Prolotherapy, a Nonsurgical Treatment for Joint Pain
November 25, 2003
By Stephanie Riesenman for Knee1
Patients with chronic joint pain are getting relief from an alternative non-surgical procedure called prolotherapy. It’s an injection performed in the doctor’s office that stimulates the body into healing itself.
Also known as nonsurgical ligament reconstruction—prolotherapy is used to treat various types of musculoskeletal pain, including arthritis, back pain, carpal tunnel syndrome, and sports injuries, just to name a few. The treatment stimulates growth of new ligament tissue in areas where it has become weakened.
Prolotherapy is prescribed for patients with degenerative conditions, such as arthritis, or for athletes with over-use injuries. These conditions can lead to laxity or weakness in the ligaments—the structural rubber bands that connect bone to bone—and it is this laxity that results in pain. Tendons connect muscle to bones; and injuries to these structures can also be healed with prolotherapy.
The procedure is done in a licensed physician’s office and takes just a few minutes. A mixture of sugar and water is injected into the ligament or tendon where it attaches to the bone. This irritation causes a localized inflammation and the production of collagen. Blood flow increases to the injured areas supplying nutrients and stimulates the tissue to repair itself. When the tissue is strengthened, nerves in that area are no longer stretched and irritated, and the pain is relieved.
Dr. Cliff Stark, a Primary Care/Sports Medicine physician and an assistant clinical professor in the Columbia University College of Physicians and Surgeons, has referred many patients to prolotherapy.
"We’re finding more and more that inflammation isn’t necessarily a bad thing," said Stark. Adding that anti-inflammatory drugs are not always the best solution.
"You're trying to take something that over time has become unstable, and you're trying to generate the body to mount it’s own inflammatory response to wake up that area," said Stark. "It’s the body’s natural repair mechanism."
The response to prolotherapy varies from person to person; some may need only a few treatments while others may need 10. The average number is 4-6 injections over a period of several weeks. Re-evaluation and treatment is scheduled six weeks apart because that’s how long it takes for most ligaments to heal after inducing inflammation.
Several studies have validated the success of prolotherapy, with a majority of patients maintaining pain relief several years after treatment. The most common side effect is muscle stiffness, which can last a few days after the injections. Dr. Stark says the procedure is safe, but patients should be carefully picked.
"Not everyone is a candidate, you want to believe that instability [either caused by degenerative arthritis or over-use injuries] is contributing to the person’s symptoms," said Stark.
And Dr. Stark says patients whose pain is caused by ligament tears should not undergo prolotherapy. Instead these injuries should be treated surgically.
Insurance companies do not specifically pay for prolotherapy treatments, but it’s usually covered as an office visit.