The concept of using sclerosing agents (leads to inflammatory response to produce fibrotic response) to stimulate soft tissue repair, specifically in hernias and hemorrhoids, took place in the 1920’s and early 1930’s. Following an injury to his own thumb, Earl Gedney, an osteopathic surgeon, began experimenting by injecting his own thumb with various sclerosing solutions and was successful in treating his own injury. In the late 1930s’, he went on to develop treatment protocols utilizing sclerosing injections, for other orthopedic conditions.
Prolotherapy or regenerative injection therapy as it is known as today, was first named in the 1950’s as a means of treating painful soft tissue injuries. By the 1960’s several hundred practitioners were practicing using the prolotherapy technique that was coined by Dr. George Hackett, a general surgeon from Canton, Ohio. It is believed that Dr. Hackett began experimenting with injecting a solution into damaged tendons and ligaments and found that it resolved pain. He conducted further histological analysis using an animal model to identify what was happening at the cellular level. The literature reflects that Dr. Hackett treated over 10,000 patients using this “fibroroliferative therapy” with a reported success rate in the range of 80 – 90%. While not a “traditional” treatment option, Prolotherapy has been utilized successfully for over 60 years.
So what is Prolotherapy? Prolotherapy involves injecting a proliferant (“irritant”) solution into an injured area of soft tissue (ligaments and tendons). It is believed that this initially produces inflammation and then then promotes natural healing of the tissues by way of multiple growth factors leading to a deposition of collagen (main structural protein of connective tissue). The exact mechanism of how prolotherapy works is still largely unknown despite extensive research, but the published results have shown favorable results for many who have suffered with chronic pain and disability.
There are different agents used as the proliferant in Prolotherapy. The common theme amongst the agents is that they all incite local soft tissue irritation leading to an influx of inflammatory mediators. Injection techniques and protocols vary considerably amongst practitioners as this continues to be an area of regenerative medicine that continues to grow.
Prolotherapy is endorsed by The American Academy of Orthopaedic Medicine (AAOM), The American Academy of Pain Management (AAPM) and The American Association of Interventional Pain Physicians (ASIPP) for chronic, unresolved pain.
Prolotherapy or regenerative injection therapy is not a quick fix or a cure all. While documented results have shown success rates above 80%, not everyone will achieve these same outcomes. Prolotherapy is not necessarily a single treatment, but rather one that should be included as a part of a comprehensive management plan for those have defined chronic musculoskeletal problems.