What it is and how it can help you
Prolotherapy is one of the most promising and safe
alternative approaches to managing chronic pain
caused by injured ligaments or tendons. In the
1950s, George S. Hackett, MD coined the term
prolotherapy for a non-surgical injection technique
to treat back and related ailments. The term "prolotherapy" means "proliferation,
or growth treatment".
The procedure evolved from sclerotherapy, an
injection therapy used by physicians in the 1800s
to treat inguinal hernias. However, the origins
of prolotherapy can be traced back to ancient
Greece around 400 B.C. It is said that Hippocrates,
the Father of Modern Medicine, used a forerunner
of prolotherapy to treat soldiers and javelin
throwers suffering from dislocated, torn shoulder
joints. He would thrust a hot poker into the
tissue surrounding the unstable joint. While
this technique may seem extreme, it increased
the body's ability to heal.
Today, prolotherapy is also known as non-surgical
ligament reconstruction therapy (LRT) or regenerative
injection therapy (RIT). The term sclerotherapy,
or sclerosant therapy is now reserved for a
cosmetic injection technique used to eliminate
varicose and spider veins. Prolotherapy stimulates
the formation of new ligament tissue in areas
where it has become weak. In several studies
published in reputable medical journals, researchers
report that prolotherapy is beneficial for healing
connective tissue injuries of the musculoskeletal
system especially injuries that have not responded
well to conventional therapy. According to some
surveys 85% to 90% of patients using prolotherapy
have had good-to-excellent results in pain relief.
Prolotherapy is well-suited to conditions caused
by over-stretched or weakened connective tissues
such as ligaments and tendons. Ligaments act
like "wire cables" by holding bone
to bone with little or no elasticity. Ligaments
have poor blood supplies so when they are torn
or weakened after an injury they have difficulty
healing completely. If they do not heal properly
they never regain their normal length and strength.
As a result, ligaments which have been injured
are often unable to maintain joint stability.
Over time, the excessive abnormal motion of the
joints can cause arthritis. Additionally, nerves
in the ligaments can transmit pain from the strained
and traumatized ligaments.
Tendons are the elastic connective tissues
that attach muscles to bones. As in the case
of ligaments, they may be painful when injured,
stretched or their blood supply is reduced.
Prolotherapy promotes the growth and hypertrophy
of the tendons and ligaments by making them stronger.
It does this by increasing the amount of collagen
in tendons and ligaments.
How does prolotherapy work?
During prolotherapy, a solution of dextrose
(sugar water) or another irritant is injected
into the ligament or tendon where it attaches
to the bone. This triggers a healing of the injected
structure by causing an injury to the tissue
injected. The body “knows” how to heal tissue
injury. The injury causes cells in the area to
break apart and releases chemicals into the area
which leads to a response by the body with both
chemical inflammation and a cellular response.
White blood cells called macrophages “eat
up” the debris produced by the injection
of proliferant. The macrophages continue the
healing process by attracting and directing fibroblasts
which are connective tissue building cells to
lay down new collagen in the injured areas.
In addition, as the injected area becomes “inflamed” there
is an increased blood supply with an increased
supply of nutrients. The nutrients help heal
the tissue by triggering the growth of new blood
vessels and increasing the circulation thus bringing
in more nutrients for collagen production. As
the new collagen matures and becomes stronger
over time, it regains its usual function of controlling
normal joint movement.
Thus the type of inflammation in the injured
tissue caused by injection of a proliferant
is actually a healing response.
Painful musculoskeletal conditions reported
to be helped by prolotherapy:
- Whiplash, degenerative disk disease of the
neck, thoracic spine or low back
- Instability of the neck and back
- Chronic strain of the neck and back, knees,
ankles, wrists, elbows and shoulders
- Osteoarthritis of neck, shoulders, elbows,
wrists, thumbs, fingers, hips, knees, ankles
- Bursitis and tendonitis of the neck and back,
tennis elbow, rotator cuff strain, knee ligament
strains, recurrent ankle sprains, plantar fasciitis
- Areas that require repeated chiropractic
adjustments or repeatedly “go out”
- Sports injuries,
- Degenerated or herniated disks
How long is the course of treatment?
The length of treatment varies with each individual
and the severity of his condition. Most people
require 6 to 8 treatments every 2 to 3 weeks
to reap the full benefits of this therapy.
In some cases, 10 or more treatments may be
needed. Dr. Kochan reviews each patient's case
individually and develops a treatment plan
and follow-up that best suits the patient’s
Are there side effects?
There may be mild swelling, joint stiffness,
and soreness for a few days after treatment.
These symptoms are temporary, however, and
can be reduced with ice packs. They are a normal
response that shows that the treatment is working
and the proper strength of proliferant solution
is being used.
How does prolotherapy differ from anti-inflammatory
drugs like aspirin and ibuprofen?
The difference between prolotherapy and anti-inflammatory
medications such as aspirin, ibuprofen, and
cortisone is that anti-inflammatory drugs,
although they might provide short-term relief
from pain, do not repair the cause of the
pain- the damaged connective tissue. In fact
there is evidence that over-the-counter and
prescription anti-inflammatory drugs can
block some of the natural chemicals that
stimulate the repair of the underlying injury.
Prolotherapy, on the other hand, works by promoting
the self-repair of connective tissue. It triggers
the growth of new tissue for tighter and stronger
ligaments and tendons that are ultimately needed
to stabilized the joint. Once the joint is
stable the pain greatly decreases and often
disappears. This process of self-healing explains
why prolotherapy has been so successful for
the vast majority of people who have complied
with the full course of their treatment plan.
Are all health care providers qualified to
Dr, Kochan is one of only a few hundred physicians,
primarily MD's and DO’s, in the United
States who are qualified to give prolotherapy
injections. Dr. Kochan received his first training
in this technique more than 20 years ago. Inspired
by the tremendous relief that prolotherapy
brought so many of his patients, Dr. Kochan
soon made this treatment the major part of
his chronic pain clinic. Over the past two
decades he has performed thousands of prolotherapy
procedures. Dr. Kochan has the clinical expertise
to choose the right regimen which includes
the correct solution, dose of dextrose, frequency
of treatments, and length of therapy for each
Are there any restrictions on diet and lifestyle
while going prolotherapy?
Prolotherapy works best when anti-inflammatory
drugs are avoided during the full course
of treatment. These substances will interfere
with the effectiveness of the therapy and
prolong the course of treatment needed. Ice
and non-anti-inflammatory pain medications
are recommended for the discomfort following
prolotherapy. Vitamins and specific nutrient
supplementation are recommended to optimize
the healing process. Vigorous exercise is
discouraged but normal activity and stretching
is encouraged especially during the early
stages of healing. See AFTER PROLOTHERAPY
TREATMENT ADVICE for more details.
The following are links to various published
papersand organizations of interest: