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Prolotherapy for Osteoarthritis

Injection Therapy Promotes Healing of Joints

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Updated February 22, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What Is Prolotherapy?

Prolotherapy is one of the lesser-known alternative or complementary treatments for muscle and joint pain. Prolotherapy is an injection therapy in which an irritant solution is injected into a joint, tendon, or ligament to heal the affected structure and ultimately relieve pain. Physicians who administer prolotherapy are trained by the American Association of Orthopedic Medicine.

How Does Prolotherapy Work?

Prolotherapy has also been referred to as regenerative injection therapy, sclerotherapy, proliferative therapy, ligament reconstruction therapy, and fibro-osseous injection therapy. Usually the irritant solution used for prolotherapy contains glucose, and sometimes anesthetic agents, too.

By injecting the irritant solution directly into the site of an impaired ligament, tendon, or joint, prolotherapy essentially creates a controlled injury that stimulates natural healing through the growth of new tissue. The injection itself causes a mild inflammatory reaction that stimulates new tissue fibers to form and restore the impaired structure.

Typically, prolotherapy is administered every 1 to 3 weeks; your doctor will determine how often it needs to be repeated. Success of the treatment is said to depend on your ability to heal, though no nutritional deficiency or secondary conditions should impair healing.

History of Prolotherapy to Modern Day Assessment

Dating back to the 1920s, injection therapy was used to cause scarring or to fuse tissues. In the 1940s and 1950s, an osteopathic doctor, Earl Gedney, began injecting joints in his orthopedic practice. In 1950, George Stuart Hackett, M.D., wrote a book about injection therapy that's still used to train practitioners today.

While advocates of prolotherapy explain that it can stimulate healing and relieve painful musculoskeletal conditions, scientific evidence to back it up is scarce. Of the approximately 45 studies published on prolotherapy, only a few were randomized clinical trials (the type of trial that is respected and carries weight). Because its effectiveness is not proven, many insurers do not cover the procedure, which carries a price tag of anywhere from $200 to $1,000 per session, according to The Wall Street Journal. Among doctors, there is a wide range in the level of support for prolotherapy, from those who believe it offers a beneficial effect to those who think prolotherapy is completely without merit.

There have been studies that pit prolotherapy using glucose solution against prolotherapy using a saline solution. Essentially, there was found to be no difference. Some argue that patients who improve with prolotherapy are experiencing a placebo effect (i.e., they expect to get better, so they do).

Which Body Sites Can Be Treated With Prolotherapy?

Prolotherapy can be used to treat the knee, hip, ankle, wrist, and sacroiliac joints. It has also been used for carpal tunnel syndrome and TMJ (temporomandibular joint dysfunction). Prolotherapy has shown inconsistent results for low back pain, but some feel it may be most effective for low back pain when used with an adjunctive therapy, such as spinal manipulation or corticosteroid injection. There has been more success with treating tendonopathies. More recent studies have looked at prolotherapy for osteoarthritis, but more investigation is needed to reach definitive conclusions about its effectiveness for osteoarthritis.

Who Should Not Consider Prolotherapy?

Prolotherapy is contraindicated (not recommended) for patients with allergies to the irritant solutions, or those with bleeding or coagulation disorders.

Sources:

Prolotherapy in primary care practice. Rabago. D. Primary Care. 2010 Mar;37(1):65-80. doi: 10.1016/j.pop.2009.09.013.
http://www.ncbi.nlm.nih.gov/pubmed/20188998

Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. Distel LM et al. Physical Medicine and Rehabilitation. 2011 Jun;3(6 Suppl 1):S78-81. doi: 10.1016/j.pmrj.2011.04.003.
http://www.ncbi.nlm.nih.gov/pubmed/21703585

Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004059.
http://www.ncbi.nlm.nih.gov/pubmed/17443537

Injection Therapy FAQs. American Association of Orthopaedic Medicine.
http://aaomed.org/Prolotherapy-FAQs

Prolotherapy. University of Pittsburgh Medical Center. Accessed 2/19/2013.
http://www.upmc.com/Services/integrative-medicine/services/Pages/prolotherapy.aspx

A Pinch of Sugar for Pain. Laura Johannes. Wall Street Journal. October 19, 2010.
http://online.wsj.com/article/SB10001424052702304410504575560214236534310.html

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