Prolotherapy is an injection therapy to stimulate ligamentous and tendinous healing in patients with chronic nociceptive pain. I have been seeing some tremendous results in patients that have been carefully selected for this therapy, even if the initial injury was many years ago. Prolotherapy is effective for ligamentous and tendinous pain in the spine or the extremities. It can be effective in patients with “radicular” symptoms, if the pain is more aching in nature, without burning, numbness or tingling. Injection would be at the corresponding spinal level at the areas of sclerotomal triggers around the facet joints and other posterior spinal ligament and tendon insertions. It is also very helpful for extremity pain, especially around joints, including joints that are partially unstable due to ligament laxity (not disruption). It also can be used with chronic pain after a fracture.
Prolotherapy is indicated in patients with chronic pain who have a history of a traumatic episode that could have caused micro-tears in fascial tissues, or repetitive motion strain (including overly frequent therapeutic manipulation). Physical examination will typically reveal tenderness over these damaged structures that have not responded to other interventions. I am frequently seeing results after 2-4 injection sessions. Patients with more extensive damage will require more treatment. Ideally, the patient should be a non-smoker, have adequate nutrition (especially regarding protein intake), and not be immunosuppressed. Contraindications include allergy to any of the medications used, cellulitis, cancer in the area to be injected, acute ligamentous injury, full ligamentous tear, and muscle tears. Diabetes is a relative contraindication depending on severity of disease. However, we have seen results in well controlled diabetics.