Webster’s Third New International Dictionary defines prolotherapy as “the rehabilitation of incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells”, that is done for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. The term derives from the word prolo - short for proliferation. The therapy aims to proliferate tissue growth in the damaged area.
Prolotherapy is also called "proliferation therapy" and "regenerative injection therapy” (RIT). It can be distinguished from sclerotherapy, the use of injections of caustics into the veins, in vascular surgery and dermatology, to remove varicose veins and other vascular irregularities.
In prolotherapy we inject solutions into the area where connective tissue has been weakened or damaged through injury or strain. Many solutions are used, including dextrose, lidocaine, combination of both, animal own blood, added growth factors, phenol, glycerine, sodium morrhuate etc.
The injection is given into joint capsules or where tendon connects to bone. Many points may require injection. The Injected solution causes the body to heal itself through the process of inflammation and repair. In the case of weakened or torn connective tissue, induced inflammation and release of growth factor at the site of injury may result in a 30-40% strengthening of the attachment points.
Prolotherapy treatment sessions are generally given every two to six weeks. Many patients receive treatment at less and less frequent intervals until treatments are required only every several years, if at all. Prolotherapy is often used as an alternative to an invasive and expensive surgery.
In our practice we are using 15% dextrose as our injection solution into ligaments. Added to the solution is a small amount of Lidocaine without epinephrine. We take 1 ml of Lidocaine 2%, 3 ml of 50% Dextrose and 6 ml of sterile water. We shave the area to be injected, scrub it with Septal Scrub (4% Chlorhexidine), wash it with alcohol 70%, and finish up the preparation by putting on the area P.V.P Iodine 10%. The injection is done with 27-30 g needle and it is important to inject small webs into the ligaments rather than one or two large amounts. In most of the animals that can be done without sedation, nor anaesthesia. In some active animals – sedation or short time anaesthesia is needed.
For a successful therapy one should know the anatomy of the region to be treated. We know that many acupuncture points are located at the junction of ligaments to bones, or in ligaments, therefore it is easier to a qualified animal acupuncturist to locate the proper sites for injections, and be able to manipulate the small needles.
Usually there is some local pain and swelling for a few weeks, and great improvement is achieved after this period of time. In the first few weeks one can give NSAIDS on-off as needed, but not as a routine protocol – after all – we are looking for the inflammatory response to boost in.
Limited physical activity is advised (viz no jumping), but at the same token – do manual therapy 2-3 times a day (by the instructed owner) for the first few months. In some animals “a tune-up” injection is needed after 6 months or 12 months.
Different solutions can be injected in prolotherapy:
The mechanism of action of prolotherapy is complex and multifaceted. Six identified components include:
Injections of irritant solutions were used in the late 1800’s to repair hernias and in the early 1900’s for jaw pain due to temporomandibular joint laxity. Dr George S Hackett MD developed the technique of prolotherapy in the 1940s. He claimed in his book “Ligaments and tendons relaxation treated by prolotherapy” (1958) that he cured 90% of 656 patients. At the time he used as an injection solution fatty acids mixture to induce inflammatory reaction. Today, we use a simple dextrose solution diluted with local anaesthetic, like lidocaine, to achieve the same results without the possible risks (viz shock). Hackett found that the injected tendons increased in diameter by 40% after prolotherapy, and histological exams showed no destruction of nerves or blood vessels and no scarring, which is a chaotic matrix of collagen fibres. The ligaments and tendons produced after prolotherapy appear much the same as normal tissue, except that they are thicker, stronger, and contain fibres of varying thickness with normal histological organization. There is an increase in collagen producing fibroblasts, the ligaments orientation and internal organization is linear.
Gustav A Hemwall MD is one of Hackett’s most famous students. He began his studies and treatments in the 1950s and continued until the mid 1990s. In his study of almost 10,000 cases, he found from 75%-90% successful results, and some of them for longstanding problems that have been resistant to other treatments.
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Indications for Veterinary Prolotherapy:
Syndromes and diagnostic entities, caused by ligaments and tendon pathology that have been successfully treated with prolotherapy include:
Specific veterinary examples include:
Summary: Prolotherapy is a safe and effective therapy, in which a mild irritant solution is injected into ligaments, tendons, or their insertions to bones or muscles. This causes a mild inflammatory response that stimulates healing. The result is a thicker, stronger, more organized tendon/ligament that is less sensitive and that decreases local and remote structure stresses. Of patients treated with prolotherapy, 75-90% improve significantly or are cured.