/or tendons the blood supply is very poor. That is why they appear white on dissection. The poor blood supply decreases the effectiveness of the inflammatory and healing mechanisms and can result in chronic ligament/tendon laxity and, often, pain.
Prolotherapy increases the circulation and inflammation in these damaged areas by stimulating the healing cascade.
Prolotherapy stimulates the body heals itself.
How did I get involved with Prolotherapy?
As a military physician in Special Operations I was exposed to a large number of patients with multiple aches and pains. I was able to help some. There were others that, despite my best efforts, didn't get any better.
I remember one patient in particular. He was 26 years old and had low back pain that was so severe that he was being processed out of the military because he could no longer perform his job. His xrays and MRI were all normal. We could not identify any cause for his pain. He was an 'operator' in special operations and had endured countless tests and hardships and had come through with flying colors. He was one of America's best. Yet, there were those that felt he was simply whining about his back because nobody could find anything wrong. I believed him when he told me that he truly did hurt - he wanted to stay in the military but told me that it wasn't worth the pain. Unfortunately, I couldn't do anything for him at the time.
This problem is not uncommon. I have seen numerous patients that had pain but the doctors, labs, and radiology studies (x-rays, CTs, and MRIs) could not find a reason for it so the patients are often labeled as problem patients or whiners.
I was one of those physicians that would inappropriately label these patients. After all, we are doctors. Surely we know everything about the human body, right?
It is extremely frustrating for physicians when patients state there is something wrong yet no one can identify the problem. It is difficult to fix a problem you can't identify.
This leads primary care physicians to refer patients to orthopedic surgeons or neurosurgeons since they can't fix the problem. When these surgeons can't identify the problem they often recommend surgery.
That sets up a cycle of pain due to relaxation of ligaments, treated by steroids, NSAIDs, or Surgery which further weaken the ligaments and further exacerbates the problem!
A couple of years ago, one of my Military Commanders came to me requesting Prolotherapy. I had no idea what prolotherapy was but we were eventually able to find a physician in Nashville that performed the procedure.
I was very skeptical that this procedure would work. How could sugar water cure pain?? Isn't sugar water/sugar pill simply a placebo?
However, I was very intrigued by what he said. He explained how it works and how it healed the tissues. It made total sense.
If it truly did what Dr. Johnson said it did then it made total sense and answered so many questions.
A whole new world had opened up to me.
I was excited about the prospect but still very skeptical. Never the less, my commander improved under Dr. Johnson's treatment.
I began studying the effects of this procedure. It just made sense. Maybe there was more to it that I had originally thought.
Finally, I decided that I had to try it.
I slowly began introducing it into my practice and the results have been nothing short of phenomenal! I have never seen another procedure have such an impact on patients or in my practice.
I have always believed that physicians should strive to attain the highest levels of education and certification possible. Therefore, I began searching for education and certification in prolotherapy. However, there is no certification process for prolotherapy.
I read multiple textbooks on prolotherapy and sought to learn everything I could about the history and procedure. I have studied the techniques of the top prolotherapists in the world and adapted the best techniques from each.
I have been doing Prolotherapy since 2009. I learned the history of prolotherapy and about the Hacket-Hemwall Foundation (see below). I contacted the director of the foundation, Jeff Patterson, DO, to learn more. He invited me to the annual prolotherapy workshop in Wisconsin. This is the same workshop that was started by Dr. Hemwall over 40 years ago.
The Hacket-Hemwall Foundation (HHF) sponsors a trip to Honduras every year to train other physicians in Prolotherapy. This is the most comprehensive training in prolotherapy available. Physicians have the opportunity to work with several other physicians to enhance their training and experience.
No other organization offers any training even remotely as comprehensive and I have come to believe that any physician offering prolotherapy should attend this training.
If I were searching for a doctor who performs prolotherapy, I'd look for a doctor trained by the Hacket-Hemwall Foundation!
There are other good organizations who promote prolotherapy and I encourage participation in all of them. However, they do not have the same training opportunities as the Hacket-Hemwall Foundation.
There are physicians across the country who have attended weekend seminars, watched a DVD, or read a book and started performing prolotherapy. This doesn't mean that they are incompetent but there is no way to ensure appropriate skill and safety.
If you are considering Prolotherapy be sure to find an experienced and appropriately trained Prolotherapist.
The proliferant solution stimulates the bodies own immune system to deposit new collagen which is what makes up these ligaments & tendons. The tissue that is formed after prolotherapy is healthy, strong, and flexible. No scars are formed.
As this new collagen matures, it shrinks resulting in a tightening of the ligament.
This results in a tighter, thicker, and stronger ligament.
If your pain or sports injury is due to ligament or tendon weakness then prolotherapy could be 100% effective in curing your pain.
Many patients & athletes with acute or chronic pain or sports injuries are starting to turn to prolotherapy for their injuries and pain with excellent results.
How did Prolotherapy get its start?
The procedure is over 80 years old and was first described by George Hackett, MD. He was a trauma surgeon in Ohio and noticed that injecting the proliferant solution increased the thickness of ligaments and set out to study its effects. He started injecting patients in attempt to help them. He studied thousands of patients with an approximately 90% success rate. He published his first book in 1956 entitled "Ligament and Tendon Relaxation Treated by Prolotherapy". It is a fascinating read!
Dr Hackett lectured extensively on prolotherapy. One of his students was Gustav Hemwall, MD who carried the torch of prolotherapy from the 1950's to the 1990's and did a lot for propagating prolotherapy. He started the Hacket-Hemwall Foundation in 1969 to help others worldwide. When he retired he transferred his practice to Ross Hauser, MD. Dr Hauser operates Caring Medical & Rehabilitation Services in Oak Park, IL. He is the author of several books on Prolotherapy including Prolo Your Pain Away!
It is an approved procedure by the American Osteopathic Association of Prolotherapy Integrative Pain Medicine. Dr C. Everett Koop, the former Surgeon General of the United States, was a huge proponent of prolotherapy. In fact, he wrote the introduction to the first edition of Dr Hauser's book Prolo Your Pain Away! You can read Dr C. Everett Koop's Story here.
The effectiveness of Prolotherapy is dependent on a number of factors. Anti-inflammatory medications, steroids, smoking, and applying ice are all interventions that decrease the bodies ability to mount an inflammatory response and will decrease the effectiveness of prolotherapy.
There is an article written by the physician who introduced me to prolotherapy that describes the mental process that many people go through when they have a painful condition. I highly recommend reading it! Read the entire article here.
Here is an article from Practical Pain Management (Jan/Feb 2007) on Prolotherapy - Prolotherapy for Musculoskeletal Pain
Why Haven't I Heard of Prolotherapy Before?
That's a great question and I asked myself the same question when I first heard of it. Honestly, I thought it was some gimmick that someone had come up with to make a few bucks.
Most physicians have never heard of prolotherapy. In fact, Dr Koop stated "In my opinion, it is because medical folks are skeptical and Prolotherapy, unless you have tried it and proven its worth, seems to be too easy a solution to a series of complicated problems that afflict the human body and have been notoriously difficult to treat by any other method. Another reason is the simplicity of the therapy: Injecting an irritant solution, which may be something as simple as glucose, at the junction of a ligament with a bone to produce the rather dramatic therapeutic benefits that follow."
The proliferant solutions are inexpensive, natural, and easy to mix. Thus, no pharmaceutical company will market them. There is no money in developing the substances or the procedure so it is difficult to fund studies. In an environment where there are so many reasons to be skeptical, it makes sense to be skeptical.
We live in a medical society driven by Evidence Based Medicine (EBM) which means that many medical decisions are based on the evidence of a medical practice or procedure derived from sound scientific research.
I have yet to come across anyone who has been exposed to the benefits of prolotherapy that walked away from it doubting its effectiveness.