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Regenerative Injection Therapy and Prolotherapy— Frequently Asked Questions

By: Hal S. Blatman, MD

Prolotherapy Is a Method of Treatment that involves injection of a solution that is designed to Stimulate Healing. The treatment is administered in an injection directly to the area where a ligament needs to be strengthened.

Soft tissue injuries are actually connective tissue injuries. That is, these injuries primarily affect muscle and the ligaments that hold the bones together and the muscles to the bone. Prolotherapy is a method of treatment for pain coming from the fibro-osseous junction, where the ligaments meet the bones.

This tissue is usually injured by a strong muscular contraction, or a high velocity injury such as a sudden forceful hit, or a motor vehicle accident. Strong muscular contractions occur with strain injuries. Sometimes only the muscle is injured. When injury also occurs to the ligament, it is often not recognized and chronic pain may follow. Sudden forceful hits catch the body off guard, either before the muscles can act for protection, or with force beyond the muscle's capacity. In either case, the ligaments are the final defence, holding the body and bones together.

After injury, the body has a repair mechanism, and the ligaments heal and contract. This healing process takes a few weeks to reach partial strength, and more than 6 months to reach 90% strength. The biologic process requires two stages of inflammation from the injury that occur over the next 3 and 10 days. Toward the end of the inflammatory stage, Fibroblasts are drawn to the area of injury, and they are stimulated to produce new ligament tissue. This new tissue makes the healing wound strong.

If the ligaments are too stretched, they may never contract to their pre-injury state. Also, when the ligaments are not protected by splinting, or when the person's healing power is poor, lengthening of the ligaments is more likely. This lengthening allows an abnormal and increased range of movenent, further stretching the ligaments and setting off pain impules from local nerves. This repeated stretching and irritation to the nerves causes local and referred pain.

In 1936 Rice reported that fibrous tissue began forming 15 hours after injecting a specific solution into the tissue. The new fibrous tissue was firm by seven days and progressed to mature connective tissue in 18 days. Hackett in 1956 corroborated these findings and indicated that prolotherapy resulted in stabilization of unstable joints.

Specific solutions are injected into the injured ligaments. These proliferant solutions start a wound healing sequence similar to what the body does in response to "natural" injury. The process results in deposition of new collagen tissue and strengthening of the treated ligament.

Yes, Regenerative Injection Therapy can help heal cartilage. Nutrients can be injected into a joint that promote healing of cartilage surfaces. Also, as ligaments loosen and cartilage thins with wear and tear, joint motion becomes less precise and this accelerates the wear and tear process. Reducing ligament looseness has been demonstrated to help preople with osteoarthritis.

The history of injury, and physical examination findings provide information that helps determine the need for specific treatment. Many times treatment for myofascial pain provides resolution of the problem. The need for prolotherapy may be evident from the beginning of treatment, or it may become evident during the course of treatment.

After evaluation, an individualized treatment program is begun.

About the Author:
Hal S. Blatman, MD is the founder and medical director of The Blatman Pain Clinic, and a globally recognized specialist in myofascial pain. He is board certified in both Pain Management and Occupational and Environmental medicine. More information is available at www.blatmanpainclinic.com or by calling 513-956-3200