What is Prolotherapy?

Prolotherapy, meaning to strengthen and grow, is a form of regenerative injection therapy stimulating the healing, growth, and stability of damaged tissues. Prolotherapy is a safe and effective non-surgical approach for treating joint and spine pain caused by weakened and damaged ligaments and tendons. Ligaments are tough bands of tissue that connect bone to bone. They are found along all joints and along the spine of your back. Tendons are tough bands of tissue that attach muscles to bone. Weakened tendons and ligaments irritate surrounding nerve fibers signaling the brain. This often stimulates the surrounding muscles to overcompensate by tightening. The area may feel tight, achy, numb, fatigue, weak, sore, and painful.

Created by colleague and friend Jose Barreto, MD.

Who is Prolotherapy for?

If you have acute, chronic or recurrent pain, without long lasting relief by rest, strengthening exercises, or physical therapy, prolotherapy is likely a good option for you. If you have weak or damaged ligaments and tendons causing instability, strongly consider prolotherapy.

Prolotherapy is commonly effective for pain associated with joints, spine, neck, back, shoulder, knee, elbow, wrist, ankle, foot, hip, sciatica, arthritis, sports injuries, bursitis, tendonitis, ACL tears, headaches, TMJ disorder, fibromyalgia, and overuse.

Prolotherapy is effective in healing pain, not just covering it up. It is a great alternative to corticosteroid injections, which long-term studies have demonstrated an increased risk of weakening tissue.

Conditions Treated

  • Acute, chronic, or recurrent pain
  • Weak or damaged ligaments
  • Weak tendons
  • Joint pain
  • Spine, neck, shoulder, and back pain
  • Elbow and wrist pain
  • Hip, knee, ankle, foot, and sciatica pain
  • ACL tears
  • Headaches
  • TMJ disorder
  • Fibromyalgia

What is in the Prolotherapy Solutions?

The most commonly used medicines include dextrose (sugar water), sodium morrhuate (a fish oil product), glycerin, mannitol, glycerin, and lidocaine (short acting numbing medicine).

Prolotherapy Injection Treatments

Based on your physical exam, tender and dysfunctional areas are injected with the proliferant solution. A local anesthetic is added for minimal discomfort with the injections. The number of treatment appointments needed varies from patient to patient. A standard course of prolotherapy is 5-8 sessions spaced 2-4 weeks apart. If no benefit or change is noticed after 4 visits, we will reevaluate our plan and treatment options. If you feel benefit after 1 visit, it is highly suggested to return for 1-2 more visits to optimize strengthening of tissues for long term benefit.

Why do ligaments and tendons need additional assistance in healing?

Bones and muscles have a good blood supply and can therefore recruit necessary healing factors. This is why broken bones and torn muscles commonly heal well with time. Unfortunately, ligaments and tendons have a poor blood supply. This limits the available amount of nutrients and necessary healing factors for repair. By injecting the proper concentration of proliferant solution at these weakened areas, the body is able to locally stimulate the proper response for repair and restrengthening.

History of Prolotherapy

Forms of prolotherapy have been around for hundreds of years. In the 1950’s Drs. George Hackett and Gus Hemwall routinely performed prolotherapy with what is today/s most common and tested solution mixture of dextrose, lidocaine and normal saline.

Former US Surgeon General C. Everett Koop, called by President Reagan was a prolotherapist. He stated, “I was so impressed with what what prolotherapy could do for musculoskeletal disease… I continue to see many people who have benefited from prolotherapy as a treatment for ligament laxity… In my own case, I had been diagnosed by two separate neurological clinics as having intractable pain. My symptoms and the lack of sleep were affecting my work. I obtained complete relief from prolotherapy… I saw remarkable benefits… Certainly, if used properly, prolotherapy dosed no harm but can be of extraordinary benefit. I have changed many lives."
– quoted from the Prolotherapy Institute

Created by colleague and friend Jose Barreto, MD.

Prolotherapy Around the World

Hackett Hemwall Foundation, associated with the University of Madison Wisconsin, is the number one educator of prolotherapy worldwide. In addition, each year top physicians volunteer their time to join the organization in treating hundreds of people suffering both acute and chronic pain internationally. Dr. Nourani has joined them on these missions every year since 2011. In addition, in 2013, Dr. Nourani became an instructor for the organization, teaching other physicians prolotherapy. To learn more about the Hackett Hemwall Foundation or how you can donate.