Dr. Robert F. Kidd    

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Manipulation
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Prolotherapy
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Prolotherapy

See also: Backache, Sciatica, Caudal Epidural Block, Publications

Prolotherapy (or sclerotherapy) is a method of treating loose or weak ligaments by injecting a mildly irritating solution into their attachments to bone. The irritation provokes the body into laying down new ligamentous tissue (collagen fibre) thereby strengthening, thickening, and tightening the ligaments. Experiments have shown that ligament strength can be increased by 50% and possibly more using this method.

Prolotherapy has been used by osteopathic and medical physicians in the US and Britain for over 60 years. Its use has not become widespread, probably because it requires a very detailed understanding of how to diagnose joint and ligament problems and where to inject.

The solutions used range from mild (e.g. dextrose 12.5%) to strong (e.g. pumice suspensions). The concentration must be strong enough to cause inflammation but not strong enough to cause tissue damage. All solutions used in this practice have been in use for at least 50 years and the incidence of side effects is low. Note that proliferant solutions do not include cortisone.

Prolotherapy is a slow process requiring weekly injections from three to a dozen times or more. The reason for this is that the body is doing the healing. The solutions merely stimulate the body to heal. The injections themselves are mild to moderately painful and there is some local soreness for a day or two after. With back problems there is usually little improvement in the first few weeks, and sometimes vague aches or pains develop in other parts of the body (e.g. a headache, or knee or wrist pain). These usally last only a day or two and are part of the body's adaptation to a new posture. Gradual improvement is the rule, and overall my experience and that of others is a 75 to 80% improvement in pain.

The length of the response to treatment depends very much on what caused the weakening of the ligaments to begin with. If there is a clear cut history of injury, prolotherapy is often curative. If there are continuing stresses on the ligaments however, prolotherapy may have to be repeated from time to time in the future. Examples are stress on ligaments from arthritic hips, past spinal fusions, etc. Repeat injections over the years cause no problems whatsoever. Some patients have had single yearly treatments for over 20 years.

What are the dangers? In the low back, prolotherapy is relatively safe. Allergic reactions are rare. It is theoretically possible to puncture the spinal canal but if properly done, this should not occur. An added safeguard is that no injection is given unless the needle tip is resting on bone. This prevents injections into a large nerve or other important structure.

In the upper back and neck, treatment is somewhat less safe. Puncturing the top of a lung occasionally occurs and sometimes there is bleeding from a blood vessel into the soft tissue of the neck. These occurrences are rare however, and can be treated should they occur.

During treatment there should be no limitation of every day activities. Heavy lifting, prolonged stooping and frequent twisting movements, such as while playing golf or tennis should be avoided in the early stages or treatment. Walking is helpful and one or two miles a day should be a goal. Anti-inflammatory medications including aspirin, should not be taken during prolotherapy as these drugs counteract the effect of proliferants.