What is Prolotherapy?
Prolotherapy is a safe, cost effective injection technique used for treating musculoskeletal injuries and chronic pain in various parts of the body. It is noninvasive, has limited side effects and does not require sedation. Prolotherapy is a treatment that provides a long term solution and in many cases should be considered before prolonged narcotic therapy or surgery.
Unlike steroid injections which act to reduce inflammation, prolotherapy stimulates the growth of cells and therefore repairs and strengthens tendons, ligaments, articular cartilage and joints. Since chronic pain is often caused by injury and/or weakness of these structures, prolotherapy can significantly alleviate and often times cure chronic pain by addressing the root cause.
Prolotherapy has been used in the US since the 1930s and has a substantial amount of research to support its use in a wide range of musculoskeletal conditions including low back pain, neck pain/whiplash, knee, hip and sacroiliac joint pain, some forms of chronic headaches, TMJ disorder, osteoarthritis of the knee, hip, thumb and finger joints, golfer/tennis elbow, chondromalacia patella and many more. In addition, prolotherapy has been endorsed by the former US Surgeon General, C. Everett Koop.
What do you inject during Prolotherapy?
The medications Dr. Hibbitts uses for prolotherapy are ubiquitously used in medicine, are non-toxic and safe. They include local anesthetics, saline and dextrose (a naturally occurring sugar) and vitamin B12. Other therapies including neural therapy and trigger point use a different solution of medications while platelet rich plasma (PRP) uses extracted platelets from the patients’ blood.
Do the injections hurt?
The most common side effects of prolotherapy are pain and soreness, a sense of swelling or fullness at the injection site. Bruising and mild bleeding from needle trauma may also occur. Pain and soreness post injection are self-limited and typically last 24-72 hours but may last longer. Since the solution contains anesthetics, patients often report an immediate relief of pain indicating the injured or weakened tissue was injected. In the rare instance that you experience persistent, unbearable post injection pain please contact Dr. Hibbitts as you may require pain medication and/or further evaluation.
Can I take ibuprofen, aspirin or naproxen?
These over the counter non-steriodal anti-inflammatory drugs (NSAIDs) may provide pain relief, however they are counter-productive to the repair process that prolotherapy stimulates and therefore should be avoided. If you feel you need further pain management with medication please discuss this with Dr. Hibbitts and he will recommend the best course of action.
All NSAIDs should be discontinued 3-4 days prior to injections and abstained from use for another 3-4 days after the treatment.
How do I know if prolotherapy is working?
The majority of patients receive prolotherapy until they are pain free or achieve an acceptable level of improvement in pain and/or mobility. It is normal to experience waxing and waning of pain and mobility during the course of treatment. Below is a list of signs that prolotherapy is working:
- Pain level and tenderness is decreasing
- Clicking or grinding of the joint is decreasing
- The amount of pain medication required is decreasing
- Function and mobility is increasing
- Level of exercise and tolerability are increasing
What if I don’t feel any immediate improvement?
Many patients report improvement in pain and mobility after the first treatment while others require multiple treatments before improvement is seen. Do not be discouraged if you don’t experience improvement after your first injection! It is normal to experience waxing and waning of pain and mobility during the course of treatment. Dr. Hibbitts generally tells his patients to plan on receiving at least three treatments. If you haven’t experienced improvement after multiple treatments you may be reevaluated and other therapies will be considered.
How Many treatments will I need?
The number of treatments varies with each patient and depends on a multitude of factors including severity of injury and the patients overall health. Typically, patients receive between three and eight sessions of prolotherapy, given at two to six week intervals. Some patients need more treatments and others need less. It is normal to experience waxing and waning of pain and mobility during the course of treatment. Repeated treatments should provide continued repair to damaged or weakened tissues and longer periods of pain relief until maximum improvement is achieved. To help accelerate the repair process other treatments may be used including nutrition, supplements, and exercise.
Can I go back to work after prolotherapy?
Since prolotherapy is a relatively quick and noninvasive procedure most patients are able to return to work the next day if not the same day, however this is completely dependent on the individual, the individual’s line of work and how many areas were injected.
What else can help accelerate my healing?
On your initial visit Dr. Hibbitts will perform a thorough intake and evaluation to identify any risk factors that may be preventing you from healing. This may include standard lab testing for hormones, thyroid function and other conditions that effect healing. Prolotherapy is just one tool used by Dr. Hibbitts to address pain and connective tissue injury. He also uses diet and nutrition, lifestyle modifications, supplements, IV therapy and other treatments.
What are the risks of prolotherapy?
Prolotherapy is extremely safe and has been safely administered to hundreds or thousands of patients. The medications Dr. Hibbitts uses for prolotherapy are ubiquitously used in medicine, are non-toxic and safe. Dextrose, a naturally occurring sugar, is extremely safe and FDA approved for intravenous use in the treatment of low blood sugar (hypoglycemia) and for calorie supplementation.
While all injection procedures are performed with universal precautions and safety measures there is a potential risk for lightheadedness and fainting, allergic reaction, infection, bruising and hematoma. Of these, the most common reaction to injection therapy is lightheadedness and fainting, also known as a vaso-vagal response. Serious adverse events are extremely rare when prolotherapy is used for treating joints such as the shoulder, elbow, wrist, knee and hip. Dr. Hibbitts has extensive knowledge of musculoskeletal anatomy and has attended numerous injection therapy training courses, assuring the highest level of efficacy and safety of his treatments.
Contraindications: Reasons NOT to get prolotherapy
The contraindications for prolotherapy include acute infection such a cellulitis, abscess and infectious arthritis. Prolotherapy is not typically used to treat acute injuries such as recent sprains/strains or bone fractures. In addition, allergies to the specific anesthetics used in prolotherapy are absolute contraindications. Dr. Hibbitts will perform a thorough intake and physical exam to ensure you are an appropriate candidate. Please note that if a tendon or ligament is completely torn or if a nerve is pinched surgery is typically warranted.
For more technical information regarding prolotherapy please ask Dr. Hibbitts or click on the links below.
- Rabago D, Slattengren A, Zgierska A. Prolotherapy in Primary Care Practice. Primary care 2010;37(1):65-80. doi:10.1016/j.pop.2009.09.013.
- AbbottLabs. FDA indications for 50% dextrose. 2004. http://www.fda.gov/cder/foi/nda/98/19445-s4-s6.htm.